What is Esketamine Nasal Spray (Spravato) for Depression?

Esketamine (sold under the brand name Spravato) is a new medication approved by the U.S. Food and Drug Association in March 2019 for treatment-resistant depression (TRD). It is the first nasal spray to be used to treat depression, which is one of the reasons why it is making waves in the mental health field. Spravato is closely related to ketamine, so it has to be administered with strict guidelines and taken under medical supervision. However, the results of extensive studies have shown that esketamine is highly effective against treatment-resistant depression. Here is everything you need to know about the new antidepressant nasal spray.   

What Is Esketamine and Why Do We Need It?

Esketamine nasal spray will be used solely to treat adults with depression who have tried at least two other antidepressants without success. The drug works by binding to NMDA-receptors in the brain, blocking the reuptake of glutamate while activating AMPA receptors. In short, they strengthen synapses in the areas of the brain associated with motivation and mood.

Studies show that 30% of depression sufferers don't see results from standard depression treatment options. It's also clear that patients who don't respond to antidepressant medications are at higher risk of suicide than those who are treatment-responsive.

What's more, unlike oral antidepressants (which can take up to six weeks to work), esketamine is fast-acting. Patients may see relief from severe depression symptoms within hours. This is what makes the drug so impactful for individuals with severe depression, especially as many of the SSRIs and more traditional tricyclic antidepressants on the market come with significant side-effects.

During clinical trials, researchers found that esketamine, when taken by patients at risk of suicide, resulted in "significantly rapid improvement in depressive symptoms." The effects of treatment were also long-lasting, with many patients requiring no more than a single dose per week.

What Are the Side-Effects of Esketamine?

Esketamine can have some serious side-effects. These include:

• Nausea and vomiting
• Dizziness and vertigo
• Anxiety
• Increased blood pressure
• Dissociation
• Decreased sensitivity
• Feeling drunk

However, because a doctor always administers esketamine, the side-effects can be easily managed. They are also temporary, usually occurring directly after a dose.   

How Do You Use Esketamine for Depression?

Esketamine has been approved by the FDA to be taken alongside an oral antidepressant. Although it sounds like a miracle drug, it is administered under strict guidelines.  

Firstly, you cannot take esketamine at home. The nasal spray has to be administered in your doctor's office under medical supervision, and you'll have to wait there for two hours (or until your doctor says that you're okay to leave). You won't be able to drive after taking esketamine. If you suffer from treatment-resistant depression, you may have to do this 1-2 times a week.

How Much Does Esketamine Cost?

One of the downsides of esketamine nasal spray is the cost. Currently, one treatment of the esketamine nasal spray Spravato will cost between $590 and $885. It is unclear whether insurance companies will cover this treatment.  

Some patients, providing they live in the U.S. and meet eligibility criteria, may be able to seek help with the cost through a Spravato patient assistance program like the Johnson & Johnson Patient Assistance Foundation.

Overall, esketamine could provide fast and effective treatment for severe depression. Rather than waiting for up to six weeks to see is an antidepressant takes effect, patients will know immediately whether the nasal spray has worked for them. In the long-run, esketamine should provide almost instantaneous and prolonged relief for the millions of people suffering from treatment-resistant depression.

See Also:

• Medication for Treatment-Resistant Depression

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