Southwest Florida's Health and Wellness Magazine Health and Wellness Articles
By Steven Stein, MD – Board-certified Psychiatrist
Depression affects millions of people world-wide, with a significant number experiencing treatment-resistant depression (TRD) that doesn’t respond to traditional therapies. However, an exciting breakthrough treatment modality known as intranasal esketamine, marketed as Spravato®, has emerged as a promising option for patients battling TRD. This article explores the concept of treatment-resistant depression, its impact on patients’ lives, and the effectiveness of intranasal esketamine in providing new hope and relief to those who have not responded to conventional treatments.
Understanding Treatment-Resistant Depression
Treatment-resistant depression is a condition where one has continuous depression despite multiple attempts at treating the disorder with antidepressant medications, procedures and/or psychotherapies. Approximately 30% of people diagnosed with depression are considered treatment-resistant. TRD can have devastating effects on practically all aspects of one’s life, including mental and physical health, job performance, relationships and more. This condition affects far too many of us and our overall quality of life, but there is a new and exciting FDA-approved treatment now available.
The Rise of Intranasal Esketamine
Esketamine was approved in March of 2019 and is the first new therapy indicated for TRD in over 30 years. In the few years since, intranasal esketamine, marketed under the brand name Spravato®, has gained recognition as an innovative, safe and effective treatment option for TRD. Esketamine is a derivative of ketamine, an anesthetic, and has shown rapid-acting antidepressant effects in several studies in recent years. Spravato® has been approved by the U.S. Food and Drug Administration (FDA) for use in conjunction with an oral antidepressant for patients with TRD, is covered by most insurance providers, and can offer long-lasting symptom relief. Unlike some procedures that are more invasive or may require additional anesthesia or needles, esketamine is delivered under the supervision of a healthcare provider at a certified treatment center as a nasal spray (also referred to as intranasal).
The Evidence and Efficacy of Intranasal Esketamine
To obtain FDA approval, investigators conducted a phase 3, multicenter, double-blind withdrawal study involving 297 patients who achieved stable remission or response after 16 weeks of esketamine (56 or 84 mg), plus oral antidepressant treatment. Of the people suffering from treatment-resistant depression involved in the study, almost 70% achieved a response to esketamine plus an oral antidepressant after 4 weeks of use. Over 50% of these people had a full remission after the first 4 weeks. This therapy has also been shown to decrease the risk of depression returning by >50%. Most of the commonly used antidepressants treat depression by increasing levels of the neurotransmitters serotonin, norepinephrine, and/or dopamine in certain areas of the brain. Esketamine instead works on the brain’s glutamate system by targeting the N-methyl-D-aspartate receptor. It is characterized by its fast-acting benefits due to restoring patients’ synaptic connections between neurons. This is a unique mechanism of action of that differs from traditional antidepressants. This distinct approach allows for faster symptom relief, often within hours or days.
Safety and Considerations
Spravato is not for everyone, so to best determine if a person can safely receive this therapy, they must first be evaluated by a REMS-certified healthcare provider. This initial consultation should also provide a full list of risks, benefits, contraindications, typical and serious side effects, alternative treatments and allow for the time and space for any additional questions. Once a determination has been made that a person is a good and safe candidate to receive this therapy, studies have indicated intranasal esketamine has a favorable safety profile. Common side effects such as dissociations and dizziness, are typically transient and resolve shortly after treatment. Clinicians closely monitor patients during and after each session to ensure their well-being.
The availability of intranasal esketamine as a treatment option offers new hope to individuals struggling with TRD. It provides an alternative to those who have not responded to other treatments and the hope of depression relief. However, it is important to note that esketamine treatment requires close medical supervision and must be administered in a healthcare setting.
Treatment-resistant depression can be a debilitating condition, but intranasal esketamine, marketed as Spravato®, has emerged as a promising treatment modality with the potential to provide rapid relief from depressive symptoms, even in individuals who have not responded to traditional therapies. While further research is needed to fully understand the exact way it works and its long-term effects, esketamine offers hope for patients grappling with TRD, providing an opportunity for improved wellness, mental health and a better quality of life.
Steven Stein, MD
I am a board-certified general psychiatrist who works with adolescents, adults, and geriatric patients. I specialize in the evaluation and treatment of a wide array of psychiatric conditions including depressive and mood disorders, anxiety and panic disorders, ADHD, OCD, PTSD, personality disorders, and bipolar and schizophrenia spectrum illnesses. My clinic provides comprehensive care with a patient-centered approach and concentration on psychopharmacological interventions, while implementing supportive and motivational psychotherapies. All my staff are highly qualified, professional and courteous.
I am originally from the Tampa Bay, FL area where I completed my undergraduate and master’s degrees at the University of South Florida. I attended medical school at Ross University School of Medicine and completed my psychiatric residency training at Tulane University School of Medicine.
I am based in Sarasota, FL and see local patients in person or virtually. I also accept patients virtually throughout the state of Florida. Outside of TTMC, I continue to treat patients in the hospital setting. I believe that stable mental health is a fundamental cornerstone of achieving overall optimal health, vitality, satisfaction, success and purpose.
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