Traditional antidepressants, like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), have been used for decades to treat depression. These medications work by balancing chemicals in the brain, particularly serotonin and norepinephrine, which play a role in mood regulation. Common examples include:

• SSRIs: Prozac, Zoloft, Lexapro
• SNRIs: Cymbalta, Effexor
• Other classes: Tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and more

For many patients, these medications can be effective after a few weeks of treatment, reducing depressive symptoms and improving overall well-being. However, for those with TRD—depression that doesn’t respond to at least two different antidepressants—traditional options may not provide the desired relief.

Spravato (esketamine) is a nasal spray approved by the FDA for treatment-resistant depression. Unlike traditional antidepressants, which primarily target serotonin and norepinephrine, Spravato works on a different neurotransmitter—glutamate. Glutamate is the most abundant neurotransmitter in the brain and is involved in learning, memory, and mood regulation.

Spravato is a form of ketamine, an anesthetic that has been used for decades. However, its discovery as a fast-acting antidepressant has revolutionized the way doctors approach TRD. Spravato is administered in a clinical setting under supervision, typically alongside an oral antidepressant.

1. Speed of Effectiveness
   • Traditional Antidepressants: These medications can take 4-6 weeks to show their full effect, as they slowly alter serotonin and norepinephrine levels in the brain.
   • Spravato: One of the most significant advantages of Spravato is its rapid action. Many patients experience a reduction in depressive symptoms within hours or days, making it a potential life-saving option for those at risk of suicidal thoughts or behaviors.
2. Mechanism of Action
   • Traditional Antidepressants: They primarily work by regulating serotonin, norepinephrine, or dopamine levels. While effective for some, they may not address deeper neurological imbalances seen in TRD.
   • Spravato: By targeting the glutamate system, Spravato offers a new pathway for improving mood and brain function. This is a game-changer for those who haven’t responded to traditional approaches.
3. Treatment Setting
   • Traditional Antidepressants: These are typically taken at home as a daily pill. Patients are monitored through regular follow-ups with their healthcare provider.
   • Spravato: Because of its potential side effects, such as sedation or dissociation, Spravato is administered in a healthcare setting under supervision. Patients are observed for two hours after receiving the treatment, ensuring safety and monitoring for adverse reactions.
4. Potential Side Effects
   • Traditional Antidepressants: Common side effects of SSRIs and SNRIs include nausea, weight gain, insomnia, sexual dysfunction, and emotional blunting. While these effects can subside over time, they sometimes cause patients to discontinue treatment.
   • Spravato: While generally well-tolerated, Spravato’s side effects can include dizziness, dissociation, increased blood pressure, and nausea. However, since it’s administered in a clinical setting, patients are monitored closely to ensure their safety.
5. Patient Suitability
   • Traditional Antidepressants: These are the go-to first-line treatment for most forms of depression. They are widely available and cost-effective, making them accessible for most patients.
   • Spravato: This option is specifically for those with treatment-resistant depression who have not found relief through traditional means. It’s also used for patients with major depressive disorder (MDD) who experience suicidal thoughts or actions. Due to its nature, Spravato is not usually the first choice unless other options have been exhausted.

Spravato offers a promising alternative for individuals who have struggled to find relief from depression through traditional methods. Its rapid action and unique mechanism of targeting the glutamate system set it apart from conventional antidepressants. However, it’s not for everyone. The decision to try Spravato should be made in consultation with a healthcare provider who can assess your history, symptoms, and treatment goals.

At Haracec Complete Health, we specialize in providing tailored mental health treatments to meet the unique needs of each patient. Whether you’re exploring traditional options or considering innovative treatments like Spravato, our team is here to guide you every step of the way.

Interested in learning more about Spravato? Contact us today to see if it might be the right treatment for you!