Key Takeaways Key Takeaways

  • Spravato is an FDA approved medication for two types of difficult to treat depression: depression in patients who have failed traditional oral antidepressants and depression in patients with suicidal thoughts and intent.

  • Spravato cannot be taken at home. The FDA requires the medication to be administered to a patient under medical supervision in a certified treatment center.

Here’s What You Need to Know About Spravato Nasal Spray (esketamine) and How It Can Help Treatment Resistant Depression

What Is Spravato?

Spravato is a type of medication administered through a nasal spray to individuals who have not responded well to conventional antidepressants or experience depression with suicidal ideation and intent.  It is a new treatment approach that offers the potential for rapid relief of depression.

What sets Spravato apart is its differentiated mechanism of action and its active ingredient, esketamine. It’s a derivative of racemic ketamine, a widely used generic anesthetic consisting of esketamine and arketamine, and unfortunately, a drug of abuse when used recreationally and outside of a medical indication.

Spravato is delivered via 2-3 intranasal spray devices administered 5 minutes apart, each providing 28 mg of esketamine in a fine mist, allowing the medication to be absorbed through the nasal passage. Patients typically receive 8 treatments the first month and respond quickly, often within 3-7 days, compared to traditional antidepressants that can take 6-8 weeks to take effect.

Difficult to treat depression and depression in those with suicidal thoughts cause many problems for patients and families, including prolonged suffering, functional impairment, job loss, caregiver stress and reduced quality of life. According to Dr. Rachel Dalthorp, a board-certified psychiatrist who specializes in Treatment Resistant Depression, “What’s special about Spravato is the differentiated way it works. It impacts a different neurotransmitter system in the brain, the GABA and Glutamate system, it works rapidly, and it helps people who haven’t been responsive or able to tolerate the side effects from traditional oral antidepressants.”

In addition, Spravato appears to offer rapid relief to people who are depressed and considering suicide. Studies have found that more than 40% of suicidal patients with depression, who got 4 weeks of treatment with Spravato, had greatly reduced symptoms of depression at the end of that period.

Now, let’s talk about compatibility. Can you take Spravato if you’re already on other medications for depression? Yes, Spravato is not only safe to use while on an oral antidepressant, but also only FDA approved for use alongside an oral antidepressant.

Side Effects

Per Dr. Dalthorp, “nausea, sedation, and increased blood pressure are the most common side effects we see during treatment, these side effects resolve prior to discharge from our clinic.” Another common side effect during treatment is dissociation, or an altered level of consciousness, in which a patient may experience colorful hallucinations or have an out of body experience. While most patients aren’t bothered by this side effect, for some it can be an uncomfortable experience. Dissociation is brief and transient; patients return to a normal level of consciousness before discharge. Finally, the treatment can impact a patient’s ability to drive safely, patients are discouraged from driving the day of treatment and must have a driver to be discharged from treatment.

Spravato demonstrated safety and effectiveness in large clinical trials, becoming the first FDA approved medication of its kind. Because it works differently than other antidepressants, it gives hope to many with difficult to treat depression. Research as recent as 2023 has demonstrated Spravato provides consistent long-term success and safety outcomes for patients with depression.

Is Spravato Addictive?

The question of addiction is a crucial one, especially when discussing a drug with psychoactive properties like Spravato. The short answer is, yes, it has the potential for abuse and misuse, especially in patients with active or a recent history of substance abuse disorder. Careful patient screening and administration under medical supervision minimizes the risk of misuse.

As with any treatment, the patient and their mental health provider should weigh the risk of Spravato abuse and other treatment side effects, against the benefits of treatment for each individual patient. Spravato can only be administered in a healthcare setting to decrease the risk of drug abuse and ensure patients are monitored for potential side effects during treatment.

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Who Should Not Use Spravato?

Spravato is contraindicated in several conditions, which means it should not be considered for certain individuals. This includes women who are pregnant, breastfeeding or planning for pregnancy, patients with a history of uncontrolled high blood pressure, bleeding in the brain, known aneurysmal vascular or heart valve disease. Patients with active psychosis, active substance abuse and those experiencing bipolar mania, should not be prescribed Spravato.

Your mental health provider will review your medical and psychiatric history to determine whether Spravato is an appropriate treatment option for you. Your current medications, over-the-counter supplements and use of recreational substances and alcohol will also be included. It’s important to be transparent with your healthcare provider because mixing certain medications with drugs with alcohol can cause harm.

In conclusion, Spravato is a relatively new medication option providing hope for patients struggling with depression and looking for a different kind of treatment. It has the potential to rapidly relieve suffering in the most challenging types of depression.

LifeStance Health offers several certified treatment centers for Spravato as other innovative treatments for depression, such as transcranial magnetic stimulation (TMS). Reach out to a LifeStance clinic in your area to determine if Spravato could be an appropriate treatment option for you.

In addition, we offer nearly nationwide access to commercially in-network, psychiatric clinicians specializing in difficult to treat depression. This includes a multidisciplinary team of mental and behavioral health clinicians providing evidenced based treatments, in-person and via telehealth, across 34 states.

Who Should Not Use Spravato?

Spravato is contraindicated in several conditions, which means certain individuals should steer clear of it. The drug is not recommended for patients with aneurysmal vascular disease, which affects vessels like the thoracic and abdominal aorta as well as intracranial and peripheral arteries. Additionally, if you have a history of intracerebral hemorrhage, Spravato is a no-go. Those with hypersensitivity to esketamine, ketamine, or any other components in Spravato should also avoid it.

Due to its potentially intense side effects, individuals with certain psychiatric conditions, including Acute Psychosis, should also exercise caution.

Your mental health provider will typically review your medical history in depth to determine whether Spravato is an appropriate treatment option for you. This medical history review will also include other medications you’re already taking. It’s essential to be transparent with your healthcare provider about any other drugs you’re on because mixing medications can sometimes lead to interactions that are less than ideal.

Remember, Spravato isn’t your everyday antidepressant. It’s a specialized treatment often reserved for people who haven’t responded to other forms of therapy. LifeStance Health offers numerous locations and providers specialized in esketamine and Spravato treatment. If this is something you’d like to learn more on, reach out to the nearest LifeStance Spravato treatment provider.

Authored By 

LifeStance Health

LifeStance is a mental healthcare company focused on providing evidence-based, medically driven treatment services for children, adolescents, and adults.

Reviewed By

Dr Rachel J Dalthorp, MD
Head of Specialty Services

Dr. Dalthorp is board certified by the American Board of Psychiatry and Neurology and a Fellow of the American Psychiatric Association. She is a former member of the board of directors for the American Association of Ketamine Physicians and founding board member of the nonprofit International Society of Reproductive Psychiatry. She currently serves as Secretary and member of the Executive Council, CME, and DEI committees of the Oklahoma Psychiatric Physicians Association.