Spravato (Esketamine) - A new treatment for depression that has not been cured by medication!

Depression is not just a feeling of sadness, it is a medical condition that requires treatment. Sometimes, even after using a variety of antidepressant medications, some people's depression does not improve. We call this type of condition treatment-resistant depression. Today, we are talking about a modern treatment method that can help such people and those who suffer from severe depression with suicidal thoughts.

What is Spravato? How does it work?

Spravato is a nasal spray containing the drug esketamine . It is a treatment approved by the US FDA in 2019.

You've probably heard the name ketamine before. Ketamine is a drug that is given intravenously (IV) as a painkiller and anesthetic in hospitals. It's also used in veterinary clinics. You may have heard the name because some people misuse it to get high and experience hallucinations.

Spravato is a special form of ketamine. Simply put, this drug works on receptors in our brains called N-methyl D-aspartate (NMDA) receptors . Through this, it can reduce the symptoms of depression by changing the chemicals involved in our mood.

How did you find out how effective this medicine is?

Four clinical studies have been conducted to test the safety and effectiveness of Spravato. These studies included adults between the ages of 18 and 64.

They used a special scoring system to measure the severity of depression and the improvement of symptoms. It is called the Montgomery-Asberg Depression Rating Scale (MADRS) . It is a 10-question questionnaire. It asks about things like mood, feelings of guilt, sleep patterns, and suicidal thoughts. The score ranges from 0 to 60, with higher scores indicating more severe depression . After treatment, the more negative the MADRS score, the lower the score, indicating more improvement in symptoms.

What are the results of these studies?

These results show that people who used Spravato had a significant reduction in depressive symptoms. The studies also found that those who continued to use Spravato had a delayed recurrence of symptoms.

What's special about this is that Spravato shows a significant reduction in symptoms within as little as 24 hours of using it . Typical antidepressants take several weeks to show results. Therefore, this can be very important in an emergency.

Can Spravato interact with other medications?

Yes, you need to be careful with other medications when taking Spravato.

• Blood pressure medications: Spravato may temporarily increase blood pressure. This risk is increased if you are taking another type of antidepressant, such as a monoamine oxidase inhibitor (MAOI) , or stimulants for attention problems. Therefore, if you are taking these medications, you should have your blood pressure checked regularly.
• Medications that cause drowsiness and dizziness: Spravato can cause drowsiness and dizziness. These side effects can be made worse if you use drugs that depress the central nervous system, such as benzodiazepines (e.g., alprazolam, clonazepam), opioids (painkillers), and alcohol .

How do I get Spravato treatment?

This is not a medicine that you can buy from a pharmacy and take home to use.

Due to the side effects and risk of misuse of Spravato, this treatment can only be administered at certified treatment centers . These centers must be registered under a special program called Spravato REMS (Risk Evaluation and Mitigation Strategy).

1. Talk to your doctor: If you are interested in this treatment, talk to your family doctor or a psychiatrist.

2. Referral: If your doctor thinks Spravato is right for you, he or she will refer you to a certified treatment center.

3. Consultation: You will then be given a consultation at the treatment center. There, doctors will also examine your condition and further decide if this is right for you.

4. Starting treatment: If everything is OK, treatment can begin at your second visit.

How do you use Spravato?

This is taken once or twice a week, at a certified center, under the supervision of medical staff .

• Dosage and use: Your doctor will determine the dosage you need. They will also teach you how to use the nasal spray.
• Food and water: Since the medication may cause nausea and vomiting, it is advised to avoid eating 2 hours before treatment and drinking water 30 minutes before .
• Observation period: After taking Spravato, you will be monitored by your doctor for at least 2 hours to check for changes in your blood pressure and other side effects.
• Driving: This medication may affect your concentration and decision-making ability on the day of treatment. Therefore, you should arrange for someone to drive you home from the treatment center . It is best to drive or do other tasks that require concentration the next day after you have had a good night's sleep.

What are the side effects and how can they be avoided?

Spravato can have serious side effects, which is why it is only given under medical supervision.

• Drowsiness and disorientation: Excessive drowsiness, dizziness, fainting, and dissociation may occur.
• Difficulty breathing: Breathing may become slow or shallow. This is especially true if you have other respiratory conditions or are taking other medications that slow your breathing.
• Increased blood pressure: Blood pressure may temporarily increase for about 4 hours after taking the medicine. If you experience chest pain, difficulty breathing, severe headache, vision changes, or seizures , tell your doctor immediately .
• Increased suicidal thoughts: As with some antidepressants, there is a small risk that some people may have increased suicidal thoughts or actions during the initial period of taking Spravato. Tell your doctor right away if you have any new or serious changes in your behavior or thoughts.

In an emergency, call the Suwa Saria Ambulance Service at 1990 , or call the mental health hotline at 1926. Or go to the nearest hospital Emergency Treatment Unit (ETU) .