Spravato is an esketamine nasal spray used at Andala to treat a range of mental health conditions. FDA-approved for treating treatment-resistant depression, Spravato uses an intranasal spray version of esketamine, which has been used as an anesthetic in medical practice for decades. Spravato is administered in our outpatient clinics and typically prescribed in tandem with an oral antidepressant.
Esketamine nasal spray, also known as Spravato, is an FDA-approved intranasal spray that can be prescribed to help patients with treatment-resistant depression along with an antidepressant.
Not only is Spravato potentially rapid-acting, but it is the first truly new mechanism for depression that has been approved by the FDA in over 60 years. This drug is intended to be used for people with major depression who have not responded well to at least two antidepressants.
Andala providers may recommend prescribing Spravato as part of your treatment plan. Nasal esketamine is related to ketamine, a safe, FDA-approved anesthetic that has been effective in the treatment of depression when used off-label in low-dose ketamine infusion therapy.
Spravato, a nasal spray version of ketamine, works by inhibiting the NMDA (N-methyl-D-asparate glutamate) receptor. While Spravato has been demonstrated in multiple clinical trials to be an effective treatment for treatment-resistant depression (TRD), it is not known how exactly Spravato works to treat this depressive disorder. Spravato must be prescribed by a medical professional, and patients self-administer the treatment in our clinic under medical supervision.
While treatment plans may vary, an average course of treatment for a patient on Spravato runs as follows:
Spravato has been proven effective in trials lasting up to one year.
What to Expect During a Spravato Appointment
Each Spravato treatment is self-administered in a certified clinical setting under the supervision of psychiatrists and psychiatric mental health nurse practitioners. The medication is self-administered to support patient agency and to ensure ideal timing between administration and inhalation of the medication.
Please arrive for your first appointment about 15 minutes early. You will be taught by a provider how to administer the medicine yourself by spraying it into your nostrils. We want to make sure you are comfortable and answer any first-time questions.
During these treatment sessions you will be monitored by an Andala care provider for two hours after the Spravato has been administered for any possible side effects.
After you leave Andala, avoid operating any motor vehicles or heavy machinery, engage in hazardous activities, or make significant business or personal decisions until the day after treatment.
The dosing schedule for the first four weeks is an “induction” series of twice weekly treatments. Self-administering Spravato is similar to administering an OTC nasal spray. The tip of a small bottle is inserted into the nasal cavity; the patient then inhales as they initiate the spray into the nose.
The starting dose is 56 mg, which may be increased to the maximum dose of 84 mg as needed and tolerated for the second treatment and beyond. During the second month, the frequency is reduced to weekly, and may then be reduced to less frequent treatment as clinically indicated.
After each Spravato treatment, our Andala providers monitor patients for at least two hours in the office to ensure patient safety.
The most common side effects that a patient may experience after taking Spravato include dissociation, dizziness, nausea, sedation, and transiently increased blood pressure. Side effects are typically mild and rarely persist beyond the hours after treatment.
The dosing schedule for the first four weeks is an “induction” series of twice weekly treatments. The starting dose is 56 mg, which may be increased to the maximum dose of 84 mg as needed and tolerated for the second treatment and beyond. During this time, you will work with your Andala provider to determine the effectiveness of treatment and make adjustments to optimize the outcome.
During the second month of treatment, the frequency is reduced to weekly, and may then be reduced to less frequent treatment as clinically indicated. Maintenance treatment may continue as frequently as once weekly or every other week if necessary, though many patients are able to reduce this frequency over time.
The most common side effects that a patient may experience after taking Spravato include:
Spravato side effects are typically mild and do not persist beyond the time in the office.
After your first Spravato treatment, Andala encourages you to look out for any unusual side effects after leaving the treatment center.
An increase in blood pressure may occur for up to 4 hours after taking Spravato. If you experience excessive depressive or suicidal thoughts, increased blood pressure beyond four hours, problems thinking clearly, or bladder problems, contact your psychiatrist immediately.
It is imperative that you disclose all other medications you are taking when working with your Andala care team. Any medication may potentially influence how Spravato reacts with your body, either reducing the effectiveness of the medicine or increasing side effects.
Possible Spravato interactions may include, but are not limited to, psychostimulants (e.g., amphetamines, methylphenidate, modafinil, armodafinil) and monoamine oxidase inhibitors (MAOIs), which may increase blood pressure. Benzodiazepines, opioids, or alcohol may increase sedation and make the treatments
Spravato is covered by some medical benefit or pharmacy benefit plans. Whether an insurance plan will cover Spravato depends on multiple factors, including type of insurance and the types of benefits offered by a plan. Patients should discuss insurance coverage for Spravato with their doctors before beginning treatment. Our providers may be able to work with your insurance providers to get authorization if it is indicated.
Spravato is FDA-approved in the treatment of treatment-resistant depression in adult patients who have not benefited from treatment plans that used other antidepressant medicines, as well as adults with major depressive disorder who experience suicidal thoughts or behaviors. Given risk factors including dissociation and sedation post-administration, the FDA requires that Spravato be prescribed by a physician and administered under medical supervision.
If you’re about to have your first Spravato treatment at Andala, there are a few tips we recommend to all new Spravato patients:
Andala’s Reconnect Lounge is a comfortable space for patients to spend time reflecting and relaxing after administering Spravato under the supervision of a member of our care team.
How often you take Spravato will depend on your particular treatment plan. Any patient taking Spravato should only do so under medical supervision. Generally, Spravato is administered two times a week during the first 30 days of treatment, then once a week during the next 30 days of treatment. Ongoing administration of Spravato may occur on a weekly basis or every two weeks, as clinically indicated.
The FDA has approved Spravato for administration under medical supervision at certain clinics. Patients can self-administer Spravato at Andala clinics or another certified Spravato treatment center, and only under the guidance and supervision of a health care professional.
Spravato has been shown to be effective in multiple clinical trials in the treatment of depression. In one study, Spravato plus an oral antidepressant showed superior improvement in symptoms over an oral antidepressant plus a placebo after four weeks. The treatment difference between Spravato and the placebo was also clear after just 24 hours. Spravato has also been shown to delay time to relapse in some patients.
Spravato has not been FDA-approved in the treatment of anxiety. Ongoing research is needed to confirm the efficacy of Spravato in the treatment of anxiety. Ketamine, a medicine related to the esketamine used in Spravato, has been used in the treatment of some forms of anxiety, though FDA approval and research into its efficacy are still pending. Patients interested in esketamine and/or ketamine to address anxiety can consult with their doctor to determine what approach works best for their needs.