Esketamine, marketed as Spravato, details on adverse reactions, pricing, dosage, and additional information
Spravato is a potent nasal spray that's used to treat certain types of depression. The active drug in Spravato is esketamine, which interacts with the brain's NMDA receptors to improve mood.
Approved since 2019 by the FDA, Spravato is prescribed for adults who have treatment-resistant depression (TRD), a form of depression that hasn't improved after treatment with two or more antidepressants, and for major depressive disorder (MDD) with thoughts or actions of suicide.
Spravato is always used in combination with at least one other oral antidepressant medication. This drug is a Schedule III controlled substance, meaning it's regulated due to the risk of dependence or misuse.
For both conditions, doctors prescribe Spravato after careful consideration and thorough discussion about potential risks and benefits. It's essential to prioritize open communication with your healthcare provider about your mental health journey, treatment expectations, and any concerns.
Key Information About Spravato
- Drug Class: N-methyl-D-aspartate (NMDA) receptor antagonist
- Drug Form: nasal spray
- Generic available? no
- Prescription required? yes
- Controlled substance? yes
- Year of FDA approval: 2019
Spravato for Depression
Spravato is FDA-approved to treat these conditions:
- Treatment-resistant depression (TRD): A type of depression that has not improved after trying at least two different antidepressants.
- Major depressive disorder (MDD) with thoughts or actions of suicide: Also known as depression, it's a serious mental health condition that can be life-threatening if left untreated.
Spravato is not approved to treat pain.
For either condition, doctors will monitor you closely during and after treatment to ensure your safety. This includes assessing your symptoms, blood pressure, and other potential side effects.
Effectiveness for depression
Research shows that Spravato can help decrease depressive symptoms in people with TRD and MDD with thoughts or actions of suicide. In studies, those taking Spravato had fewer symptoms than those taking a placebo (treatment with no active drug).
The greatest improvement in symptoms typically occurs within the first 24 hours after taking Spravato. Some people may choose to enroll in longer-term studies to monitor their progress.
Off-Label Use
While Spravato is FDA-approved for treatment-resistant depression and MDD with thoughts or actions of suicide, it may also be used off-label for other mental health conditions like anxiety or obsessive-compulsive disorder (OCD). However, it's essential to consult with your healthcare provider to discuss the safety and effectiveness of using Spravato for these conditions.
Side Effects
Like all drugs, Spravato can cause side effects. Some common ones include:
- anxiety
- dizziness
- feeling drunk
- increased blood pressure
- lethargy
- nausea
- numbness
- vertigo (feeling like you're moving when you're not)
- vomiting
- mild allergic reaction
Serious side effects are rare but can include:
- Cognitive impairment (difficulty thinking, memory problems)
- Urinary tract and bladder problems
- Risk of sedation, dissociation, and respiratory depression
- Risk of misuse
- Risk of suicidal thoughts and behaviors (particularly in young adults, ages 24 years and younger)
- Serious allergic reaction
Cost
Spravato's cost can vary depending on your insurance coverage and location. Your doctor's office will purchase Spravato from a specialty pharmacy, as it's not available for purchase at a pharmacy. Financial and insurance assistance programs are available if needed.
When to Seek Help
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
- Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
- Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
- Not in the United States? Find a helpline in your country with Befrienders Worldwide.
- Call 911 or your local emergency services number if you feel safe to do so.
Additional Resources
For more information about Spravato, visit the Spravato website or talk to your doctor or pharmacist.
- The mental health industry, including the pharmaceutical sector, may view Spravato, a treatment for certain types of depression, as a potential investment opportunity, given its effective role in addressing unmet treatment needs for depression, particularly treatment-resistant depression (TRD) and major depressive disorder (MDD) with thoughts or actions of suicide.
- Those in the wealth-management and personal-finance sectors may consider incorporating Spravato's success in the business strategy discussions, as improved mental health can have a positive impact on overall wellness and quality of life, which can potentially improve productivity and financial stability.
- The finance industry might take an interest in the cost structure and affordability of Spravato, as access to affordable treatments is critical for individuals struggling with depression. Financial and insurance assistance programs could play a significant role in addressing affordability concerns.
- As multiple conditions, such as anxiety and obsessive-compulsive disorder (OCD), may have overlapping symptoms with depression, the pharmacy and healthcare sectors should collaborate to explore the potential of Spravato's off-label use for these additional mental health conditions, enhancing its overall impact on mental health management.
- To ensure the long-term success and business viability of Spravato, the healthcare industry should maintain a strong focus on open communication and comprehensive guidelines regarding its use, risks, and benefits, considering a patient-centered approach to mental health care that addresses concerns about misuse and potential side effects.
