While depression is a highly treatable problem, it can take time and patience to find a protocol that delivers substantial, sustained symptom relief. Even so, conventional treatment strategies fail to provide adequate or enduring relief for a full one-third of adults with major depression.
As mental health experts who specialize in treating persistent depression, the team at TMS & Brain Health is dedicated to providing innovative, scientifically proven solutions for patients who haven’t found success with a more traditional approach.
Here’s what you should know about Spravato™, the fast-acting esketamine nasal spray that was recently approved by the FDA to help patients with treatment-resistant depression (TRD).
How ketamine treats depression
Ketamine is an FDA-approved anesthetic that’s been widely used in the operating room, on the battlefield, and in veterinary clinics for roughly half a century. Its importance was underscored by the World Health Organization (WHO) in 1985, when they included it on their list of essential medicines.
At the turn of the century, researchers began exploring ketamine as a possible antidepressant. What they found was promising — ketamine binds to NMDA receptors in the brain, causing the rapid activation of glutamate; glutamate is a neurotransmitter that helps “switch on” key brain circuits that shape your mood and drive your behavior.
Traditional antidepressants also activate glutamate, but they do it in a more roundabout way. After they build up in your system for a few weeks, they activate a class of neurotransmitters called monoamines (serotonin, norepinephrine). These newly activated neurotransmitters are what bind to NMDA receptors, activate glutamate transmission, and boost your mood.
Because ketamine works directly on NMDA receptors and glutamate, its effects are far more rapid and dramatic — most people experience significant symptom relief within a few short hours.
The evolution of esketamine
Ketamine is a mixture of two mirror-image molecules: “R” ketamine and “S” ketamine. As an off-label treatment for depression, it’s given intravenously, as an infusion into the bloodstream.
Esketamine, on the other hand, only contains the “S” ketamine molecule. As an FDA-approved treatment for persistent depression, it comes in the form of a nasal spray.
Spravato is the brand-name of the esketamine nasal spray that was approved by the FDA in March of 2019. It’s the first treatment of its kind, and the only NMDA receptor antagonist that’s FDA-approved for the treatment for persistent depression in adults.
Where you can find esketamine
When the FDA announced that it was approving a fast-acting nasal spray for the treatment of persistent depression in adults, many people who had been living with TRD felt hopeful — and rightfully so — for the first time in years.
But this doesn’t mean you can simply get a prescription for Spravato and pop over to your local pharmacy and pick it up. When the FDA approved esketamine to treat major depression, it also provided strict guidance on exactly how the medicine should be administered.
That’s because, besides its immediate cognitive and mood-enhancing effects, ketamine can have sedating and dissociative effects. In fact, that’s why ketamine became a relatively popular recreational substance among partygoers in the 1990s.
Because of the adverse risks of sedation and dissociation as well as the potential for misuse, Spravato is only available through a restricted distribution system under a Risk Evaluation and Mitigation Strategy (REMS).
What does this mean for you? It means that, even though ketamine is self-administered, it must be taken under the guidance of an experienced physician in an authorized medical office.
A ketamine-certified treatment center
Here at TMS & Brain Health, we’re proud to be the first clinic in southern California to provide ketamine infusion therapy as well as Spravato esketamine nasal spray treatments for qualified patients.
Even though it only takes a moment to administer Spravato, each esketamine treatment lasts about two hours from start to finish. Most of this time is spent monitoring your reaction to the medicine, to ensure you’re safe if you experience any mild hallucinations, dizziness, or vertigo.
Because you won’t be able to drive until the next day following a good night’s rest, you can only receive Spravato if you’ve arranged for someone else to drive you to and from your treatment.
If you suffer from persistent depression, we can help. Call your nearest TMS & Brain Health office in Los Angeles or Santa Monica, California, today, or click online to book an appointment with one of our experienced ketamine experts any time.