What is the use of Spravato (esketamine)?

From the Guidelines

Spravato (esketamine) should be used as an adjunctive treatment for treatment-resistant depression (TRD) and major depressive disorder (MDD) with acute suicidal ideation or behavior, administered at 56-84mg twice weekly for the first month, then weekly for month two, and weekly or biweekly thereafter based on response, as evidenced by a meta-analysis of 5 RCTs 1. The use of Spravato (esketamine) is supported by recent clinical practice guidelines, which recommend it as an adjunctive treatment for short-term reduction in suicidal ideation in patients with suicidal ideation and MDD 1. Key points to consider when using Spravato (esketamine) include:

• Administration in a certified healthcare setting under supervision due to potential side effects including dissociation, dizziness, sedation, and blood pressure increases 1
• Monitoring for at least two hours after administration and patients cannot drive on treatment days 1
• Typical use alongside an oral antidepressant for optimal results 1
• Potential for faster relief compared to traditional antidepressants, targeting the NMDA receptor and glutamate system 1
• Importance of discussing complete medical history with the doctor before starting, as certain conditions like aneurysms or severe cardiovascular disease may preclude its use 1

From the FDA Drug Label

SPRAVATO is indicated for the treatment of: Treatment-resistant depression (TRD) in adults as monotherapy or in conjunction with an oral antidepressant Depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior in conjunction with an oral antidepressant

The use of Spravato (esketamine) is for the treatment of:

• Treatment-resistant depression (TRD) in adults, as monotherapy or in conjunction with an oral antidepressant
• Depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior, in conjunction with an oral antidepressant 2

From the Research

Use of Spravato (Esketamine)

• Spravato (esketamine) is used for the treatment of depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior 3, 4, 5.
• It is also used for the treatment of treatment-resistant depression (TRD) in conjunction with an oral antidepressant 4, 6.
• Esketamine has been shown to rapidly reduce depressive symptoms in patients with major depressive disorder who have acute suicidal ideation or behavior, especially in those with a history of suicide attempt 3.
• The use of esketamine has been associated with common adverse events such as dizziness, dissociation, nausea, somnolence, and headache 3.

Efficacy and Safety

• Studies have demonstrated that adjunctive intranasal esketamine treatment is safe and effective in decreasing depressive symptoms in patients with major depressive disorder 7.
• Esketamine has been shown to have a favorable risk-to-benefit profile, with demonstrated efficacy in reducing depressive symptoms more rapidly than monotherapy with traditional oral antidepressants 6.
• The efficacy and safety of esketamine have been evaluated in several clinical trials, with results indicating that it is a rapidly effective treatment for individuals with treatment-resistant depression, suicidal ideation, and suicidal behavior 7, 5.

Administration and Monitoring

• Esketamine is self-administered under the supervision of a healthcare provider and is used as an adjunct to oral antidepressant therapy 6.
• Patients are supervised for 2 hours after self-administering the medication to monitor for sedation, dizziness, dissociation reactions, and increased blood pressure 6.