Spravato is the first prescription nasal spray used in conjunction with oral antidepressants to help treat adults experiencing treatment-resistant depression. It was designed for those with major depressive disorder (MDD) with suicidal thoughts or actions. It can also be an effective complement to transcranial magnetic stimulation (TMS) therapy. Depression, and particularly MDD, can have several co-morbidities including anxiety and sleep disorders. At the TMS Institute of Arizona, we are one of the few clinics that can dispense Spravato in the region.
Spravato was designed to help those with treatment-resistant depression, which includes patients not responding adequately to at least two oral antidepressants. The first line of treatment for depression is typically medication, often coupled with mental health therapy, but in some cases pharmaceuticals are not effective enough. This is when Spravato can help. Oral antidepressants work by increasing various levels of neurotransmitters including dopamine, serotonin, and norepinephrine in the brain—these neurotransmitters affect mood. Spravato works differently.
The Spravato Difference
Instead of informing neurotransmitters, Spravato is sprayed into the nostrils by a professional and targets the N-methyl-D-aspartate (NMDA) receptor. However, the exact means by which Spravato works is not entirely known (which is common with a number of treatments and medications). Still, there have been several clinical trials that show the efficacy of Spravato. The spray must be taken in conjunction with an oral antidepressant. One short- and long-term trial that included over 1,700 patients compared the effectiveness of Spravato. Some participants were given Spravato while others were given a placebo. Results showed that those who received Spravato showed a decrease in symptoms.
There are some contraindications to using Spravato. You should not take it if you have blood vessel disease or issues such as an aneurysm or arteriovenous malformation. Those who are pregnant, planning to get pregnant, or breastfeeding are not suitable candidates for Spravato. If you have a history of bleeding in the brain, do not take Spravato. Be sure to tell your physician and Spravato provider your full health history, conditions, and current medications to ensure a safe and effective treatment plan.
Is Spravato and Ketamine the Same?
Spravato is derived from ketamine, but is not ketamine itself. It is an FDA-approved spray, whereas ketamine has not been FDA-approved to treat depression. Still, Spravato and ketamine are both Schedule III controlled substances. This is one of the reasons you cannot take Spravato at home or on your own. Instead, it must be administered in an approved Spravato dispensary clinic, like the TMS Institute of Arizona.
Spravato cannot be purchased at a pharmacy due to the high risks of sedation, abuse, and dissociation. If you are considered a good candidate for this nasal spray, you will self-administer at your Spravato clinic and will stay some time for supervision. During your first visit to a Spravato center, you will undergo a consultation so your provider can note your full medical history. This is also when you can determine if your insurance policy covers this treatment (most major plans do). There will also be an assessment to determine if this treatment plan is right for you. A customized regimen will then be built for you and you will be registered in the SPRAVATO Risk Evaluation and Mitigation Strategy (REMS) program. During your second visit, treatment can commence.
On average, in clinical trials most participants saw an improvement in their depressive symptoms just four weeks after starting their treatment. This is compared to those in trials who were given a placebo spray. However, it is important to remember that not everyone will respond to Spravato. It is an addition to a current oral antidepressant treatment plan, not a replacement for it. This means that your symptoms will not get worse, but there is a chance there may be no improvement.
What to Expect During Treatment
Spravato is taken twice a week for the first month, then once a week in month two. Next, it is taken once a week or every two weeks for an undetermined amount of time. Since everyone is different, the exact length of time you may be recommended to use Spravato may vary. This will be informed by how you respond to the treatment and the stability of that response. Your dose frequency may shift in the weeks following initial therapy. Throughout this period, you will also be taking your oral antidepressants.
In addition to oral antidepressants and Spravato, you may also benefit from treatments like TMS and mental health therapy. To get help building a more holistic treatment plan for depression and learn more about Spravato and TMS, contact the TMS Institute today. Call the clinic or complete the online contact form today.
