Information about Spravato® – Esketamine nasal spray for depression
With Spravato® (esketamine, which is a form of ketamine), a new drug for the treatment of certain forms of depression has also been available in Germany since March 1, 2021, having already been approved by the European Commission in December 2019. It is a drug developed in the form of a nasal spray that is already available in the US since March 2019.
At OVID Clinic Berlin, we see the biological, pharmacological effect of the drug ketamine, but we are convinced that deep and long-term healing cannot be achieved without a combination with psychotherapeutic methods. That is why we administer ketamine intravenously and embed the pharmacological treatment in a psychotherapeutic process.
Our attitude to Spravato® Nasal Spray
Our treatment concept differs significantly from treatment with ketamine nasal spray. We do not only want to relieve symptoms and use the pharmacological mechanism of action of the substance. Instead, we rely on what our patients experience during ketamine administration. Instead, we rely on the experiences that our patients have during the administration of ketamine. We thus combine pharmacological mechanisms of action with findings from psychedelic psychotherapy, in which altered states of consciousness are used to intensify pyschotherapeutic processes.
Dosage form and dosage of Spravato®
The BfArM has published a guideline for safe use for patients. After that, each trigger spray gives a total of 2 sprays. Depending on the prescribed dose, a patient receives 1, 2 or 3 sprays. Between the application of individual sprays should be 5 minutes break.
In treatment weeks 1-4, Spravato® is used twice a week. The initial dose is 56 mg of esketamine (2 sprays). Thereafter, the dose is either 56 mg or 84 mg of esketamine. During treatment weeks 5-8, Spravato is used only once weekly at a dose of 56 mg or 84 mg. Starting at treatment week 9, Spravato is used only every two weeks or once weekly (depending on response) at a dose of 56 mg or 84 mg.
Effect of Spravato® against depression
The mechanism of action leading to the antidepressant effect of esketamine is largely unclear. The antidepressant effect of esketamine is thought to be mediated via antagonism at the N-methyl-D-aspartate receptor (NMDA-R), which causes a transient increase in glutamate release. This causes increased stimulation of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPA receptor) and subsequently increased neurotrophin-induced signal transduction. This mechanism may contribute to the restoration of synaptic functions in brain regions responsible for mood and emotion regulation. Recent research indicates that the antidepressant effect is caused by the metabolite (2S,6S;2R,6R)-hydroxynorketamine (HNK) via activation of the AMPA receptor.
So what is “new” about Spravato®?
Spravato® is a chemically refined form of ketamine and is not new per se: the chemical structure of ketamine can be divided into two enantiomers – known as S-ketamine (esketamine) – the levorotatory form of the molecule – and R-ketamine (arketamine) – the dextrorotatory version. A bottle of generic ketamine is a “mixed” (or racemic) solution containing a mixture of S- and R-ketamine. This preparation can be found in hospitals and ketamine clinics around the world. The Janssen Company has succeeded with Spravato® in isolating only S-ketamine by filtering the racemic molecule and discarding the R-enantiomer. And this left-handed solution (S-ketamine) is the only ketamine formulation currently approved for the treatment of treatment-resistant depression. So the substance is not generally new – just “chemically adapted,” so to speak.
Published on 06.04.2022
Overview over Spravato® nasal spray for depression
With Spravato® (esketamine, which is a form of ketamine), a new drug for the treatment of certain forms of depression has also been available in Germany since March 1, 2021, having already been approved by the European Commission in December 2019. It is a drug developed in the form of a nasal spray that is already available in the US since March 2019.
First of all, it is useful to take a closer look at the conditions of admission:
- The nasal spray should be used only under direct supervision of healthcare professionals to prevent possible misuse.
- The drug may only be used in addition to treatment with an SSRI or SNRI, i.e., during ongoing therapy with a modern antidepressant.
- It is limited to the treatment of adult patients with the following disorders:
- A moderate to severe depressive episode that is resistant to treatment (known as treatment-resistant depression,or TRD for short). TRD occurs when patients have failed to respond to at least two different antidepressant drug therapies during the current moderate-to-severe depressive episode. The definition is independent of any psychotherapeutic treatment carried out.
- As an acute and especially rapid short-term treatment for a psychiatric emergency.
