Intranasal SPRAVATO™ (esketamine)

Intranasal SPRAVATO™ (esketamine) is a prescription nasal spray for treatment-resistant depression in adults.

How Does SPRAVATO™ (esketamine) Work?

SPRAVATO™ (esketamine) targets the N-methyl-D-aspartate (NMDA) receptor found in nerve cells. It is taken in addition to oral antidepressants to help increase levels of neurotransmitters in areas of the brain that impact mood.

What Should You Expect During a SPRAVATO™ (esketamine) Treatment?

SPRAVATO™ (esketamine) is administered under the supervision of a healthcare provider in a healthcare setting. A healthcare provider monitors a patient for at least two hours after a SPRAVATO™ (esketamine) treatment is performed, then determines when a patient is ready to leave a healthcare setting. Patients need to be driven home from each SPRAVATO™ (esketamine) treatment and are not cleared to operate heavy machinery or resume daily activities until one full day after each treatment.

SPRAVATO™ (esketamine) is taken twice a week for the first four weeks. Following the initial four weeks, SPRAVATO™ (esketamine) is taken once a week for one month. Afterwards, SPRAVATO™ (esketamine) is typically used either once a week or once every two weeks or longer.

Is SPRAVATO™ (esketamine) Effective?

The effectiveness of SPRAVATO™ (esketamine) nasal spray has been studied in both short- and long-term clinical trials of adults diagnosed with treatment-resistant depression. Studies of adults dealing with treatment-resistant depression who used SPRAVATO™ (esketamine) and a daily oral antidepressant revealed a greater reduction in depression symptoms at four weeks, in comparison to adults who received a placebo and an oral antidepressant. In addition, after 16 weeks of therapy, patients who continued to receive SPRAVATO™ (esketamine) while taking an oral antidepressant did better than those who stopped therapy.

Is SPRAVATO™ (esketamine) Safe?

Across short- and long-term clinical studies of SPRAVATO™ (esketamine) nasal spray, discontinuation rates due to adverse reactions were less than 5%. Adverse reactions reported in these studies included dissociation, elevated blood pressure, and sedation.

Dissociation is the most common psychological effect of SPRAVATO™ (esketamine), which refers to dissociative/perceptual changes like distortion of time and space, illusions, derealization, and depersonalization. In a demonstrated safety profile, dissociation was reported in approximately 41% of patients treated with SPRAVATO™ (esketamine) at any dose. Also, when evaluated on the Clinician-Administered Dissociative States Scale (CADSS), 61% to 75% of patients treated with SPRAVATO™(esketamine) reported dissociative or perceptual changes.

In short-term studies, elevated blood pressure was recorded in 10% of patients who used SPRAVATO™ (esketamine) with an oral antidepressant. SPRAVATO™ (esketamine) has also been shown to cause an increase in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP), which reach their peak level at approximately 40 minutes after the nasal spray is administered.

In clinical trials, 49% to 61% of patients treated with SPRAVATO™ (esketamine) experienced sedation, and 0.3% experienced loss of consciousness.

A long-term study is currently underway to evaluate the safety and tolerability of SPRAVATO™ (esketamine) to help patients dealing with treatment-resistant depression. The study began June 9, 2016, and its estimated completion date is March 31, 2022.

Can SPRAVATO™ (esketamine) Be Used with TMS?

SPRAVATO™ (esketamine) can be used to stabilize a patient prior to transcranial magnetic stimulation (TMS) treatment. In this case, the patient may be treated with SPRAVATO™ (esketamine) for about a month, after which he or she would receive TMS treatment.

Although there are currently no double-blind trials , based on the understanding of psychopharmacology and neuromodulation, it is expected that these two services can be used in a serial fashion with appropriate monitoring for side effects.


Schedule a TMS Treatment Consultation

 To learn more about TMS or to schedule a consultation, please contact us online, or call or text us today at 877-247-0101.

Within California, Oregon, and Alaska, Transcranial Magnetic Stimulation has been approved for use with treatment resistant depression by several insurance providers. Insurances that we’re in network with include Cigna, Anthem Blue Cross, Magellan, Tricare, Blue Shield of CA, Blue Shield Federal Employee, Optum, Aetna, MHN, Healthnet, Beacon, Prime Health Services, Provider Select, Medicare, Providence Preferred, Providence Health Plan, Regence Blue Cross Blue Shield, First Choice Health Network, First Health National Network, Pacificsource, Moda, OHA (fee for service only), First Health, and Premera Blue Cross. Please call us for a full list of providers. We would be happy to help check with your insurance regarding pre-approval.

*Unfortunately, Medi-cal currently does not cover TMS treatment in California. Please contact your Medi-cal provider to inquire further.


Depression treatment - TMS Society