Spravato, the brand name for esketamine nasal spray, has recently been approved by the FDA as a treatment for TRD (treatment-resistant depression), particularly for those who have not responded to traditional antidepressants. Below, we compare Spravato with conventional antidepressant treatments, including differences in their mechanisms of action, efficacy, and patient outcomes.
Mechanisms of Action:
Traditional antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), primarily work by increasing the availability of neurotransmitters like serotonin and norepinephrine in the brain. They typically take several weeks to produce noticeable effects, as they gradually alter neurotransmitter levels and neural connectivity.
Spravato targets the N-methyl-D-aspartate (NMDA) receptor, a glutamate receptor in nerve cells, with immediate impact. By modulating glutamate signaling, Spravato can rapidly influence neural plasticity and connectivity. This distinct mechanism of action sets Spravato apart from traditional antidepressants and may explain its faster onset of action.
Onset of Action (Speed of Results):
One of the most significant differences between Spravato and traditional antidepressants is the speed at which they take effect. Conventional antidepressants often require 4-6 weeks of consistent use before patients experience substantial improvements in their depressive symptoms. This delay can be challenging for individuals struggling with severe depression or suicidal ideation.
In contrast, Spravato has demonstrated rapid antidepressant effects, with some patients reporting significant mood improvements within hours or days of their first treatment. This rapid onset of action can be particularly beneficial for those experiencing acute depressive episodes or those at risk of self-harm.
Efficacy for Treatment-Resistant Depression
Traditional antidepressants are effective for many individuals with depression. However, a significant portion of patients – approximately 30-40% – do not respond adequately to these medications, a condition known as treatment-resistant depression (TRD).
Spravato has shown promise in treating TRD, offering hope to patients who have not found relief with conventional antidepressants. In clinical trials, Spravato, when used in combination with an oral antidepressant, demonstrated superior efficacy compared to placebo plus an oral antidepressant in patients with TRD.
Administration (Frequency) and Monitoring
While conventional antidepressants are typically taken orally on a daily basis, Spravato is administered as a nasal spray in a controlled healthcare setting. Patients receive treatment under the supervision of a healthcare provider and are monitored for at least two hours after each administration.
This supervised administration allows for close monitoring of potential side effects and ensures proper usage of the medication due to addiction and misuse potential of self-administered keatmine. However, it also requires more frequent clinic visits compared to traditional antidepressants, which can be taken at home.
Side Effect Profiles
Both Spravato and traditional antidepressants can cause side effects, but their profiles differ. Common side effects of SSRIs and SNRIs include nausea, sexual dysfunction, weight gain, and sleep disturbances. These side effects can persist throughout treatment, have long-term effects, and tend to “creep” on without a clear recognition of their start and end points, making it difficult for the patient to even recognize these side effects are happening.
Spravato’s side effects are often transient and occur primarily during or shortly after administration. These can include dizziness, dissociation, nausea, and increased blood pressure. While these effects can be strong, they typically resolve within hours of treatment.
Long-Term Considerations
Traditional antidepressants are often prescribed for extended periods, sometimes years, to maintain symptom relief and prevent relapse. The long-term effects of these medications have been extensively studied, providing a wealth of data on their safety and efficacy over time – and an impact on patients’ overall quality of life (negatively)
Spravato, being a newer treatment, has less long-term data available. Current guidelines recommend its use in conjunction with an oral antidepressant, and ongoing research is examining its long-term safety and efficacy. As more data becomes available, treatment protocols and information about its long-term effects may evolve.
Cost and Accessibility
Traditional antidepressants are generally more affordable and widely covered by insurance plans. Generic versions of many SSRIs and SNRIs are available, further reducing costs.
Spravato, as a newer and more specialized treatment, tends to be more expensive. Insurance coverage varies, and some patients may face higher out-of-pocket costs. Additionally, the requirement for in-clinic administration can add to the overall treatment expense.
While conventional antidepressants remain the first-line treatment for many patients in menatl healthcare, Spravato provides a valuable alternative, particularly for those with treatment-resistant depression.
Its rapid onset of action and efficacy in TRD are notable advantages, but considerations such as administration requirements and cost must be weighed. As research continues, our understanding of these treatments will evolve, potentially leading to more personalized and effective depression management strategies.
Curious about Spravato for you or a loved one? Learn more about Spravato here.
