Spravato® for Treatment-Resistant Depression: What You Need to Know

Spravato® (esketamine) is an innovative treatment for adults living with treatment-resistant depression. If antidepressant medications have not provided enough relief, Spravato may offer a different approach. Learn more about who is eligible, how treatment works, what to expect, and whether Spravato could be right for you.

What is treatment-resistant depression (TRD)?

Treatment-resistant depression (TRD) is a type of major depressive disorder in which a person has not experienced significant improvement after trying at least two different antidepressant medications, taken at the appropriate dose and for an adequate length of time.

Living with treatment-resistant depression can make it difficult to work, maintain relationships, enjoy everyday activities, or manage daily responsibilities. Symptoms may include persistent sadness, loss of interest in activities, fatigue, changes in sleep or appetite, difficulty concentrating, feelings of hopelessness, or thoughts of self-harm.

If traditional antidepressants have not provided adequate relief, other evidence-based treatment options - including Spravato® (esketamine) nasal spray used in combination with an oral antidepressant - may be appropriate. A psychiatric evaluation can help determine the best treatment plan based on your individual needs.

Who is a good candidate for Spravato treatment?

Spravato® may be an option for adults with treatment-resistant depression (TRD) who have tried at least two different antidepressant medications without experiencing significant improvement.

Because Spravato can temporarily increase blood pressure during treatment, individuals with uncontrolled high blood pressure or certain cardiovascular conditions may not be appropriate candidates. A comprehensive evaluation with one of our psychiatric providers will determine whether Spravato is right for you.

What is Spravato?

Spravato® (esketamine) is an FDA-approved prescription nasal spray used in combination with an oral antidepressant to treat treatment-resistant depression. It is also approved for certain adults with major depressive disorder (MDD) who have acute suicidal thoughts or behaviors.

Unlike traditional antidepressants that are taken at home, Spravato must be administered under the supervision of a healthcare provider in a certified medical office or clinic as part of the FDA's Risk Evaluation and Mitigation Strategy (REMS) program.

What should I expect during Spravato treatment?

Your treatment begins with a comprehensive evaluation by one of our psychiatric providers to determine whether Spravato is an appropriate option for you. If you are a candidate, your provider will explain the treatment process and schedule your appointments.

During the first four weeks (induction phase):

• You will visit the office twice each week for treatment.
• You will self-administer the Spravato nasal spray under medical supervision.
• You will remain in the office for at least two hours so our clinical team can monitor your blood pressure, safety, and response to treatment.

After the induction phase (maintenance):

• Most patients transition to once-weekly treatments for several weeks, with some eventually moving to treatments every other week, depending on their individual response and treatment plan.

Some people experience temporary side effects during treatment, including:

• Sleepiness
• Dizziness
• Dissociation (feeling disconnected from your surroundings)
• Nausea

These effects typically improve before the monitoring period ends.

Because Spravato can temporarily impair your ability to drive or operate machinery, you must arrange transportation home after every treatment session.

What conditions does Spravato help treat?

Spravato is designed to help reduce symptoms of:

• Treatment-resistant depression (TRD)
• Major depressive disorder (MDD) with acute suicidal thoughts or behaviors (when used as indicated)

Many patients report improvements such as:

• Reduced depressive symptoms
• Improved mood
• Increased motivation and energy
• Less hopelessness
• Greater ability to participate in work, school, family life, and everyday activities

Every person's experience is different, and individual results vary.

How is Spravato different from traditional antidepressants?

Most antidepressants work by affecting neurotransmitters such as serotonin, norepinephrine, and dopamine.

Spravato works differently by targeting the brain's glutamate system, which plays an important role in communication between brain cells and may help restore neural connections affected by depression.

Additional differences include:

• It is the first FDA-approved nasal spray antidepressant for treatment-resistant depression.
• It is administered in a certified healthcare setting under medical supervision.
• Patients are monitored for at least two hours after each treatment.
• Some patients notice improvement more quickly than with traditional antidepressants, although individual results vary.

Have questions about Spravato® or treatment-resistant depression? Contact us to schedule an evaluation or learn more about our Spravato treatment program. Our clinics in West Philadelphia (Preston Street) and Rhode Island provide expert, compassionate care for adults living with depression.