Spravato
Approximately one-third of patients with major depressive disorder (MDD) do not achieve an antidepressant response despite treatment with multiple antidepressants and are considered to have treatment-resistant depression (TRD).
Patients with TRD have higher rates of relapse (~70% within 6 months that respond to treatment) and higher suicide rates, compared to patients with MDD who are not treatment resistant.
Mechanism of Action
Spravato (esketamine) differs from other treatments for depression due to its unique mechanism of action and delivery method. Administered as a nasal spray, Spravato works by targeting the NMDA receptors in the brain.
When introduced to the body, esketamine acts as a potent agent that increases the amount of glutamate between neurons, which then activates connections in the AMPA receptor. As a result, new neuronal growth and communication pathways are fostered, creating and reconfiguring the brain’s neuron firing patterns, making the transformation of negative thoughts possible. According to clinical trials, many patients begin experiencing significant improvement in their depressive symptoms after four weeks of treatment.
Dosing Information
- For depressive symptoms in patients with major depressivedisorder (MDD) with suicidal ideation or behavior:
- Adults: 84 milligrams (mg) 2 times per week for 4 weeks
- For treatment-resistant depression (TRD): Adults starting dose is 56 milligrams (mg) on Day 1, followed by 56 or 84 mg taken 2 times per week for 4 weeks
- Introduction phase (weeks 1-4): Twice weekly for 4 weeks
- Optimization phase: (weeks 5-8) Once weekly for 4 weeks
- Maintenance phase: (weeks 9+) Once every 2 weeks, ongoing maintenance phase: Once every 2-4 weeks if the patient's mood is stable
Provider follow up
(Spravato follow up #) 4 weeks post induction; repeat baseline metrics determine optimization dose 56-84mg weekly
(Spravato follow up #2) 8 weeks post induction; repeat baseline metrics to determine maintenance dose 56-84mg monthly or bimonthly
(Spravato follow up #3) 16 weeks post induction. Repeat baseline metrics. Follow up minimum every 2-3 months going forward
