Spravato®: Finally a New Hope for Treatment-Resistant Depression

Depression is a mental health disorder characterized by a persistent feeling of sadness, hopelessness, and thoughts of death. It shouldn’t be confused with “the blues,” which are temporary fluctuations in mood that everyone experiences from time to time as a normal part of life.

When depressive symptoms are recurrent and moderate-to-severe, depression can become a serious health condition, leading to:

Isolation and detachment
Poor performance at school or work
An inability to form and maintain family and social interactions
Suicide

Depression is a primary cause of disability worldwide, affecting some 3.8% of the population. Fortunately, though, there are treatments that can help.

At Sidhu Psychiatric in Palm Harbor, Florida, Kanwaljit “Kavi” Sidhu, NP-C, PMHNP-BC, and our team offer help for their patients struggling with depression. Since not every person responds to treatment in the same way, and because some people are treatment-resistant to the more common and conservative options, the practice would like to highlight a new therapy that can help: Spravato®.

Depression symptoms

Just as the cause of depression may be different for different people, symptoms can vary as well. They may include any or all of the following:

Blue mood
Decreased interest in social activities or hobbies
Loss of libido
Changes in appetite, weight loss or gain
Sleeping too much or too little
Overwhelming fatigue
Feelings of worthlessness, hopelessness, or guilt
Difficulty thinking, focusing, or making decisions
Recurrent thoughts of death or suicide
Suicide attempt

Certain symptoms generally occur more often in women: irritability, anxiety, mood swings, and dwelling on negative thoughts. In addition, related conditions unique to women are postpartum depression and premenstrual dysphoric disorder.

You need to be in a depressed mood for at least two weeks to be diagnosed with depression.

What are antidepressants, and how do they work?

Antidepressants target certain neurotransmitters in the brain that have a role in mood and emotion, including serotonin and norepinephrine. By adjusting the levels of the transmitters, the medications can improve your mood and pull you out of a depressive state.

Some common classes of medication are:

Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Tricyclic antidepressants

Most antidepressants affect the monoamine transmitters, including dopamine, norepinephrine, and especially serotonin. And the effects of these medications aren’t instantaneous. It may take six to 12 weeks before you can tell if it’s having any desired effect.

Over time, doctors realized that serotonin levels alone couldn’t fully explain depression, for two reasons:

More than one-third of people are resistant to SSRIs
Growing research has shown that serotonin and related transmitters make up less than 20% of transmitters in a person’s brain

Clearly there was a need for something that would target that other 80%.

Ketamine and why it works

Since so many people have treatment-resistant depression, it means that standard conventional therapies such as psychotherapy and antidepressant medications aren’t effective. For these people, ketamine offers a beacon of hope.

Most antidepressants target serotonin, but ketamine affects glutamate, the brain's most

common excitatory neurotransmitter, which regulates the brain's processing of emotions, thoughts, and the way new nerve connections form. It’s a major part of how a person learns, remembers, and responds to experiences.

Glutamate produces and balances the levels of GABA, a calming neurotransmitter. Depleted stores of glutamate and GABA can result in depression, but ketamine increases the number of glutamate receptors to restore normal levels of both.

Once your levels return to normal, ketamine helps the brain grow new neural connections, which can reset the brain and your mood.

Spravato® (esketamine) CIII is a nasal spray that’s a derivative of ketamine, and it's been FDA-approved for treatment-resistant depression. It’s also been approved to treat depressive symptoms in adults who have major depressive disorder with suicidal thoughts or actions. It’s not approved for depression as a whole, though.

You have to get the spray from a certified treatment center and take it while you’re there under medical supervision, as ketamine is a dissociative anesthetic and can produce uncomfortable symptoms.

Struggling with depression and want to learn more about how Spravato can help? Call Sidhu Psychiatric at 727-382-1383, or contact us online today.