Spravato® is a nasal spray containing esketamine, the first antidepressant in nearly 30 years approved with a novel mechanism of action for Treatment-Resistant Depression (TRD). Unlike traditional antidepressants such as SSRIs or SNRIs, which mainly target serotonin or norepinephrine, Spravato® works on the glutamate system.
This new approach offers hope for patients who have not responded well to conventional medications, especially:
- Adults who have tried at least two different classes of antidepressants without sufficient improvement
- Patients with depression accompanied by acute suicidal thoughts or behaviors
How Spravato® Works
- Boosts glutamate release: Rapidly increases glutamate levels in the brain, strengthening synaptic connections between neurons
- Enhances neuroplasticity: Improves brain regions involved in mood regulation and reward systems
- Rapid onset: Studies show that when combined with oral antidepressants, some patients feel mood improvement within 24 hours
Treatment Process
Spravato® must be administered in a medical facility under professional supervision. It cannot be taken home for self-use.
1. Preparation
- Avoid food for 2 hours before treatment; avoid drinking water 30 minutes before
- Blood pressure is checked to ensure stability
- Medical staff explain the procedure and possible side effects
2. Administration
- Delivered via nasal spray (2–3 devices per session, 56mg or 84mg)
- One spray per nostril, with a 5-minute rest between sprays
3. Post-treatment monitoring
- Patients remain in the clinic for about 2 hours for observation
- Blood pressure, mental state, and side effects are monitored
4. Treatment frequency
- Induction phase (Month 1): Twice weekly
- Maintenance phase (Month 2): Once weekly
- Continuation phase: Every 1–2 weeks, adjusted based on progress
Benefits of Spravato®
- Fast-acting: Especially important for patients at risk of suicide
- Novel mechanism: Provides an alternative for those unresponsive to traditional drugs
- Synergistic effect: Works alongside oral antidepressants for stronger results
- Sustained relief: Some patients maintain improvement for months after completing treatment
Common Side Effects
- Dizziness, drowsiness
- Nausea, vomiting
- Temporary rise in blood pressure
- Dissociation (feeling detached from reality or self)
- Altered taste, blurred vision
Note: Most side effects resolve within 1–2 hours. Patients should not drive or operate machinery on the day of treatment.
Safety Considerations
- Must be used under medical supervision to manage side effects and blood pressure changes
- Not suitable for patients with recent heart attack, brain haemorrhage, aneurysm, or severe liver disease
- Caution in individuals with a history of substance misuse
- Pregnant or breastfeeding women should discuss risks and benefits with their doctor
Psychiatrist’s Reminder
Spravato® is not a “magic cure”, but part of a comprehensive treatment plan. Best results usually come from combining:
- Spravato® + oral antidepressants
- Psychotherapy (e.g., Cognitive Behavioural Therapy – CBT)
- Lifestyle adjustments (regular sleep, exercise, social support)
For patients struggling with long-term depression unresponsive to traditional medications, Spravato® may represent a life-changing opportunity. However, whether it is suitable must be determined by a psychiatrist, based on medical history, physical health, and treatment goals.
