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How Long Will I Stay on SPRAVATO® for Depression?
2022-08-08T21:58:40Z
Medically reviewed on by
Regional Medical Director Greater St. Louis
When you’re just starting out with any new antidepressant or therapy, you may wonder how long you’ll need to stick with it. A couple of months? A year? The rest of your life? If you’ve been approved to begin SPRAVATO® treatments for depression, these questions may be at the front of your mind. After all, the FDA approved SPRAVATO® for treatment-resistant depression (TRD) in 2019, followed by approval for major depressive disorder with suicidal ideation or behavior (MDSI) in 2020. This means that most people haven’t taken SPRAVATO® treatments for much longer than a year or two.
The good news is that long-term studies conducted in the mid-2010s give us clues to help understand the safety and efficacy of SPRAVATO® duration beyond the initial treatment period, which can help us understand how long SPRAVATO® depression treatment can last.
What is SPRAVATO® Treatment and How Did it Start?
SPRAVATO® is the brand name for esketamine nasal spray, a ketamine-derived depression treatment. A dissociative anesthetic, ketamine has been delivered through an IV as an off-label mental health treatment since the early 2000s. The drug is a mixture of (S)-ketamine and (R)-ketamine, which are mirror-image molecules. (S)-ketamine, or esketamine, is more potent at lower doses than ketamine.
Ketamine seemed to help depression patients improve at a much faster rate than oral antidepressants. It prompted researchers at the beginning of the 21st century to study whether esketamine could produce the same benefits as ketamine.
Phase I clinical trials began in 2014, followed quickly by Phase II trials from 2014 to 2016. These trials focused on making sure that esketamine nasal spray was safe for adults to take. Phase III trials began in 2015 and continued for at least one year but usually more. These studies focused on testing both the safety and efficacy of esketamine nasal spray in patients with TRD and MDSI.
Most trials were completed by 2018, paving the way for the 2019 FDA approval, but at least one trial is ongoing. Begun in 2016,
A Long-term Safety Study of Esketamine Nasal Spray in Treatment-resistant Depression (SUSTAIN-3) aims to determine the long-term safety and tolerability of nasal esketamine for depression. The study is slated to end in December of 2022, with results available sometime after that. In other words, as of 2022, some patients had been taking SPRAVATO® treatments for about five years.
Researchers believe that esketamine nasal spray acts on two of the most abundant neurotransmitters in the central nervous system: glutamate and gamma-aminobutyric acid (GABA). This helps facilitate rapid neuroplasticity, which is believed to be how the medicine helps depression.
When combined with oral antidepressants that increase the levels of monoamine neurotransmitters like serotonin, dopamine, and norepinephrine, SPRAVATO® treatments may help you feel rapid relief from symptoms and help sustain this remission from depression. Learn more about
SPRAVATO® and what your treatments can look like.
How Long Do You Have to Stay on SPRAVATO®?
It depends. At Greenbrook’s SPRAVATO® REMS-certified treatment centers, patients who have found success with SPRAVATO® often choose to take it indefinitely after the initial treatment period. During the first four weeks of treatment, you’ll come in twice a week to self-administer your SPRAVATO® treatment dose and stay for the mandatory two-hour observation period.
During the second four weeks, most patients take SPRAVATO® once a week. After that, treatment can continue for as long as you need it. Some of our patients keep taking SPRAVATO® once weekly. Others come in once every two weeks. Some patients only come in for maintenance doses when they notice that their depression symptoms seem to be returning. Before every single dose, you’ll fill out a depression scale to help your provider monitor how well the medication is working.
Ultimately, the goal is for you to take SPRAVATO® as infrequently as possible while also maintaining remission from depression. You and your Greenbrook provider will communicate often, working together to create a treatment plan that fits your needs. Find out more in a
nasal eksetamine spray consultation with Greenbrook.
How Your Health Affects SPRAVATO® Duration?
The amount of time you stay on SPRAVATO® will also depend on your health. If you decide to plan on becoming pregnant, or you become pregnant during SPRAVATO® treatment, tell your provider right away. Like many other antidepressant medications, SPRAVATO® can cause pregnancy complications. However, it’s still important to make sure your mental health needs are taken care of, including during pregnancy. Talk to your primary care provider or OB/GYN for support, and keep in mind that SPRAVATO® should not be taken if you are breastfeeding or planning to breastfeed.
Other medical conditions can also impact SPRAVATO® duration. If you have any major changes in your health, communicate with your provider as soon as possible. They can give you guidance on whether or not you’ll need to discontinue SPRAVATO®.
Schedule a Consultation at Greenbrook
Our SPRAVATO® REMS-certified clinics are a comfortable and relaxing setting for your ketamine-based treatment for depression. We provide private rooms or bays for your treatment sessions yet can accommodate multiple patients at once, meaning you won’t experience delays in treatment. Your Greenbrook Care Team will attend to your needs from the beginning to the end of each session.
We also provide TMS therapy should you prefer a medication-free option with fewer side effects.
Schedule a free consultation with one of our Patient Consultants to learn more about how we can help lift the fog of depression.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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