Across the world, Major Depressive Disorder (MDD) continues to be a leading source of suffering and disability. MDD causes a staggering burden with the highest morbidity rate in the world, with a great deal of the cost being the indirect expense of loss of productivity. For many people, standard treatment with medications and/or psychotherapy is either not effective or causes serious side effects. New and more effective treatments are needed urgently, and thankfully, medical advancements have been made in recent years. One new form of treatment is SpravatoTM.
Dr. Irakli Mania, Psychiatrist and Medical Director of Keystone Behavioral Health, talks about this new type of treatment for MDD which he hopes will help many people in the community.
What is SpravatoTM?
SpravatoTM is a new medication for depression (low mood) that is delivered through the nose with a nasal spray. It is an exciting step forward in the treatment of depression and is a valuable addition to the growing list of treatment options. SpravatoTM contains the medication Esketamine, and works differently compared to all other available antidepressants. Usually it is used in addition to traditional antidepressants because this was evaluated as an “add-on” treatment.
Who is a good candidate for this treatment?
SpravatoTM is for individuals who have treatment resistant depression, which is depression that has failed to respond to standard treatment approaches with medications and therapy. In other words, SpravatoTM may be considered if patient’s condition has not improved with two or more medication trials. Usually this is also a requirement by the insurance companies in order to have this treatment approved.
There are instances where use of SpravatoTM would not be appropriate. For example, this is not to be used during pregnancy or by a woman who is breastfeeding. It should not be used by anyone who is allergic to SpravatoTM or any of its ingredients. Patients with a history of bleeding in the brain or any blood vessel disorders should inform their doctor as this treatment may not be right for them. SpravatoTM only treats MDD and is not used for other mental health disorders like anxiety, schizophrenia, PTSD, OCD, etc.
Is it effective?
As of March 2019, SpravatoTM was approved by the Food and Drug Administration for the treatment of depression. It has been evaluated in several trials establishing its effectiveness. Its precursor, Ketamine, has been around for longer and has strong evidence for effectiveness.
What are the side effects?
Even though SpravatoTM was designed to remove side effects of its parent drug Ketamine, it still has some side effects. These may include feeling sleepy and an increase in blood pressure. Due to the potential side effects, treatment must be given in a doctor’s office. For more information on all the potential side effects and whether you would be a good candidate for this treatment, please talk to your healthcare provider.
What should people know before trying this treatment?
Treatment is done in a doctor’s office under physician supervision because there is a requirement that patients are monitored for side effects for at least two hours. In my office, during this time, the patient is sitting in a comfortable reclined chair in a private room, and medical staff will monitor them for side effects like an increase in blood pressure.
There are only two possible dosages of this medication, and if needed, a higher dosage can be given within first week. It is very important to note that the patient will need to make arrangements to have designated driver after receiving treatment. It is not recommended that they drive or operate machinery the rest of the day until they’ve had a restful night’s sleep. If the patient is taking sedating medications, they are advised to avoid them the day of the treatment.
How long do the results last?
The treatment schedule is twice a week for the first month. If the patient is responding well to treatment, it can be decreased to once a week. Eventually, treatments may be decreased to every other week.
Benefits can be seen as quickly as the first day or during the first week. The fast result is a big advantage of this drug because we know that with many antidepressants, we have to wait weeks to months before dosage can be adjusted and real benefits are observed. Unfortunately, the benefits of this medication are short-lived, requiring twice-a-week administration. With time, if the patient responds well, we start seeing longer-term improvement allowing us to decrease the frequency of administration. There is no good data yet as to how long this treatment needs to continue for. Depression is a chronic and recurrent disorder and often we need to continue effective treatments in order to prevent symptoms from returning.
How should patients prepare for the appointment?
You will need to have a psychiatric evaluation by a qualified psychiatrist before this treatment can be recommended for you. When preparing for an appointment with a doctor, make sure you have a complete list of medications that you have tried for treating depression. You should also have a complete list of current medications, whether they are used for psychiatric reasons or not, available to the doctor at the time of appointment. You should know your medical history or have somebody come with you who can help in providing this information.
If you are struggling with depression, or any other mental health concerns, please contact your healthcare provider as help is available. While there is no cure for MDD, by finding the right treatment for you, there is hope to lead a full, happy and productive life.
This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.