Esketamine, known as Spravato: Information about potential side effects, cost, appropriate dosage, and further details
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Spravato, a brand-name nasal spray, has been approved by the Food and Drug Administration (FDA) for adults with treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal thoughts or actions. Unlike traditional antidepressants, Spravato works rapidly and follows a unique mechanism of action. Let's explore how Spravato differs from conventional antidepressants and its implications on treating depression.
Mechanism of Action
The primary mechanism behind traditional antidepressants involves targeting monoamine neurotransmitters like serotonin and norepinephrine, aiming to alter brain chemistry over time. In contrast, Spravato concentrates on the glutamate system, which opens up a different neural pathway. This alternative approach may help restore disrupted neural connections in the brain, potentially addressing treatment failures with traditional antidepressants [1, 2, 4].
Onset of Effect
Traditional antidepressants might take weeks to months to produce noticeable clinical benefits. However, Spravato offers quicker relief, with many patients experiencing improvements within hours or days. This rapid action is particularly important for those who struggle with severe symptoms or face immediate risks such as suicidal ideation, as it offers prompt relief in critical situations [2, 3].
Administration
While traditional antidepressants are taken orally as pills, Spravato is administered as a nasal spray under medical supervision at certified clinics. Treatment typically begins with twice-weekly doses for four weeks before transitioning to weekly or bi-weekly maintenance doses. Due to potential transient side effects, patients are monitored for approximately two hours following each dose [2, 5].
Side Effects
Common side effects associated with traditional antidepressants may include weight gain, insomnia or drowsiness, nausea, sweating, anxiety, and sexual dysfunction. Conversely, Spravato's typical side effects include dissociation, dizziness or lightheadedness, nausea, increased blood pressure, and drowsiness. These side effects tend to be short-lived, usually resolving within hours after treatment [2].
Indications
Spravato is FDA-approved for adults dealing with treatment-resistant depression (TRD) and MDD complicated by suicidal ideation or behavior. It's prescribed in combination with a traditional oral antidepressant to boost the overall treatment efficacy [2, 5].
| Feature | Spravato (Esketamine) | Traditional Antidepressants ||----------------------------------|---------------------------------------------|---------------------------------------------|| Mechanism | Targets glutamate system | Targets serotonin and other monoamines || Onset of Effect | Hours to days | Weeks to months || Delivery | Nasal spray under supervision at clinics | Oral pills || Use Case | TRD and MDD with suicidal ideation | MDD and other depressive disorders || Side Effects | Dissociation, dizziness, increased BP, nausea| Weight gain, sexual dysfunction, insomnia || Monitoring After Dose | Required for 2 hours after administration | Generally no monitoring required post-dose|
Spravato's unique mechanism and rapid onset make it particularly useful for individuals who have not responded to traditional antidepressants and for those facing acute suicidal risks. Traditional antidepressants remain the first-line treatment option for most other depressive disorders [1, 2, 4, 5].
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