As many as 40% of people with depression can find no relief for their condition.
“These are patients who experience feelings of hopelessness, helplessness and worthlessness,” said Olivia Patterson, PMHNP-BC, psychiatric mental health nurse practitioner, Blessing Health System. “They’ve tried multiple conventional antidepressants and experienced no relief.”
For patients with this condition, known as Treatment-Resistant Depression (TRD), a new option is available through Blessing’s Outpatient Behavioral Health Services. It is a nasal spray that goes by the generic name of esketamine and the brand name of Spravato.
Ketamine is a drug that has been used for many years to treat depression. Esketamine is a form of ketamine that recently earned FDA approval specifically as a nasal spray for use with TRD.
“Spravato works in combination with an oral antidepressant,” Patterson explained.
Conventional oral antidepressants can take several weeks to begin relieving symptoms. Spravato impacts brain cells much more quickly, with the goal of boosting the effectiveness of the oral antidepressant.
“Studies show an average timeframe of 4 hours to 28 days for symptom improvement with Spravato,” Patterson said.
She added that some Blessing patients who take Spravato have reported significant decreases in the severity of their symptoms. Blessing began offering Spravato in January of this year.
Spravato starts as a two-times-a-week treatment, delivered in Blessing’s outpatient behavioral clinic where the patient is monitored for two hours after taking the medication. Based on the level of success of the treatment, the patient receives fewer doses over time, with the goal of reaching the maintenance phase of one dose every three months.
“There are people who do really well on Spravato and can eventually come off of it all together and stay in remission from depression,” Patterson said.
Spravato is not appropriate for pregnant women and can be used only for people with a diagnosis of TRD, meaning the patient has had no documented symptom improvement after taking at least two conventional antidepressants. Conditions including bipolar disorder and schizophrenia do not qualify for Spravato.
Patients with treatment resistant depression may ask their provider if a referral to Blessing Outpatient Behavioral Health Services is appropriate for them, to see if they qualify for Spravato treatment.