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What Should You Know about New Antidepressant Spravato?

FDA approved the nasal spray esketamine (Spravato) for hard-to-treat depression. A new study shows that when it's added to an SSRI it helps!

The Food and Drug Administration approved a completely new type of antidepressant on March 4, 2019. The nasal spray called esketamine is supposed to help people who have not responded to standard antidepressants. It has been marketed under the brand name Spravato.

What Is Esketamine (Spravato)?

This drug is chemically related to the injectable anesthetic ketamine that has been on the market since 1970. Ketamine is available generically. It has been used off-label for pain and treatment-resistant depression (Schoevers et al, British Journal of Psychiatry, Feb. 2016).

One disadvantage of ketamine as an anesthetic is that it can cause a dissociative state while it is wearing off. Many people find this alarming. (Others enjoy this sensation, explaining ketamine’s popularity as a club drug, “Special K.”)

Drug company Johnson & Johnson developed esketamine following reports that infusions of ketamine itself could lift depression quickly (Andrade, Journal of Clinical Psychiatry, Mar/Apr. 2018). In particular, ketamine had a strong effect on suicidal thoughts (Ballard et al, Journal of Psychiatric Research, Nov. 2014). Many people who have not overcome depression with older antidepressants might benefit from Spravato.

How Do People Use Spravato?

Although eskatamine is administered as a nasal spray, people will not be permitted to purchase it for home use. To guard against abuse, patients may need to use Spravato under medical supervision at a clinic or doctor’s office. J&J recommends that people use it twice a week for four weeks. Then switch to once a week.

According to Drugs.com:

“The cost for Spravato nasal spray (28 mg (56 mg dose)) is around $784 for a supply of 2 spray, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans.”

That means a patient might have to spend $1,568 out of pocket each month.

Some experts have challenged the FDA’s approval process for esketamine. While two clinical trials demonstrated some benefit, two others did not show that esketamine is better than placebo. The drug may work a bit better for adolescents and young adults than for older adults.

The latest Research on Spravato:

A new study compared the nasal spray Spravato, to an older antipsychotic drug quetiapine, sold as Seroquel. Results were published in the New England Journal of Medicine, Oct. 5, 2023. Both groups of patients with treatment-resistant depression were also taking a standard antidepressant. The group getting esketamine fared better than those on quetiapine. Long term results also favored esketamine.

What Are the Side Effects of Spravato?

This novel antidepressant can cause nausea, dizziness, headache and a feeling of dissociation. Spravato can also trigger an unpleasant taste in the mouth. Some people in the clinical trials reported vomiting, anxiety, numbness or tingling in hands or feet and drowsiness (Canuso et al, AJP in Advance, 2018).

To learn more about ketamine and its use against suicidal thoughts, you may wish to listen to Show 983: Intriguing Approaches to Overcoming Depression.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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  • Reif, A., et al, "Esketamine Nasal Spray versus Quetiapine for Treatment-Resistant Depression," New England Journal of Medicine, Oct. 5, 2023, DOI: 10.1056/NEJMoa2304145
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