The Department of Veterans Affairs (VA) just received $40 million to research which is most effective in helping veterans with treatment-resistance depression (TRD)—Spravato or aripiprazole. Understandably, many veterans have TRD, a kind of depression that typically does not respond well to traditional treatments such as behavioral therapy and medications. Those with TRD who do not get the help they need have a propensity to become chronically ill, become addicted to narcotics, and/or attempt suicide. Currently, Spravato is the only FDA-approved treatment that uses a nasal spray to buoy a patient’s current depression-care regimen (i.e. you continue taking your prescribed depression medications during your series of Spravato treatments). Spravato is esketamine and is only administered by medical professionals in approved Spravato clinics like the TMS Institute of Arizona.
According to the associate director of the VA Northeast Program Evaluation Center,
Esketamine represents the only currently FDA-approved approach that holds the promise of being a breakthrough. It produces greater remission rates, has more sustained benefits with fewer side effects, and lower health-related costs. The benefit to thousands of Veterans and millions of other patients would be substantial.
This is one of the first studies to compare esketamine to aripiprazole (more commonly known as Xanax). Researchers suggest that those who get Spravato treatment to amplify their established antidepressant regimen can be “significantly more likely to achieve remission for their depression after six weeks of treatment than those adding aripiprazole [to their treatment plan].” The FDA first approved Spravato as a new therapy for TRD in 2019, which came on the heels of numerous phase III studies that showed it had remarkable promise. However, these studies did not compare it to other treatments, like Xanax.
Xanax is, of course, an oral medication that many patients must take indefinitely. Spravato is a series of treatments and although there is no one-size-fits-all answer to how many treatments are needed, it is not a lifelong plan. This is one of the many appeals for those struggling with TRD.
The VA Study Details
The VA study will be comprised of over 900 Veterans across 25 sites. The participants will receive either esketamine or aripiprazole for a maximum of six months. The goal is to consider the safety and efficacy of treatments, but also how acceptable Spravato is (since the concept of nasal treatment for TRD is new to many). The researchers will assess depression scores with the Quick Inventory of Depressive Symptomatology tool, which is easy to translate to other depression scales.
Previously, VA studies have looked at how adding aripiprazole shifts depression remission when compared to bupropion. It was found that those given aripiprazole over three months enjoyed an additional six months of benefits (whether they also had PTSD or not). This was the very first study to examine if one TRD treatment was “better” than another, and there is clearly the need for more such studies. Researchers are hopeful about the Spravato results, sharing,
If esketamine produces greater remission rates, the results of this research may provide an empirical basis for revising current practice guidelines for TRD. With this large, multi-site study, VA’s role as a leader in improving the treatment for depression would be firmly established.
You don’t need to be a veteran to struggle with TRD. Depression can already be difficult to treat, and if you are resistant to first-line therapies, Spravato may be able to help. It is important to never stop or change medications without talking to your prescribing physician, and it is a requirement that you continue your established treatment while taking Spravato. Since Spravato can cause short-term side effects like fatigue, the treatment itself is quick but you are required to stay on-site for two hours after each administration.
There is no standardized treatment plan, but in most cases Spravato is administered twice per week for 1 – 4 weeks as an induction phase. Maintenance then occurs for the next 1 – 4 weeks, then once every two weeks moving forward until the treatment is deemed to not be needed. After the induction phase, it is easy to fit into your schedule. To learn more about Spravato or schedule a consultation, contact the TMS Institute by calling the office or filling out the online contact form.
