Spravato (esketamine) nasal spray is a game-changer for depression treatment. It helps with depression that has not responded to first-line treatments, where there are suicidal thoughts and where a faster effect is required.
This article discusses how Spravato works, how effective it is, what it feels like, and the pragmatics of getting this treatment.
What does Spravato do?
Spravato is a filtered version of ketamine that blocks NMDA receptors in the brain’s depression pathway. This is a novel mechanism of action compared to standard medications that work via serotonin and norepinephrine.
Psychiatry is hungry for new medications that work in different ways because, in a percentage of cases, first-line medications such as SSRIs and SNRIs just don’t work well enough.
What is the response rate of Spravato?
The response rate is about 70% (defined as a 50% drop in the MADRS depression score) and the remission rate is about 50% (defined as a MADRS depression score of 12 or less).
Twenty-four hours after the first dose, patients who get Spravato show significantly more improvement in their depression scores compared to a control group. In other words there is measurable improvement after the first dose, which is groundbreaking for depression medications.
What does Spravato feel like?
Spravato can cause a brief period of dissociation (feeling spacey, drunk or euphoric) and it can make you sleepy right after you get it. That’s why you can’t drive after treatment but you can take an Uber or use public transport.
What are the commonest side effects of Spravato?
Transient high blood pressure can occur in 8-19% of people. For this reason, your blood pressure will be monitored for 2 hours after each treatment to make sure it has returned to baseline.
About 8-9% of patients experience transient urinary tract symptoms.
Antidepressants can worsen suicidal thoughts before they improve them and this is a known, albeit rare occurrence.
There are also non-specific side-effects such as nausea, rashes, dizziness, headache, dry mouth, diarrhea, constipation, etc., that can occur.
You can’t receive Spravato if you are pregnant or breast feeding and it should not be mixed with alcohol or other social drugs.
Is Spravato addictive?
Spravato is a controlled medication and that is why it’s closely monitored for abuse or diversion. Used under supervision as a short-term medication for the approved indications, it is not thought to be habit-forming but people with a prior history of substance use are at greater risk of misusing Spravato.
What does Spravato treatment involve?
Treatment involves 2-3 nasal sprays in each nostril, twice a week for 6 weeks.
You will receive the treatment in a comfortable recliner. Blood pressure will be monitored for 2 hours.
Staff is available to comfort or help should you need assistance.
How long does Spravato stay in your system?
It rapidly declines in your system after the first 2-4 hours but it can take 6-12 hours before it or its metabolites are completely out.
Can I keep my current psychiatrist and therapist and still get Spravato?
Yes, Tomer T. Levin M.D. will coordinate care with your psychiatrist and therapist so that you can get Spravato under our supervision but continue under their care.