About 31% of the nearly 9 million Americans with major depressive disorder have treatment-resistant depression — meaning traditional medications and talk therapy don’t improve their symptoms.
For many years, these people faced steep challenges as they and their physicians worked to find the most effective combination of treatments, but a breakthrough came in 2019. The Food and Drug Administration (FDA) approved Spravato®, a nasal spray version of esketamine, for treatment-resistant depression and changed the landscape of depression treatment, giving hope to millions.
Dr. Karen Giles has expertise in using Spravato and other innovative approaches to mitigate treatment-resistant depression and offers the following guide to getting started with esketamine treatments.
To understand how Spravato delivers relief, we need to start with a quick study on neuroplasticity.
Spravato has a unique target in the brain, the N-methyl-D-aspartate (NMDA) glutamate receptor. Glutamate is a neurotransmitter or a chemical messenger in your brain. Its primary function is to activate other neurons, so they can do their jobs. Oral antidepressants developed prior to Spravato target one or a combination of the following neurotransmitters in the brain: serotonin, norepinephrine, and dopamine. Studies show that people with depression often have low glutamate levels — and that’s where Spravato comes in. Spravato blocks the NMDA receptor, which activates a rapid acting glutamate receptor called the amino-hydroxy-methyl-isoxazolepropionic acid (AMPA) receptor. This increases production of brain-derived neurotrophic factor (BDNF), which promotes neuronal growth, or “neuroplasticity”. People with depression have been shown to have neurons that are shrunken and make fewer connections to other neurons. By increasing BDNF, Spravato is able to quickly enable neurons to form new connections and efficiently communicate, thereby relieving depressive symptoms quickly.
Spravato offers hope for those with treatment-resistant depression, but it isn’t for everyone. Once Dr. Giles determines you’re a good candidate for Spravato, she monitors you closely to ensure you tolerate the protocol and that it’s working. She also discusses what to expect — here are the essential things to know before you get started.
Everyone responds slightly differently to Spravato, so it’s good to know what you may encounter. The most common side effects are:
Side effects are most intense during your first couple of treatments, and they typically wear off within an hour or two. But don’t worry; you stay in our care the entire time.
Spravato can work immediately, but it takes more than one treatment session to deliver long-term results.
During the first month, you come in twice a week for your Spravato treatments.
During the second month, you only need one treatment per week.
After the second month, Dr. Giles offers a customized maintenance protocol based on the FDA’s recommendations.
Because Spravato sometimes causes nausea, it’s best to avoid food and liquids for about two hours before your treatment.
You can only receive Spravato under the supervision of a trained health care professional, like Dr. Giles, at a certified treatment facility. While in the clinic, you will administer the nasal spray on your own under our care.
After you receive your Spravato treatment, you can relax in your private treatment room for the next two hours while we monitor you. Read a book, listen to music, or answer emails — whatever you prefer.
Make sure you line someone up to drive you home because you won’t be allowed to drive (or operate heavy machinery) until the next day.
We also offer an intravenous version of ketamine. Dr. Giles can help you decide whether Spravato or IV ketamine could be helpful for your depression.
If you still have questions about getting started with Spravato, call Breakthru Psychiatric Solutions in Sandy Springs, Georgia, or request an appointment online.