Antidepressants are an important part of depression treatment, but they do not work equally well for everyone. Antidepressants are an important part of depression treatment, but they do not work equally well for everyone. Some people experience meaningful improvement after starting medication, while others continue to have significant symptoms even after trying different antidepressants.
When depression does not improve adequately after multiple treatment attempts, a person may be experiencing treatment-resistant depression (TRD). For eligible adults in this situation, SPRAVATO treatment can provide another evidence-based option to discuss with a qualified mental health professional.
SPRAVATO contains esketamine and is approved for adults with treatment-resistant depression. Its mechanism differs from that of many traditional antidepressants, making it an option worth discussing when previous treatments have not provided sufficient relief.
What Does It Mean When Antidepressants Fail?
Not improving after one antidepressant does not necessarily mean that treatment has failed permanently. Depression treatment often requires adjustments in medication, dosage, duration, psychotherapy, or other aspects of care.
However, when a person continues to experience significant symptoms despite adequate trials of multiple antidepressants, a psychiatrist may evaluate whether the condition meets the criteria for treatment-resistant depression.
Common ongoing symptoms can include:
- Persistent sadness or low mood
- Loss of interest in everyday activities
- Low energy
- Difficulty concentrating
- Changes in sleep
- Changes in appetite
- Feelings of hopelessness
- Reduced motivation
A detailed psychiatric evaluation can help determine why previous treatment has not produced the expected results and what options may be appropriate next.
What Is SPRAVATO Treatment?
SPRAVATO treatment uses esketamine nasal spray under the supervision of a healthcare professional. The FDA currently indicates SPRAVATO for adults with treatment-resistant depression, with or without an oral antidepressant.
This makes SPRAVATO different from simply switching from one conventional antidepressant to another.
Rather than primarily working through the same pathways targeted by many traditional antidepressants, esketamine is an NMDA receptor antagonist that affects glutamate signaling. The exact way SPRAVATO produces its antidepressant effects is not completely understood.
Why Consider SPRAVATO After Antidepressants?
One reason people explore SPRAVATO treatment for depression is that traditional medications have not provided adequate improvement.
Treatment-resistant depression can be frustrating because patients may feel that they have exhausted their options. However, a lack of response to previous antidepressants does not mean that further treatment is impossible.
SPRAVATO provides another treatment approach that a psychiatrist can evaluate based on the patient’s diagnosis, previous treatment history, medical conditions, and individual needs.
How Does SPRAVATO Work?
Understanding the mechanism behind esketamine can help patients understand why it is different from many conventional depression medications.
SPRAVATO acts as an NMDA receptor antagonist and influences the glutamate system in the brain. Glutamate is a neurotransmitter involved in communication between nerve cells.
If you’re considering this treatment, learning more about how SPRAVATO treatment works can provide additional context about its mechanism, treatment process, and what patients may experience during therapy.
The treatment should only be used according to its prescribing information and under appropriate medical supervision.
What Happens During SPRAVATO Treatment?
SPRAVATO is administered as a nasal spray in a certified healthcare setting under direct supervision. Patients do not simply receive the medication and leave immediately.
Before administration, healthcare professionals evaluate the patient’s condition and check blood pressure. After treatment, patients remain under observation because temporary effects such as sedation, dissociation, dizziness, nausea, and increased blood pressure can occur.
The FDA prescribing information requires patients to be monitored for at least two hours following administration. Patients should also follow their provider’s instructions regarding driving and other activities after treatment.
How Is SPRAVATO Treatment Scheduled?
The treatment schedule depends on the individual’s treatment plan and clinical response.
For treatment-resistant depression, the prescribing information includes an induction phase followed by a maintenance phase. The FDA recommends evaluating therapeutic benefit at the end of the four-week induction phase to determine whether treatment should continue.
Because treatment response varies, patients should work closely with their psychiatric provider rather than assuming that the same schedule will be appropriate for everyone.
Who May Be a Candidate?
SPRAVATO may be considered for adults with treatment-resistant depression.
A psychiatric evaluation typically considers:
- Previous antidepressant treatments
- Response to previous medications
- Current depression symptoms
- Medical history
- Current medications
- Blood pressure and cardiovascular health
- Other relevant health conditions
Certain medical conditions can make SPRAVATO inappropriate. For example, the FDA prescribing information lists certain vascular conditions, intracerebral hemorrhage, and hypersensitivity to esketamine or its ingredients among the contraindications.
This is why eligibility should always be determined by a qualified healthcare professional.
What Are the Potential Side Effects?
Like other prescription treatments, SPRAVATO can cause side effects.
Common adverse reactions reported with SPRAVATO include:
- Dissociation
- Dizziness
- Nausea
- Sedation
- Vertigo
- Increased blood pressure
- Headache
- Anxiety
Because some reactions can affect alertness, judgment, coordination, or blood pressure, medical observation is an important part of treatment. SPRAVATO also carries important warnings regarding sedation, dissociation, respiratory depression, and abuse or misuse.
Is SPRAVATO a Replacement for Antidepressants?
Not necessarily.
Treatment plans are individualized, and the current FDA labeling allows SPRAVATO to be used with or without an oral antidepressant for adults with treatment-resistant depression.
Whether a patient should continue, change, or stop an existing antidepressant is a decision that should be made with their prescribing clinician.
SPRAVATO should not be viewed as a universal replacement for medication or psychotherapy. Instead, it is one treatment option that may be appropriate for certain patients.
Finding the Right Treatment After Failed Medications
Trying multiple treatments without getting enough relief can be discouraging. However, persistent depression symptoms are a reason to reassess the treatment plan rather than assume that nothing else can help.
A psychiatric provider can review previous medications, treatment responses, current symptoms, and medical history to determine whether advanced options such as SPRAVATO may be appropriate.
Patients considering esketamine therapy should also understand the importance of receiving treatment through an appropriate healthcare setting with trained professionals who can provide the required monitoring.
Final Thoughts
When antidepressants have not provided adequate relief, there may be additional treatment options worth discussing. SPRAVATO treatment offers an FDA-approved approach for adults with treatment-resistant depression and works differently from many conventional antidepressants.
The decision to pursue SPRAVATO should be based on a thorough psychiatric evaluation and an individualized treatment plan. Understanding the potential benefits, treatment process, eligibility requirements, and safety considerations can help patients have a more informed conversation with their healthcare provider.