Depression can affect nearly every part of daily life, from your energy and motivation to your relationships, work, sleep, and ability to enjoy the things that once mattered to you.
For many people, traditional treatments such as antidepressant medication and therapy can help manage symptoms. But sometimes, even after trying more than one treatment, depression continues.
That experience can be frustrating and discouraging. You may begin wondering why treatment has not worked or whether there are other options available.
When depression has not responded adequately to traditional antidepressant treatments, a healthcare provider may consider additional approaches. One option for some adults with treatment-resistant depression is Spravato® (esketamine).
At Pathway Healthcare, Spravato treatment is available for eligible patients at select locations as part of a personalized approach to behavioral health care.
Understanding Treatment-Resistant Depression
Depression does not respond to treatment the same way for everyone.
Some people find that the first antidepressant they try provides meaningful improvement. Others may need adjustments in dosage, a different medication, therapy, or a combination of approaches.
For some people, symptoms continue despite trying multiple treatments.
Treatment-resistant depression generally refers to depression that has not adequately improved after at least two appropriate antidepressant treatments.
Someone living with treatment-resistant depression may continue experiencing symptoms such as:
- Persistent sadness or feelings of emptiness
- Loss of interest in activities they once enjoyed
- Low energy or motivation
- Difficulty concentrating
- Changes in sleep
- Changes in appetite
- Feelings of hopelessness
- Difficulty keeping up with work or everyday responsibilities
- Withdrawal from friends, family, or activities
The term “treatment-resistant” does not mean that nothing can help. Instead, it can be an indication that it is time to talk with a healthcare provider about whether another treatment approach may be appropriate.
What Is Spravato?
Spravato is the brand name for esketamine, a prescription nasal spray approved by the U.S. Food and Drug Administration for certain adults with depression, including adults with treatment-resistant depression.
Spravato acts on NMDA receptors, which are part of the brain’s glutamate system. The exact way esketamine produces its antidepressant effects is not fully understood.
For adults with treatment-resistant depression, Spravato may be used on its own or with an oral antidepressant based on an individual’s treatment plan and healthcare provider’s recommendations.
Because Spravato has important safety risks that require observation, it is not a medication patients take home.
Treatment is provided in a SPRAVATO REMS-certified healthcare setting, where patients self-administer the nasal spray under the direct observation of a healthcare provider and are monitored during and after treatment.
Who May Benefit From Spravato?
Spravato is not appropriate for everyone, and determining whether it may be an option requires an evaluation with a qualified healthcare provider.
A provider may consider factors such as:
- Your current depression symptoms
- How long you have experienced depression
- Antidepressant medications you have previously tried
- How you responded to previous treatments
- Other medications you currently take
- Your physical and mental health history
- Other health conditions that may affect treatment
- Your overall treatment goals
Spravato may be worth discussing if you are an adult living with major depressive disorder and have tried multiple antidepressant treatments without experiencing enough improvement.
The decision should always be made with a healthcare provider who understands your medical history and individual needs.
What Happens During Spravato Treatment?
Spravato treatment looks different from taking a traditional prescription medication at home.
Patients self-administer Spravato as a nasal spray in a SPRAVATO REMS-certified healthcare setting under the direct observation of a healthcare provider.
Spravato can cause side effects including:
- Sedation or sleepiness
- Dissociation or feeling disconnected from yourself or your surroundings
- Dizziness
- Nausea
- Increased blood pressure
Respiratory depression has also been reported. Because of these risks, patients are monitored by a healthcare provider for at least two hours during each treatment session. Respiratory status is also monitored during treatment, including with pulse oximetry.
Your healthcare provider will determine when you are clinically stable and ready to leave the treatment setting.
Patients should arrange transportation home after treatment and should not drive, operate machinery, or perform activities requiring full alertness until the next day after a restful sleep.
Your healthcare provider will explain what to expect before your first appointment and discuss any instructions you should follow before and after treatment.
How Often Is Spravato Given?
Spravato treatment generally begins with appointments more frequently and may become less frequent over time.
The exact schedule depends on your treatment plan, how you respond, and your provider’s recommendations.
Your care team will continue evaluating your symptoms and overall response throughout treatment.
This ongoing communication is important because mental health treatment is not one-size-fits-all. Your treatment plan may change based on how you are feeling and what your healthcare provider believes is most appropriate.
Spravato Can Be Part of a Larger Mental Health Treatment Plan
Depression treatment is about more than finding the right medication.
Many people benefit from combining different types of behavioral health support.
Depending on your individual needs, your treatment plan at Pathway Healthcare may include services such as:
- Psychiatric evaluations
- Medication management
- Individual therapy
- Intensive Outpatient Programs
- Virtual Intensive Outpatient Programs
- Ongoing psychiatric care
- Spravato treatment for eligible patients at select locations
Having access to multiple behavioral health services allows treatment to be personalized around the person rather than centered around a single medication or approach.
What If Previous Depression Treatments Have Not Worked?
It can be difficult to stay hopeful when you have already tried several treatments.
But your experience with previous medication provides important information that can help your healthcare provider determine what to consider next.
If your symptoms have continued, consider talking with your provider about questions such as:
- Have I given my current treatment enough time?
- Could another medication or treatment approach be appropriate?
- Would therapy or another behavioral health service help support my treatment?
- Could I be experiencing treatment-resistant depression?
- Should I ask about Spravato or other treatment options?
You do not need to determine the answer on your own.
A behavioral health provider can review your history, symptoms, and previous treatment experiences and help you better understand the options available.
There May Be More Options to Explore
When depression continues despite treatment, it can feel like you have already tried everything.
But mental health care continues to evolve, and additional treatment approaches may be available for people who have not experienced enough improvement with traditional antidepressants.
Spravato is one option that may be considered for eligible adults with treatment-resistant depression.
At Pathway Healthcare, our providers work with patients to understand what they have already tried, what symptoms they are still experiencing, and what treatment options may be appropriate moving forward.
If depression has continued despite previous treatment, consider starting a conversation with a healthcare provider about what other options may be available to you.
Verification: Current SPRAVATO REMS materials confirm that treatment-resistant depression may be treated with Spravato as monotherapy or with an oral antidepressant, that treatment occurs in a certified setting under direct provider observation, that patients are monitored for at least two hours, and that patients should not drive until the next day after a restful sleep.
