For many people with depression, taking an antidepressant and seeing a therapist for psychological counseling helps to relieve symptoms and enable them to get back to enjoying life.
But standard therapies don’t do enough to alleviate depression in everyone. Those who have been treated for depression, but whose symptoms either don’t get better or keep coming back, may have treatment-resistant depression (TRD). Treatment-resistant depression affects up to one-third of those who have a major depressive disorder.
Fortunately, there’s a promising new treatment that’s providing relief for many people with difficult-to-treat depression. The medication, esketamine (brand name: Spravato®), is a nasal spray that starts working quickly, and has been shown in clinical trials to help many adults struggling with TRD feel better.
SunCloud Health is pleased to be one of a select number of providers in the Chicago area certified to offer Spravato to our patients.
How can Spravato help adults with TRD?
Having a mood disorder that isn’t responding to medication after medication can be very demoralizing for people who are already suffering from symptoms such as a persistent down mood, sadness, a loss of pleasure and feelings of despair or worthlessness.
Spravato demonstrated in clinical trials that it can help many people whose depression has proven difficult-to-treat. In subsequent studies, many patients taking Spravato reported improvements in their emotional health and social functioning. The benefits included a better mood, feeling less anxious, having more energy, greater life satisfaction, and an improved ability to cope with daily stress. And many of these benefits are seen soon after starting the medication.
- While traditional antidepressants may take a few weeks to take effect, Spravato may provide relief in as little as a few days, or even hours.
- Some of our patients report that esketamine therapy is helping them experience life without depression for the first time in years.
What is Spravato?
Esketamine (Spravato) is derived from ketamine, an anesthetic that has been used for decades by physicians to relieve pain. Interest in ketamine as a treatment for depression took off in 2000, when researchers at Yale School of Medicine published the first randomized controlled trial that showed a single dose of intravenous ketamine improved symptoms of depression in many participants in as little as a few hours.
Esketamine is similar to ketamine, with several key differences.
- Esketamine can be taken via nasal spray, whereas ketamine is given via an IV infusion.
- Esketamine is approved by the U.S. Food and Drug Administration because it was proven to be safe and effective in clinical trials. Ketamine to treat depression is not yet approved by the FDA, although research continues.
- Esketamine is covered by many major commercial insurance plans, and Medicare plans also now cover SPRAVATO® treatment for major depression. Ketamine isn’t FDA approved and therefore isn’t covered by insurance.
Who can take Spravato?
Esketamine is approved for:
- Adults with treatment resistant depression (TRD)
- Adults with major depressive disorder (MDD) who have suicidal thoughts or actions
Patients with TRD must have tried at least two other antidepressants, but haven’t experienced remission or at least a 50 percent improvement in their mood. Patients who are suicidal do not have to fail two antidepressants – they can proceed directly to Spravato.
People with major depressive disorder have other diagnoses, such as anxiety disorders, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) or a history of alcohol or other substance use. Your physician will discuss this with you, but often patients with dual disorders can still take Spravato. Spravato isn’t recommended for women who are pregnant or breastfeeding. For more information on Spravato, please visit the Spravato website.
How is Spravato taken?
Spravato is self-administered nasal spray that’s taken under the supervision of a healthcare provider at a certified Spravato treatment center, such as SunCloud Health. The dosing is typically:
- Weeks 1 to 4: Two times weekly
- Weeks 5 to 8: Once a week
- Weeks 9 and beyond: Once a week or once every other week.
Spravato is used in combination with an oral antidepressant, such as an SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin and norepinephrine reuptake inhibitor). The most common side effects include sedation, dissociation (feeling “out of body”), dizziness, nausea, and headache. For a full list of potential side effects, visit the Spravato website. (Between treatments, there are few if any side effects.)
On treatment days, patients are monitored for at least two hours. Patients may not to drive until the next day, so you’ll need to make sure you have a ride to and from treatment. To make sure you are comfortable and relaxed during the monitoring period, SunCloud Health offers:
- A quiet, comfortable setting
- High-speed internet
- Snacks and refreshments
You and your doctor will decide together how long you should continue taking Spravato. But it’s recommended that you don’t stop taking the medication abruptly or without consulting your physician.
How does Spravato work?
One reason why esketamine is so exciting is that it’s the first new medication for depression to be introduced in many years that has a different mechanism of action than existing antidepressants.
Conventional antidepressants interact with receptors involved with naturally occurring chemicals such as serotonin, norepinephrine and dopamine in the brain. These chemicals are messengers that relay communication between brain cells. It’s thought that boosting these neurotransmitters can have a positive effect on mood.
Esketamine works differently. It interacts with receptors that control the release of glutamate, a neurotransmitter found widely throughout the brain. Scientists aren’t entirely sure how this relieves depression. But it’s thought that by activating the glutamatergic system, esketamine may both immediately improve depressive symptoms, and have a longer-term effect of altering glutamate signaling in the brain.
Research has suggested that together this may improve the neuroplasticity of the brain. Neuroplasticity enables the brain to create new, more positive thought processes and behaviors. This enables the brain to cope better with stress and potentially, reverse depression-related brain changes.
How can I prepare for my Spravato treatment?
To get ready for your first Spravato treatment at SunCloud Health, we recommend:
- Ask a friend or loved one for a ride to and from your appointment.
- Bring a book, headphones or something for entertainment during the post-treatment monitoring phase.
- Spravato, like all depression treatments, works best when combined with psychotherapy.
Call us to see if Spravato is right for you.
To see if SPRAVATO® is right for you, please contact us at and our intake team will be happy to help. Many major commercial and Medicare plans now cover Spravato treatment for depression. SunCloud Health accepts many major insurances for Spravato treatment, including Aetna, Blue Cross Blue Shield, Cigna, Humana, Tricare and others. As with other medical treatments, contact your insurance provider to confirm whether SPRAVATO® is covered for you.
Having thoughts of suicide? Call 988.
If you’re thinking about suicide, please reach out for help now. The Suicide and Crisis Lifeline offers free, confidential support 24/7 from trained crisis counselors. Just dial 988.
VIDEO: DR. ANANDAPPA ON TMS AND ESKETAMINE FOR TREATMENT-RESISTANT DEPRESSION: NOT ALLOWED TO DIE PODCAST