Spravato Nasal Spray for Depression

Living with depression can be incredibly difficult, especially when traditional medications don’t bring relief. In this article, we’ll be discussing the nasal spray, Spravato, which is a breakthrough FDA-approved treatment for depression. We’ll discuss the science and safety of Spravato and what to expect during the treatment process.

What Is Spravato?

Spravato is a nasal spray containing esketamine, a chemical compound derived from ketamine. Ketamine is a widely recognised, effective, rapid-acting treatment for depression and other mental health disorders that was initially developed as an anesthetic. 

Esketamine is an enantiomer of ketamine, meaning it is one of two mirror-image molecules that make up ketamine when in its original form (“generic ketamine”). This enantiomer interacts more strongly with NMDA receptors, which are proteins thought to underlie the ketamine’s antidepressant effects.

Spravato was developed to treat depression by Janssen Pharmaceuticals, a division of Johnson & Johnson. After rigorous research and clinical testing, Spravato received FDA approval in March 2019 for adults with treatment-resistant depression. In August 2020, it also received approval for adults experiencing depression with acute suicidal ideation or behavior.

Unlike ketamine, which is often used “off-label” for various mental health conditions, Spravato is an FDA-approved and regulated treatment. It is administered only in certified healthcare settings under a strict protocol to ensure patient safety.

How Spravato Works: A Break from Traditional Antidepressants

Conventional antidepressants like SSRIs and SNRIs mainly work by changing the levels of certain brain chemicals called monoamines, such as serotonin and norepinephrine. Spravato, however, works differently. It targets a different brain chemical called glutamate, which is essential for overall communication in the brain and functions like learning and memory.

Spravato blocks NMDA receptors in the prefrontal cortex, a part of the brain involved in regulating mood and emotions. This boosts glutamate activity in that area, which is thought to be part of the reason why Spravato can relieve depression symptoms so quickly.

Spravato also increases neuroplasticity, the brain’s ability to reorganize itself. This helps with depression in three main ways:

• Synaptic plasticity refers to the brain's ability to reorganize the connections between nerve cells, called synapses. Strengthening these connections may help strengthen circuits involved in stress and emotional regulation.
• Neurogenesis is the process of creating new nerve cells. This can help repair brain areas affected by depression.
• Functional connectivity describes how different regions of the brain work together. Improved connectivity may help people escape negative thought patterns and develop healthier, more flexible ways of thinking.
  
  

Who Is Eligible for Spravato Treatment?

Spravato is approved for use in adults diagnosed with TRD. To be considered for TRD, a person must have a formal diagnosis of MDD and must have tried at least two different antidepressants, at the right doses and for a minimum of six months, without significant improvement in symptoms.

In addition to TRD, Spravato is also approved for patients experiencing depression with acute suicidal ideation or behavior. The patient will have active suicidal thoughts and intend to harm themselves. 

To be eligible for Spravato, patients must:

• Be diagnosed with MDD with TRD or MDSI
• Be currently taking a standard oral antidepressant (Spravato is used in combination with another medication)
• Be evaluated and monitored in a certified Spravato treatment center
• Be free from contraindications such as vascular disease or hemorrhage

What to Expect During a Spravato Session

Spravato is not a take-home medication. Each treatment must be administered in person at an approved clinic under close medical supervision. At our TMS and Ketamine Clinic of Southwest Florida, we’re a licensed provider of Spravato, serving Fort Myers and the surrounding areas. Here’s what you can expect if you undergo Spravato treatment at our centre:

1. Arrival and Preparation
   You’ll check in and be escorted to a comfortable, private treatment room. A clinician will review your health status and answer any questions.
2. Administration
   You’ll use the nasal spray yourself, but under direct observation. The device is pre-measured and easy to use.
3. Monitoring Period
   After administration, you’ll be monitored for at least two hours. During this time, side effects are observed and managed, and you'll be made as comfortable as possible.
4. Post-Treatment
   Once cleared by medical staff, you’ll be released to a pre-arranged caregiver or driver. You must not drive or operate heavy machinery for the rest of the day.
   
   

The initial treatment schedule typically includes two sessions per week for four weeks, followed by a tapering period where the frequency is reduced based on your response.

How Is Spravato Different from Ketamine?

Although Spravato and ketamine are chemically related and affect the brain in similar ways, there are key differences in how they’re used in clinical practice:

• Spravato is FDA-approved specifically for depression, while ketamine is used “off-label” for a variety of conditions, including PTSD, anxiety, and chronic pain.
• Spravato is administered only via nasal spray in a certified clinic, while ketamine can be delivered through IV infusion, intramuscular injection, or oral lozenge.
• Spravato has a standardized dosage and protocol, ensuring consistency across treatments. Ketamine doses and regimens may vary more widely depending on the provider and purpose.
• Some patients find ketamine’s dissociative effects more pronounced, which can lead to therapeutic insights but may also be more intense or uncomfortable for others.
  
  

Both treatments can be effective. If you’re uncertain about which one best suits you, our care team at TMS and Ketamine Clinic of Southwest Florida can help determine the most appropriate option based on your symptoms, history, and goals.

What Are the Side Effects of Spravato?

While Spravato is generally well-tolerated, it can cause side effects, most of which occur shortly after administration and resolve within a few hours. Common side effects include:

• Nausea or vomiting
• Dizziness or lightheadedness
• Dissociation (feeling disconnected from oneself or surroundings)
• Headache
• Increased blood pressure
• Fatigue or drowsiness

Because of these effects, Spravato is administered only under supervision, with patients observed until they are stable and alert.

Spravato Clinical Evidence: Effectiveness of Spravato in Depression

In a 2018 study,  participants with moderate to severe depression symptoms were treated with Spravato. At the final follow-up, 65% of participants had a 50% or greater decrease in scores of depression symptoms. Over 30% also achieved remission, meaning their symptoms had either gone or were very mild. 

In a more recent study, the effects of Spravato were assessed in 68 patients with MDD at imminent risk of suicide. Spravato led to a significant decrease in suicidal ideation and depression scores compared to the placebo, with noticeable improvement as early as four hours after treatment. 

Take the First Step Toward Relief

At the TMS and Ketamine Clinic of Southwest Florida, we specialize in cutting-edge treatments for depression, including Spravato. Our experienced psychiatrist and dedicated mental health professionals are here to provide compassionate care and support every step of the way.

If traditional treatments haven’t helped, you don’t have to keep struggling. Contact us today to find out if our innovative therapies could be the right solution for you.