Understanding Spravato: Benefits, Side Effects, Uses, and More

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Medically reviewed by Neal Swartz

a blue and white spray bottle of Spravato Esketamine therapy. REACH, Ohio
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Anyone who suffers from depression, or who has loved ones who do, will know what a difficult and debilitating illness it can be. 

While antidepressant medications and various forms of therapy have helped millions of people treat and overcome depression, sometimes these forms of treatment just don’t work. And for those people, the magnitude of their illness can feel overwhelming. 

Until now. 

Spravato is an FDA-approved esketamine intranasal spray that has emerged as a breakthrough in treating people with severe or treatment-resistant depression. And it’s being hailed as a “game-changer”. 

But what exactly is it? And how does it work? What are the potential side effects of Spravato? Is it safe, and is it effective?

In this article, we’ll explain all the basics of Spravato and answer the most common questions about this groundbreaking treatment. 

Or if you live in Ohio, contact us at REACH Behavioral Health to arrange an initial consultation, and find out if Spravato esketamine intranasal spray could be the treatment you or a loved one has been waiting for. 

What is Spravato (esketamine) intranasal?

a man wearing glasses smiling while discussing therapy treatment at REACH, Ohio

Spravato is the brand name for the esketamine nasal spray that’s prescribed for treating certain types of depression. 

It’s a form of ketamine therapy, and is often referred to under that broader name. However,  the Spravato nasal spray is in fact the only treatment of its type, and the only FDA-approved form of ketamine therapy for treating depression. There are no generic versions of the drug currently available. 

Esketamine – which is one of the main ketamine molecules – is the active ingredient in Spravato, and it’s prescribed in the form of an easy-to-use nasal spray, but always under medical supervision rather than for at-home use.

What is Spravato used for?

Spravato isn’t a first-line treatment for depression. It is specifically and exclusively used for treating adults (over the age of 18) with severe depression or those who have not experienced relief in their symptoms from other treatments. Specifically: 

  • Adults with treatment-resistant depression (TRD), which is depression that has not responded to at least two oral antidepressant treatments.
  • Adults with major depressive disorder (MDD) with suicidal thoughts and behaviors. 

Spravato esketamine intranasal spray is always prescribed alongside oral antidepressants, which the patient must continue to take throughout the course of their Spravato treatment. 

How does ketamine therapy work?

Ketamine affects a different part of the brain to oral antidepressants, which is the reason ketamine therapy is able to help treat depression when antidepressants sometimes cannot. 

Ketamine triggers glutamate production, which plays a key role in mood regulation and prompts the brain to repair the damaged or weakened neural pathways that initially cause depression, as well as to form new neural connections. 

Essentially, this means that ketamine stimulates a reprogramming in your brain that affects your mood and thought patterns, which can lead to a rapid decrease in depressive and suicidal thoughts.  

Does Spravato really work? 

Yes, it does. While the effectiveness of Spravato will differ from person to person, clinical trials and other research have shown a number of key results in the effectiveness of Spravato. These include: 

  • Rapid onset of action and relief from depressive symptoms, sometimes within just hours or days
  • Effectiveness in individuals with treatment-resistant depression 
  • A greater reduction in depressive symptoms in the longer-term, compared to patients not using Spravato
  • A greater sustained improvement of depressive symptoms, following the end of the course of treatment
  • Reduction in suicidal thoughts and behaviors for individuals suffering with MDD (major depressive disorder)

What are the side effects of Spravato?

Most side effects of Spravato are short-term and not serious. If they occur, it is usually immediately after taking Spravato, and they go away the same day, normally within a few hours. 

These mild Spravato side effects include:

  • Dissociation (feeling disconnected from yourself, your thoughts, feelings, space, and time)
  • Drowsiness
  • Dizziness or a spinning sensation
  • Headaches
  • Numbness in parts of the body
  • Vertigo 
  • Anxiety
  • Nausea or vomiting
  • Increased blood pressure
  • A feeling of intoxication
  • Lack of energy and mental alertness

In some cases Spravato can cause more serious side effects, so it is essential to fully disclose your full medical history to your practitioner before starting with treatment and to discuss and understand all potential side effects. 

More serious side effects of Spravato can include:

  • Respiratory depression or arrest
  • Risk of abuse and misuse, including physical and psychological dependence

In rare cases, Spravato can cause the inverse effect of an increased risk of suicidal thoughts and actions. This is mostly in younger patients (under 25), and within the first few months of treatment or when dosage is changed. It’s vital that you or a family member pay close attention to any negative changes in mood and tell your healthcare professional immediately if any changes are noticed. 

Does Spravato cause weight gain?

No, there’s no evidence of Spravato causing weight gain, and weight gain wasn’t reported as a Spravato side effect in its clinical trials. 

How is Spravato taken and what should I expect from a treatment session?

The treatment itself is self-administered, but always under medical supervision in a healthcare setting, as patients need to be monitored for at least two hours after treatment. 

People often feel a range of effects shortly after they administer the esketamine intranasal spray, including dizziness, a feeling of intoxication, sleepiness, wooziness, a sense of detachment, or others. These effects are temporary, and usually dissipate within a few hours, but you won’t be able to drive or perform a number of other tasks for the rest of the day, so it’s important to plan ahead for this. 

Most people wake up the next morning feeling refreshed and with an already noticeable improvement in their mood.

Is Spravato covered by insurance?

Yes, almost all insurance companies will cover Spravato if you meet the patient criteria. At REACH, we will check your insurance coverage as part of our initial consultation, so you will know in advance if you are covered or not.

Can you take Spravato if you are already on antidepressant medication?

Yes. In fact you must remain on an antidepressant medication while you undergo Spravato esketamine intranasal treatment. 

What is the difference between ketamine and esketamine?

Ketamine consists of two molecules, R-ketamine and S-ketamine, which each have slightly different effects on the brain. S-ketamine is the more active form that is primarily responsible for the antidepressant effects. 

Esketamine is a form of ketamine that has been slightly modified to contain only S-ketamine, specifically in order to treat depression. This is the form of ketamine used in the Spravato nasal spray, and which has been approved by the FDA for treating certain types of depression. 

Is Spravato the same as IV ketamine therapy?

No. IV ketamine infusions are another type of ketamine therapy used to treat depression. Unlike the esketamine nasal spray, the IV method uses ketamine in its full form, and is administered via intravenous injection rather than via a simple nasal spray. 

While there have been promising results from IV ketamine infusions in treating depression, it has more severe side effects than Spravato and is not FDA-approved, which means it is not as controlled. It is also a very expensive treatment and not covered by insurance. For these reasons, we do not offer IV ketamine therapy at REACH Behavioral Health.

Where can I find more information about Spravato?

Contact us at REACH Behavioral Health Ohio to arrange a free consultation where we will be able to give you information specific to your own situation, and answer all of your questions.

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