What is Spravato?
Spravato® (esketamine intranasal) is a prescription, FDA-approved nasal spray made up of the chemical esketamine, which is made from ketamine, an anesthetic drug that is also used to treat depression at subanesthetic doses. It is administered in a healthcare clinic. When used in conjunction with an oral antidepressant, Spravato can provide relief from treatment resistant major depression and depression with suicidal thoughts, within hours of using it.
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The Differences Between Spravato and Ketamine
Spravato is the only nasal spray formulation of ketamine on the market. The dose of Spravato and subanesthetic ketamine may vary. One is not necessarily better than the other. Both have a value and utility in the treatment of psychiatric illnesses.
How Spravato Treatments are Delivered
Spravato treatment varies based on an individual’s specific needs, but generally, the treatment includes giving yourself 3 doses of the nasal spray, spaced about 5 minutes apart, under medical supervision in a medical clinic
Who Could Benefit from Spravato Treatments?
Spravato is for adults with treatment-resistant depression (TRD) and major depressive disorder (MDD), including those experiencing suicidal thoughts.
People Who Should Not Try Spravato
Spravato is not approved for use by children. You should not use Spravato if you are pregnant or plan to become pregnant, have a history of substance abuse, including alcoholism, blood vessel disease or a history of bleeding in the brain, uncontrolled hypertension, or other medical contraindications.
Where to Receive Spravato Treatments
Spravato treatments are only available at certified Spravato treatment centers because the drug must be administered under the direct observation of a healthcare provider. Spravato is not for home use. LifeStance can refer you to the certified Spravato treatment center closest to you.
What a Spravato Treatment is Like
Each treatment session lasts approximately two hours, during which patients are monitored in a comfortable, safe, and secure setting. Due to the possible side effects of the treatment, you are not permitted to drive yourself home afterwards; you must be picked up by a friend, family member, or ride share service.
How Patients Describe Their Spravato Treatment Experience
Spravato can begin working right away, and some people experience improvements in symptoms within a matter of hours. This makes it an ideal treatment for individuals who are experiencing acute, debilitating symptoms or symptoms that may result in self-harm or suicidal behavior. Spravato has demonstrated efficacy in treating depression in patients with suicidal ideation, Spravato has not been shown to prevent suicide and is not a substitute for inpatient hospitalization, when needed. Though Spravato is fast acting, it is still necessary to complete a full round of treatment unless there are rare adverse effects that would require the treatment to be ended.
How Many Spravato Treatments You May Need
The initial course consists of twice weekly treatments for 4 weeks, then once weekly treatment for 4 weeks, followed by weekly or every other week treatment to maintain response. Ongoing treatment may be needed.
Are Spravato Treatments Covered by Insurance?
Spravato treatments are often covered by health insurance, and there are other resources that may be able to help with out-of-pocket medication costs for those with and without health insurance. Our office will complete a benefits investigation and estimate your out-of-pocket cost prior to treatment. You can also visit Spravato’s website to learn about the copay assistance program.
The Possible Side Effects of Spravato Treatments
Spravato may cause sleepiness, fainting, dizziness, a spinning sensation, anxiety, or feeling disconnected from yourself, your thoughts and feelings, and from space and time.
This content has been reviewed by Rachel Dalthorp, MD., Psychiatrist at LifeStance Health.
Spravato Treatment FAQ
Researchers believe Spravato works to treat depression by targeting the NMDA receptor and glutamate neurotransmitter system in your brain. Scientific studies have illuminated the importance of NMDA/glutamate in modulating mood, behavior, memory, and learning.
Yes. Spravato was approved by the FDA in 2019. It is under patent until 2024, after which there will likely be generic equivalents on the market.
No. Spravato should be taken in conjunction with an oral antidepressant. Insurance companies require a patient to be prescribed an oral antidepressant prior to approving treatment coverage. Spravato is intended to supplement but not replace your current antidepression treatment.
Research studies show an efficacy of 33-60% depending on the duration of treatment.
Addiction to or physical dependence on Spravato was not found in over 1700 patients included in clinical trials. It is unlikely that Spravato taken at the doses and frequency used to treat mood symptoms will lead to any dependence or addiction.
Yes. The efficacy of Spravato has been evaluated in short-term clinical trials and one longer-term maintenance-of-effect trial. In one of the short-term studies, Spravato demonstrated a statistically significant effect on the severity of depression. In the maintenance trial, patients who continued treatment with Spravato plus an oral antidepressant experienced a statistically significant longer time to relapse of depressive symptoms.
In a clinical trial for Spravato, 65% of patients responded to treatment, achieving a 50% or greater reduction in depressive symptoms and 32% were in remission, these patients did not meet criteria for depression. In addition, patients who had responded to Spravato were 71% less likely to relapse if they continued the medication and if they had been in remission, they were 51% less likely to relapse.