Should I try Spravato (Esketamine) for Treatment Resistant Major Depression?

Treatment Resistant Major Depression (TRD) is one of the most difficult conditions to treat in all of Psychiatry. Characterized by severe depression that responds poorly to different medication regimens, TRD can destroy quality of life and diminish functional capacity for decades at a time. Recent clinical trials have demonstrated very encouraging results for the use of Ketamine in TRD. Ketamine, which has been used for many years as a form of anesthesia, has been shown to yield robust and rapid responses for depression when given in lower doses. There are now newer techniques and forms of ketamine administration demonstrating even more promising results.

Q: How effective is Spravato (Esketamine) for Treatment Resistant Major Depression?
Recent clinical trials have demonstrated very encouraging results for the use of Esketamine, so much so that it received a FDA indication for treatment resistant Major Depression under the brand name Spravato. Esketamine is the “S” isomer of Ketamine, which usually is a mix of both the “S” and “R” molecules (mirror images of each other on a molecular scale). Spravato (Esketamine) has been proven effective in treating Depression.

Q: How is Spravato (Esketamine) administered for depression treatment?
Spravato is a nasal spray that is administered in the office, under observation. Patients cannot administer Spravato on their own. The desired effect is a notable mood lift while still fully awake and alert. The patient is monitored in the office to ensure tolerability, especially in regards to blood pressure. In some patients the blood pressure can elevate temporarily following administration of Spravato.

Q: How long does a Spravato (Esketamine) dose last?
The mood elevation may be notable and can last up to a few weeks after even just one administration. Most cases will require subsequent Esketamine administrations with some regularity that may be weekly or bi-monthly. Most cases maintain a very strong clinical response with ongoing treatment.

The notably high effectiveness in treating some of the hardest cases has given Ketamine and Esketamine a certain distinction in Psychiatry. Some patients with Treatment Resistant Major Depression, that had long been written off as hopeless, have had their lives restored after a series of successful Esketamine or Ketamine treatments. Aside from being highly and rapidly effective, Esketamine is well tolerated with few side effects. Response rates are typically high and can be achieved quickly. Many of the few patients who did not respond initially to the starting dose can still achieve a response if the dose of Spravato is adjusted. Some patients experience a response lasting over 4 weeks after the first administration. Many patients continue to receive weekly Esketamine administrations to maintain a strong response.

The Spravato nasal spray and Ketamine intravenous infusions are powerful tools available to achieve a response in treatment resistant Major Depression. Most insurances now actually cover Spravato with only the cost of a copay for most patients. All patients must first undergo a Psychiatric evaluation, after which all of the different treatment recommendations are discussed. The Spravato nasal spray and Ketamine intravenous infusions may be appropriate options in treatment resistant cases of Major Depression, with the best results coming as part of a comprehensive approach that includes Transcranial Magnetic Stimulation (TMS), psychotherapy, optimized nutrition, and exercise.

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