Spravato (Esketamine) for Depression

Overview
Spravato is a prescription drug approved by the U.S. Food and Drug Administration (FDA) for the treatment of adults with treatment-resistant depression (TRD), either alone or in combination with an oral antidepressant. It is also approved for treating depressive symptoms in adults with major depressive disorder (MDD) who have suicidal thoughts or behavior, in conjunction with an oral antidepressant. Spravato is also known by its drug name, esketamine.

Spravato is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist, meaning it works by blocking NMDA receptors in the brain. While its exact mechanism in depression is not fully understood, it is thought to help restore synaptic connections between brain cells, which may contribute to its antidepressant effects.

How do I take it?
Prescribing information states that Spravato is administered as a nasal spray under the supervision of a healthcare provider. A person must remain under observation for at least two hours after administration due to the risk of sedation, dissociation, and increased blood pressure. Before and after each dose, a healthcare provider will assess blood pressure.

For TRD, Spravato is generally taken twice a week for the first four weeks, with dosing frequency adjusted thereafter based on individual response. For depressive symptoms in MDD with suicidal thoughts or behavior, treatment is typically continued for four weeks, after which its continued use is reassessed. Spravato should be taken exactly as prescribed by a healthcare provider.

Side effects
Common side effects of Spravato include dissociation, dizziness, nausea, sedation, vertigo (a spinning sensation), hypoesthesia (reduced sense of touch), anxiety, lethargy, increased blood pressure, vomiting, feeling drunk, headache, and euphoric mood.

Rare but serious side effects may include significant increases in blood pressure, cognitive impairment affecting attention and judgment, and an impaired ability to drive or operate machinery until the following day after a restful sleep. Spravato may also cause fetal harm, so pregnancy planning and prevention should be considered for individuals of reproductive potential. Due to the potential for abuse and misuse, healthcare providers generally will monitor for signs of dependency.

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Label: Spravato — Esketamine Hydrochloride Solution — DailyMed