Spravato is a new medication for depression (low mood) that is delivered through the nose with a nasal spray device. It represents an exciting step forward in the treatment of depression. It is a valuable addition to the growing list of treatment modalities in psychiatric practice. This treatment is not currently used for other mental health disorders like anxiety, schizophrenia, PTSD, OCD etc.

Even though the precise mechanism of action is unknown, Spravato™ works differently than all the other antidepressants. The basic ingredient is Esketamine. It is usually used in addition to traditional antidepressants because it was evaluated as an “add-on” treatment.

Spravato™ is meant for individuals who have treatment resistant depression, which is depression that has failed to respond to standard treatment approaches with medications and therapy. In other words, Spravato™ is indicated if a patient’s condition has not improved with two or more medication trials. Usually, this is also a requirement by insurance companies in order to have the treatment approved. There are instances where use of Spravato™ would not be appropriate. For example, it is not to be used in pregnancy or by a woman who is breastfeeding. Having an allergy to Spravato™ or any of its ingredients is another contraindication. Doctors will also need to know if the patient has a history of bleeding in the brain, or any vascular disorder. Patients are also required to have a psychiatric evaluation by a qualified psychiatrist before the treatment can be recommended for them.

Even though Spravato™ was designed to remove side effects of its parent drug Ketamine, there are still some significant side effects with it that include feeling sleepy and an increase in blood pressure requiring this treatment to be conducted in a doctor’s office. For more information on the potential side effects and contraindications please talk to your healthcare provider.

The medication is administered in the office setting under the physician’s supervision because there is a requirement to monitor for side effects for at least two hours. It is recommended that you do not eat for 2 hours prior to the appointment, and do not drink for 30 minutes prior to the appointment. The physician’s office will notify you if there are any medications that you should be avoiding prior to your scheduled visit. During this visit, you will be sitting in a comfortable reclined chair in a private room. Our medical staff will be monitoring you closely for side effects, such as an increase in blood pressure and we will provide support and reassurance. There are only two possible dosages (56mg and 84 mg) and the titration to the higher dosage can be done within the first week.

You will be able to go home in about 2 hours. It is very important to know that you will have to have a designated driver because it is not recommended to drive or operate machinery the day of the procedure until after a restful night’s sleep. Proper arrangements need to be made for this.

The treatment schedule is twice per week for the first month, and after that if we have a response we can decrease the frequency to once per week. Eventually for maintenance, this is done once per week or every other week depending on the case. Benefits can be seen as quickly as one day or the first week, and this fast onset of action is a big advantage of this medication because we know that with many antidepressants patients have to wait weeks to months before the dosage can be titrated and any real benefits observed. Unfortunately, benefits are short-lived requiring twice a week administration. With time, as the patient stays well we can start seeing longer term improvements allowing us to decrease the frequency of administration. There is no good data yet as to how long this treatment needs to continue for. Depression is a chronic and recurrent disorder and often we need to maintain effective treatments in order to prevent recurrence of symptoms.