Early in 2019, the FDA approved SpravatoTM, a fast-acting esketamine nasal spray, giving many individuals who suffer from treatment resistant depression delaware (TRD) or any serious depressive disorder that hasn’t improved with conventional antidepressants unexpected hope.

Let’s examine the mechanism of action of Spravato nasal spray. Typical treatment plan and the variables that influence the appropriate dosage for you.

Esketamine Actions 

Esketamine is related to ketamine, a popular anaesthetic with FDA approval that is frequently used off-label to treat chronic depression. Arketamine (“R” ketamine) and esketamine (“S” ketamine), two mirror-image molecules that make up ketamine, are administered as an intravenous (IV) infusion.

Greater potency translates to Spravato being more effective at lower doses and being less prone to negative side effects like sedation and dissociation (fuzzy thinking).

By attaching NMDA receptors to your brain, esketamine quickly activates and transmits glutamate, one of the primary neurotransmitters that affects your mood and directs your behaviour. This gives quick and long-lasting symptom alleviation.

The process by which traditional antidepressants promote glutamate transmission in your brain is slower and meandering. They revive mood-enhancing monoamine neurotransmitters that have been dormant in your body for several weeks (i.e. serotonin). Your NMDA receptors are what these monoamines attach to in order to stimulate glutamate transmission and elevate your mood.

Esketamine Protocol  

Under the direction and supervision of a licensed medical professional, esketamine treatment continues. You must have a history of TRD and have tried at least two conventional antidepressants. 

Following approval, you take an oral antidepressant every day, which you must do for the whole length of your treatment plan. Your in-office spravato treatment sessions take place once a week for the second month after the first month’s two sessions each week.

You may decide to stick with one session per week or switch back to two sessions per week. After the first two months of treatment, depending on how well your symptoms react to the medicine.

Even though it only takes a few seconds to spray the medication into each nostril. You need to spend around two hours in the treatment room under close observation. This prolonged monitoring period lets your doctor assess how well you respond to the medication. 

Dosage

Esketamine nasal spray is a component of the FDA’s Risk Evaluation and Mitigation Strategy (REMS) drug safety program. It aims to ensure correct use so that the medication’s advantages balance its hazards. Due to the potential for abuse as well as the risk of dissociation and sedation.

As a result, the REMS set of criteria for esketamine contains recommendations for choosing the right dosage. There are two alternative dose kits for spravato. One containing 84 milligrammes of medication and the other 56 mg of esketamine.

All adults receive a 56-milligram starting dose on the first day. You may receive 56 milligrammes of esketamine in the first month or you may be shifted to a higher 84-milligramme dose depending on how you respond to the drug.

Your doctor may change your dose as needed and tolerate it as your therapy progresses. The main objective is to enable you to safely achieve full remission or optimal symptom response at the lowest esketamine dosage.