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Depression is a complex and challenging mental health condition that affects millions of people worldwide. While traditional antidepressant medications and psychotherapy have been the mainstay of treatment for decades, some individuals do not respond adequately to these approaches. 

In recent years, there has been growing interest in exploring alternative treatment options for treatment-resistant depression, and one such innovation is Spravato (esketamine).

Spravato is a nasal spray medication that received approval from the U.S. Food and Drug Administration (FDA) in 2019 as a breakthrough therapy for treatment-resistant depression. 

This article will delve into the mechanism of action of Spravato, its potential benefits, possible side effects, and its role in the treatment landscape for depression.

Understanding Depression

Depression is a multifaceted mental health condition that affects millions of people worldwide. It goes beyond just feeling sad or down; it permeates every aspect of a person’s life, creating a profound impact on their thoughts, emotions, and behaviors. 

This complex disorder can manifest in various ways, leading to feelings of hopelessness, worthlessness, and a loss of interest in activities once enjoyed. Often shrouded in silence and stigma, depression can leave individuals feeling isolated and misunderstood.

The causes of depression are diverse and may include genetic predisposition, biological imbalances, environmental factors, or significant life events. It can affect people of all ages, genders, and backgrounds, making it a pervasive and challenging issue to address.

The Complexities of Treatment-Resistant Depression

Treatment-resistant depression (TRD) is a debilitating condition that affects a significant portion of individuals living with depression.

It is characterized by persistent symptoms of depression despite undergoing multiple trials of standard antidepressant medications and psychotherapies. 

TRD can have a profound impact on a person’s life, leading to a diminished quality of life, impaired functioning, and increased risk of suicidal thoughts and behaviors.

The prevalence of TRD is not precisely defined, as it can vary depending on different factors such as the definition used and the population studied. 

However, research suggests that approximately one-third of individuals with depression may experience TRD at some point in their illness. This highlights the urgent need for more effective and innovative treatment options to address the unmet needs of this population.

What is Spravato?

Spravato is a prescription medication used in the treatment of depression, specifically for individuals with treatment-resistant depression (TRD).

It is a brand name for esketamine, which is a derivative of ketamine. Spravato is exclusively accessible at certified clinics and stands apart from traditional antidepressants.

Administered through a nasal spray, it targets the brain’s glutamatergic system. Acting as an N-methyl-D-aspartate (NMDA) receptor antagonist, Spravato effectively inhibits excitatory amino acids in the brain while simultaneously boosting dopamine, a vital brain chemical involved in mood regulation.

The Development and Approval of Spravato

The development of Spravato (esketamine) represents a significant milestone in the quest to find novel treatments for TRD. The research journey leading to the approval of Spravato involved multiple clinical trials to assess its safety and efficacy in individuals with TRD. 

In 2019, the U.S. Food and Drug Administration (FDA) granted Spravato Breakthrough Therapy designation, expediting its development and review process.

The FDA’s approval of Spravato was based on robust evidence from clinical trials showing its potential to rapidly alleviate depressive symptoms, including suicidal ideation, in patients with TRD. 

This groundbreaking approval marked the first time in decades that a new mechanism of action for depression treatment had been approved.

The Benefits of Spravato

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Spravato offers several potential benefits in the treatment of depression, particularly for individuals with treatment-resistant depression (TRD). 

1. Stabilizing Mood

Spravato has shown promise in stabilizing moods and helping individuals achieve a more balanced emotional state.

By targeting specific receptors in the brain, it can regulate mood fluctuations and create a sense of emotional equilibrium.

2. Decreasing the Severity of Depression

For individuals struggling with severe or treatment-resistant depression, Spravato offers a potential solution to alleviate the intensity of depressive symptoms. It can provide relief from persistent sadness, hopelessness, and despair.

3. Delaying the Return of Symptoms

One of the notable advantages of Spravato is its ability to extend the period of symptom relief. Unlike some traditional antidepressants, which may require frequent adjustments or changes, Spravato’s effects can be longer-lasting, helping individuals experience sustained improvement.

4. Rapid Onset of Action

One of the key advantages of Spravato is its rapid onset of action. Unlike traditional antidepressants that may take weeks or even months to show noticeable effects, Spravato has been shown to produce improvements in depression symptoms within hours or days after administration. 

This rapid response can be life-changing for individuals experiencing severe and persistent depression, providing them with much-needed relief and hope for a brighter future.

5. Reducing Thoughts of Suicide

Another benefit of Spravato is its potential to address suicidal ideation. Depression can lead to overwhelming feelings of hopelessness and thoughts of self-harm or suicide.

Clinical trials have demonstrated that Spravato can be effective in reducing suicidal thoughts and behaviors, making it a crucial option for individuals at risk of self-harm.

6. Easy Administration

Moreover, Spravato’s nasal spray delivery system is convenient and easy to administer. This non-intravenous route of administration allows for a more comfortable experience for patients during treatment sessions.

Additionally, the nasal spray format minimizes the need for extensive medical procedures, reducing the burden on both patients and healthcare providers.

Safety and Side Effects

While Spravato has shown promise in treating depression, it is essential to consider its safety profile and potential side effects. Like any medication, Spravato may cause side effects in some individuals. 

The most common side effects reported during clinical trials include dizziness, dissociation (feeling disconnected from oneself or the environment), and sedation. However, it is important to note that these side effects are typically short-lived and subside after the treatment session.

To enhance safety, Spravato is administered in a controlled setting under the supervision of healthcare professionals.

Patients are required to remain in the healthcare facility for at least two hours after receiving the nasal spray to monitor for any adverse reactions. This cautious approach ensures that any side effects are promptly addressed and mitigated.

It is crucial for healthcare providers to assess each patient’s medical history and potential risk factors before prescribing Spravato. Individuals with a history of substance abuse, psychosis, or certain medical conditions may not be suitable candidates for Spravato treatment. 

Additionally, pregnant or breastfeeding individuals should consult their healthcare provider before considering Spravato therapy.

Considerations for Spravato Treatment

Before embarking on Spravato treatment, several essential considerations must be taken into account. Firstly, healthcare providers need to conduct a comprehensive evaluation of the individual’s mental health status, medical history, and response to previous treatments. This evaluation helps determine if Spravato is a suitable option for the patient.

As Spravato is typically reserved for individuals with treatment-resistant depression, other treatment options should be thoroughly explored and optimized before considering this therapy.

Traditional antidepressants and psychotherapy may still provide relief for many individuals with depression, and healthcare providers should not overlook these proven treatments.

Incorporating Spravato into a comprehensive treatment plan for depression is essential. While Spravato may provide rapid relief from depression symptoms, it is not a standalone solution.

Psychotherapy, such as cognitive-behavioral therapy (CBT) can complement the effects of Spravato by addressing underlying psychological issues contributing to depression. 

Furthermore, ongoing support and follow-up care are crucial to monitor treatment progress and adjust the therapeutic approach as needed.

Medication and Therapy with BetterHelp

If you’re experiencing depression, it’s essential to explore various treatment options to find what works best for you. While medications can be an effective part of depression management, they may not be enough on their own. Seeking additional support through therapy can be highly beneficial. 

BetterHelp, an online therapy platform, offers a convenient and accessible way to access professional help from licensed therapists. Combining therapy with medication can provide a comprehensive approach to address the underlying causes of depression and develop coping strategies. 

Therapy can help you explore the root causes of your depression, identify negative thought patterns, and develop healthier ways of coping with emotions. The combination of therapy and medication can enhance the overall effectiveness of treatment and lead to better outcomes in managing depression symptoms. 

Remember that seeking help is a sign of strength, and you don’t have to go through this challenging time alone.


Spravato represents a significant advancement in the treatment landscape for depression, offering hope for individuals with TRD who have not responded to traditional therapies.

By understanding its potential benefits and its role in clinical practice, healthcare providers can make informed decisions about integrating Spravato into comprehensive treatment plans. 

However, it is essential to recognize that Spravato is not a cure-all for depression, and its use should be carefully assessed by qualified healthcare professionals to ensure safe and effective outcomes for those seeking relief from depression’s burdensome grip.


Is Spravato covered by insurance?

The coverage of Spravato under insurance plans can vary depending on the specific policy and the individual’s medical condition.

Some insurance companies may cover Spravato for the treatment of treatment-resistant depression, while others may have specific criteria or limitations. 

It is essential to check with your insurance provider to understand the coverage and potential out-of-pocket expenses.

Can Spravato be used in combination with other antidepressants?

In some cases, healthcare providers may prescribe Spravato in combination with other antidepressant medications for individuals with treatment-resistant depression.

The decision to use a combination of treatments is made based on the patient’s unique condition and response to previous therapies. 

How long does the effect of Spravato last?

The duration of Spravato’s effect can vary from person to person. While some individuals may experience relief from depression symptoms for several days after a single treatment session, others may require multiple sessions to maintain the benefits.

Healthcare providers typically work closely with patients to monitor their response to Spravato and adjust the treatment plan.

Is Spravato addictive?

Spravato contains the active ingredient esketamine, which is derived from ketamine, a dissociative anesthetic. While esketamine has a lower potential for abuse and dependence compared to ketamine, it still carries some risk. 

For this reason, Spravato is administered under controlled conditions in a healthcare facility, and patients are closely monitored for any signs of abuse or dependence.

Can Spravato be used for other mental health conditions?

Currently, Spravato is only FDA-approved for the treatment of treatment-resistant depression in adults.

While there may be ongoing research exploring its potential benefits for other mental health conditions, such as anxiety or post-traumatic stress disorder (PTSD), its use for these conditions is not yet approved by regulatory authorities.

Can I drive after receiving Spravato treatment?

Due to the potential side effects of dizziness and sedation, it is generally advised to avoid driving or operating heavy machinery for at least 24 hours after receiving a Spravato treatment session.

Patients are required to remain at the healthcare facility for observation during this period to ensure their safety.

Additional Posts:

  1. Can a Life Coach Help with Depression
  2. How To Find Your Passion When You Are Depressed
  3. Does Suboxone Help with Depression
  4. What to Expect After Ketamine Treatment for Depression
  5. Does Depression Go Away With Medication



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