Spravato Esketamine Nasal Spray for Hard-to-Treatment Resistant
                     What is Esketamine?
Esketamine is made from a drug called ketamine, an anesthetic that 
has also  been used for many years to treat depression. But it wasn't 
until recently that  esketamine, a more potent version of ketamine, 
gained FDA approval specifically  for use as a nasal spray for people 
with treatment-resistant depression.
“Esketamine is derived from a part of the ketamine molecule,” says 
Kaplin, who  has studied the drug for three years. “Because it is more 
potent, it can be used in  lower doses and, in theory, has fewer side 
effects. Now that it is available in an  intranasal version and approved 
by the FDA, insurance companies are more  likely to cover the 
treatment.
What is Esketamine Treatment Like?
Esketamine, like ketamine, has the potential to distort perception 
during the first  two hours after treatment, so it should be 
administered in a clinical setting.
Treatment for esketamine nasal spray is performed on an outpatient 
basis.
With the nasal spray of the spravato treatment center, you give 
yourself three  doses, five minutes apart, under medical supervision. 
You remain in the clinic  under medical observation until any possible 
side effects have passed.
Esketamine should be used together with a conventional 
antidepressant.  Esketamine is intended to provide quick relief from 
depression symptoms until  the other medication takes effect.
Treatments for depression, antidepressants and esketamine nasal spray
The nerve endings work like car battery cables and transmit electricity 
through a  chemical substance. However, instead of battery acid, 
nerve endings rely on  compounds known as neurotransmitters. The 
medical community refers to the  composition of the brain's 
neurotransmitters as brain chemistry.
Three main neurotransmitters regulate mood and emotional 
response in the  brain:
● Serotonin, a chemical that regulates emotions such as anxiety, 
happiness,  and general mood.
● Dopamine, a feel-good chemical that rewards the brain for 
actions such as  running (runner's high) or eating.
● Norepinephrine, a chemical that affects energy and concentration 
levels  (high levels of this neurotransmitter can cause euphoria 
and an increase in  blood pressure)
People suffering from depression may have an imbalance of these 
chemicals,  which explains the symptoms they experience. 
Antidepressants work to correct  the imbalance and improve the 
brain's ability to regulate mood and emotions.
Unfortunately, antidepressant medications don't work for everyone.
This is where less conventional treatments like esketamine come 
into play.  Esketamine works by increasing glutamate, a fourth type 
of neurotransmitter.  Glutamate regulates learning and memory, 
meaning the brain needs it and  produces it in large quantities. An 
increase in glutamate causes an increase in  neuronal activity, which 
intensifies the symptoms of depression.
How Mental Health Professionals Administer Esketamine Nasal Spray 
 Treatment
Treatment with Spravato® is performed under the medical supervision 
of a doctor  or mental health professional. This way, the patient can 
count on someone with  medical training to deal with possible side 
effects of the medication.
The treatment is simple and all the patient needs to do is use one 
dose of the  nasal spray every five minutes. Most patients will need 
three doses of the spray  in a single treatment.
Benefits of Spravato® Nasal Spray Treatment
Esketamine nasal spray treatments, such as Spravato®, are effective 
and
fast-acting. This therapy improves the patient's mood regulation while 
the patient  seeks long-term treatment for depression. Positive effects 
of treatment may  include an increase in glutamate levels, which leads 
to the creation of new neural  pathways, leading to increased brain 
activity. This, in turn, leads to an increase in  the production and release 
of beneficial neurotransmitters. This results in a  considerable 
improvement in brain function and mood regulation.
In other words, treatment addresses many of the symptoms that 
accompany  depression. Esketamine may also decrease the 
frequency of suicidal thoughts,  which helps with major depression.
Who is a good candidate for esketamine therapy?
Esketamine is currently approved for people with treatment-resistant 
depression.  That means you've tried at least two other 
antidepressants (for at least six weeks  each) and haven't experienced 
a remission or at least a 50% improvement in  your mood.
For people who haven't had success with other antidepressants, 
esketamine  gives them a chance to see what it's like to not have 
depression,” Kaplin says. “It  gives them hope that they can feel better 
with the right treatment.
It is effective for treatment-resistant depression
Up to 33% of people with depression do not respond to multiple 
types of  conventional antidepressants. Esketamine reduced 
symptoms of depression in  the majority of these people in clinical 
trials.
The only other approved drug therapy for treatment-resistant 
depression is a  combination of olanzapine (an antipsychotic drug) and 
fluoxetine (a conventional  antidepressant). However, this treatment 
has significant long-term effects  including substantial weight gain, 
metabolic changes, diabetes, and high blood  pressure.
What are the common side effects of Spravato?
In clinical trials, these side effects occurred in more than 5% of 
people taking  Spravato:
● Feeling disconnected from thoughts and feelings 
(dissociation)
● Dizziness
● Spinning sensation
● Feeling tired, lethargic, or drunk
● Blood pressure higher than normal
● Nausea and vomiting
● Numbness
● Anxiety
The bottom line
Spravato is an Esketamine nasal spray. It may help with difficult-to-treat  
depression in adults when used in combination with an oral 
antidepressant.  However, it has a series of risks and side effects that 
must be taken into account.  Due to these risks, the medication can 
only be taken through the SPRAVATO  REMS program. If you have 
questions or concerns about Spravato, be sure to  talk to your 
healthcare provider.