Spravato (esketamine) typically begins showing effects within hours to days of the first treatment, with some patients experiencing mood improvements within 24 hours. However, the full therapeutic benefits usually develop gradually over 4 to 8 weeks of consistent therapy during what’s called the induction phase. Most people notice meaningful reductions in depression symptoms after four sessions (two weeks of twice-weekly treatment). However, individual responses vary significantly based on the severity of symptoms and personal brain chemistry.
How Does Spravato Work? A Comprehensive Guide
Spravato (esketamine) typically begins showing effects within hours to days of the first treatment, with some patients experiencing mood improvements within 24 hours. However, the full therapeutic benefits usually develop gradually over 4 to 8 weeks of consistent therapy during what’s called the induction phase. Most people notice meaningful reductions in depression symptoms after four sessions (two weeks of twice-weekly treatment). However, individual responses vary significantly based on the severity of symptoms and personal brain chemistry.
Spravato represents a paradigm shift in how we approach depression treatment. Approved by the FDA in 2019, this medication offers something different from the antidepressants that have dominated psychiatric care for decades. What makes Spravato unique is both its active ingredient and its method of delivery, which together create a treatment option that works faster and differently than anything previously available.
The medication contains esketamine, a derivative of ketamine that has been studied extensively for its rapid antidepressant effects. Unlike pills that patients take home and use independently, Spravato requires administration in a healthcare setting under medical supervision, reflecting both its potency and the care required to ensure patient safety.
Spravato is delivered as an esketamine nasal spray, making it the first and only FDA-approved nasal spray medication specifically designed to treat depression. The nasal spray format serves multiple purposes beyond convenience. This delivery method allows the medication to be absorbed quickly through the nasal membranes, enabling it to reach the brain faster than oral medications that must pass through the digestive system.
During a treatment session, patients self-administer the spray under healthcare provider supervision. The typical protocol involves using the device to spray the medication into each nostril, with patients waiting several minutes between doses to ensure proper absorption. This process takes only a few minutes, but patients must remain at the healthcare facility for at least two hours afterward for monitoring.
Spravato is specifically indicated for treatment-resistant depression, a term that describes cases where patients have tried at least two different antidepressants without achieving adequate improvement. This condition affects approximately one-third of people with major depressive disorder, representing millions of individuals who cycle through various medications, often losing hope as each new treatment fails to provide relief.
What makes Spravato an innovative treatment is its entirely different mechanism of action compared to conventional antidepressants. Most traditional medications work by increasing levels of serotonin, norepinephrine, or dopamine in the brain. These approaches can take weeks or even months to show benefits, and they simply don’t work for everyone.
Spravato takes a fundamentally different approach by targeting the brain’s glutamate system. Glutamate is the most abundant neurotransmitter in the nervous system and plays a crucial role in neural communication, learning, and memory. By modulating glutamate activity, esketamine can rapidly influence brain circuits involved in mood regulation, potentially explaining why it can work when other treatments have failed.
To understand how Spravato works to treat depression, we need to explore its effects at the cellular level. Esketamine acts as an NMDA receptor antagonist, meaning it blocks a specific type of glutamate receptor in the brain. This blocking action triggers a cascade of events that researchers believe lead to its antidepressant effects.
When esketamine blocks NMDA receptors, it causes a surge in glutamate signaling through other pathways. This surge activates AMPA receptors, another type of glutamate receptor, which triggers the release of brain-derived neurotrophic factor (BDNF). BDNF is like fertilizer for the brain, promoting the growth and strengthening of neural connections that may have weakened in depression.
Studies have shown that depression is associated with reduced connectivity between certain brain regions and even the shrinkage of specific brain structures. The rapid increase in BDNF triggered by esketamine may help restore these connections and promote neuroplasticity, the brain’s ability to form new neural pathways. This regenerative effect could explain why some patients experience improvements in mood and cognitive function relatively quickly.
One of the most remarkable aspects of Spravato is its potential to provide rapid relief from depression symptoms. While traditional antidepressants typically require four to six weeks before patients notice improvements, some individuals using Spravato report feeling better within hours or days of their first treatment.
This rapid onset is particularly important for people experiencing severe depression symptoms that significantly impair their daily functioning. The ability to think more clearly, feel more motivated, and experience improved mood relatively quickly can be life-changing for someone who has struggled for months or years with persistent symptoms.
Clinical trials have demonstrated that Spravato can help reduce various depression symptoms, including persistent sadness, loss of interest in activities, difficulty concentrating, changes in appetite, sleep disturbances, and feelings of worthlessness. The speed at which these improvements occur sets Spravato apart from other treatment options and offers hope to those who need relief urgently.
Perhaps one of the most critical applications of Spravato is its use in individuals experiencing suicidal thoughts. The FDA has approved Spravato specifically for treating depressive symptoms in adults with major depressive disorder who are experiencing acute suicidal ideation or behavior.
The rapid action of esketamine is particularly valuable in these emergency situations. When someone is experiencing active suicidal thoughts, waiting weeks for a conventional antidepressant to take effect is not a viable option. Spravato can help reduce these dangerous thoughts more quickly, potentially saving lives while longer-term treatments take effect.
The differences between Spravato and traditional antidepressants extend beyond their mechanisms of action. Conventional antidepressants like SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) have been the cornerstone of depression treatment for decades. These medications work by gradually increasing the availability of certain neurotransmitters in the brain, a process that explains their delayed onset of action.
Traditional antidepressants are typically taken daily as pills, allowing patients to manage their treatment independently at home. They’re generally well-tolerated and have established safety profiles based on decades of use. However, their effectiveness varies considerably, and many patients must try several different medications before finding one that works.
Spravato is not intended to replace traditional antidepressants but rather to complement them. In fact, it’s prescribed separately or alongside an oral antidepressant, combining the rapid effects of esketamine with the sustained benefits of conventional medications. This dual approach offers a comprehensive treatment strategy that addresses both immediate relief and long-term management.
Like all medications, Spravato comes with potential side effects that patients and healthcare providers must consider carefully. The most common side effects include dissociation (feeling detached from reality), dizziness, nausea, sedation, increased blood pressure, and anxiety. These effects typically occur shortly after administration and generally resolve within a few hours.
The dissociative effects, while usually temporary, are one reason why Spravato must be administered under medical supervision. Patients cannot drive or operate heavy machinery for the remainder of the day after treatment. The medication also carries a risk of abuse and misuse due to its relationship to ketamine, which is why it’s only available through a restricted distribution system with specific safety requirements.
Healthcare providers monitor blood pressure before and after each treatment session, as esketamine can cause temporary increases that may be dangerous for people with uncontrolled hypertension or cardiovascular disease. Long-term safety data continues to accumulate, helping doctors better understand the risk-benefit profile of extended treatment.
Many patients with depression wonder, “How does Spravato work? Finding an answer to this common question is essential for anyone considering this innovative treatment for mental illness. By targeting specific pathways in the brain, Spravato helps restore connections between brain cells, offering rapid relief where other therapies may have failed. Because Spravato is a prescription medicine, it must be administered under the supervision of a healthcare professional, who will conduct a thorough risk evaluation and review your treatment history before starting therapy. Monitoring for side effects, such as high blood pressure, is an important part of the process. With a personalized treatment plan, Spravato can be integrated into your broader approach to mental healthcare, providing a safe and effective option for those struggling with depression.
