In short, yes—Spravato has proven to be a highly effective option for many individuals who have not found relief through traditional antidepressants.
- Rapid symptom reduction. Patients often experience relief quickly. Unlike standard oral medications that may take weeks to show results, Spravato can improve symptoms in hours or days.
- Unique mechanism of action. It targets different brain receptors. While most antidepressants focus on serotonin, Spravato targets the glutamate system to restore brain connections.
- Reduced relapse rates. Long-term use sustains improvement. Clinical studies show that continuing treatment significantly lowers the risk of depression returning compared to oral antidepressants alone.
Treatment-resistant depression is a heavy burden that affects millions of people who diligently try medication after medication without success. If you feel like you are running out of options, you are not alone. The landscape of mental health care is evolving, and new therapies are offering hope where there was once only frustration.
One such breakthrough is esketamine (Spravato), a prescription nasal spray that is changing the way providers approach difficult-to-treat depression.
What is Treatment-Resistant Depression?
Treatment-resistant depression is a term used to describe a major depressive disorder that has not responded adequately to at least two different antidepressants. For those living with this condition, the standard care simply does not work. You may have taken prescriptions for adequate durations and at proper doses, yet your symptoms persist.
This form of depression can feel incredibly isolating. It is not a failure of character or a lack of effort on your part. It is a complex biological reality. The brain is an intricate organ, and for some, the mechanisms that regulate mood do not respond to drugs that target serotonin or norepinephrine.
Finding a solution requires looking beyond the conventional pill bottle. This is where advanced therapies like Spravato treatment come into play. It offers a new mechanism for healing that differs entirely from the selective serotonin reuptake inhibitors (SSRIs) you may have tried in the past.
Understanding Spravato Treatment
Spravato is the brand name for esketamine, which is a derivative of the anesthetic ketamine. The Food and Drug Administration (FDA) approved it specifically for use in adults with treatment-resistant depression and for treating depressive symptoms in adults with acute suicidal ideation or behavior.
Unlike ketamine, which is often administered via an intravenous (IV) infusion in off-label clinics, Spravato is a nasal spray. However, you cannot take it at home like a typical allergy medication. It must be administered in a certified medical office under the supervision of a healthcare provider.
This requirement ensures safety and allows the provider to monitor your reaction to the medication. While traditionally paired with an oral antidepressant, recent FDA updates now allow Spravato to be used as a standalone treatment (monotherapy) for eligible patients, giving you more freedom in your treatment plan.
Is Spravato Effective for Treatment-Resistant Depression?
The effectiveness of Spravato has been the subject of rigorous clinical trials. The results have offered a beacon of hope for the psychiatric community.
A pivotal study published in The New England Journal of Medicine compared the efficacy of esketamine nasal spray plus an SSRI against quetiapine extended-release plus an SSRI. The study found that patients in the esketamine group were significantly more likely to achieve remission at week 8 compared to the quetiapine group. Specifically, 27.1 percent of the esketamine group achieved remission, versus 17.6 percent in the control group.
This data suggests that Spravato treatment is not just a viable alternative but potentially superior to adding an antipsychotic medication, which is a common strategy for difficult depression.
Furthermore, long-term data supports its use for preventing relapse. Another study published in JAMA Psychiatry followed patients for over a year. It found that those who remained on Spravato were far less likely to experience a return of depressive symptoms compared to those who switched to a placebo. This suggests that maintenance treatment can be a powerful tool for stability.
How Does Spravato Work in the Brain?
To understand why Spravato works when other drugs fail, you must look at brain chemistry. Traditional antidepressants usually work by increasing the levels of naturally occurring chemicals like serotonin, norepinephrine, and dopamine. These are neurotransmitters that communicate between brain cells.
Spravato works differently. It targets the N-methyl-D-aspartate (NMDA) receptor. By doing so, it increases the levels of glutamate, the most abundant chemical messenger in the brain.
Glutamate is essential for synaptic plasticity, which refers to the brain’s ability to form new connections. Chronic depression often causes these connections to wither or disconnect. Spravato treatment helps to regrow and strengthen these synapses.
This restorative process helps the brain “reset.” Because it acts on glutamate rather than waiting for serotonin levels to build up slowly, many patients report feeling a lifting of the mental fog much faster than with oral medications.
Who Is a Good Candidate for Spravato?
Not everyone with depression qualifies for this specific treatment. It is reserved for those who have not found relief through standard methods.
Generally, you may be a candidate if you have a diagnosis of major depressive disorder and have tried at least two antidepressant treatments during your current depressive episode without adequate improvement. Your healthcare provider will review your medical history to ensure it is safe for you.
There are certain conditions that may preclude you from treatment. For example, individuals with a history of aneurysmal vascular disease or intracerebral hemorrhage may not be eligible due to the temporary increase in blood pressure that the medication causes.
Additionally, because it is a controlled substance, providers look closely at histories of substance use disorder. Honest conversations with your mental health provider are essential to determining if this path is right for you.
What to Expect During a Session
The Spravato treatment experience is unique compared to other mental health appointments. Because safety is the priority, the process is highly structured.
Arrival and Preparation
You will arrive at the clinic and settle into a comfortable chair. Your provider will check your blood pressure to establish a baseline. It is recommended that you do not eat for at least two hours before the appointment to avoid nausea.
Administration
You will administer the nasal spray yourself under the supervision of the staff. The device is simple to use. Depending on your prescribed dose, you may use one, two, or three devices, with a five-minute break between each one.
The Observation Period
After administration, you must remain in the office for at least two hours. During this time, the provider will monitor your blood pressure and check for side effects. Many patients use this time to read, listen to music, or rest. You cannot drive home after the session, so you must arrange for transportation.
Are There Side Effects of Spravato?
Like any potent medication, Spravato comes with potential side effects. Most of these occur during the treatment session and resolve shortly afterward.
Common side effects include:
- Dissociation (feeling disconnected from your body or thoughts)
- Dizziness or vertigo
- Nausea or vomiting
- Sedation or lethargy
- Increased blood pressure
Because of the risk of dissociation and sedation, the FDA requires a Risk Evaluation and Mitigation Strategy (REMS) program. This ensures that only certified healthcare settings can dispense the medication.
Most patients tolerate the treatment well. The side effects typically peak around 40 minutes after dosing and fade by the end of the two-hour observation window. However, knowing what to expect can help reduce anxiety during your first session.
Treatment-Resistant Depression in Phoenix, AZ
Treatment-resistant depression can make you feel as though you have run out of roads to travel. It is exhausting to manage the trial and error of medication management alone. But the emergence of treatments like Spravato proves that science is catching up to the complexity of the human brain.
At My Buoyant Health, we specialize in helping individuals navigate complex mental health challenges. Our team understands the nuances of treatment-resistant depression and can evaluate if Spravato treatment aligns with your medical needs.
We invite you to reach out to us to discuss your condition and your goals. Together, we can determine the best path toward healing and stability.
For more information, request an appointment online or contact us at (602) 510-6582. We look forward to serving you!
