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Spravato is newly approved by the FDA for the treatment of Major Depressive Disorder that has not responded to at least two previous antidepressants.
Ketamine is the generic equivalent of Spravato. It has been used as an off-label treatment for depression for a number of years with good efficacy. However, until now ketamine was available only as an intravenous (IV) treatment. Spravato is a nasal spray with a novel delivery mechanism that provides precise dosing without the need for an IV. This provides a simpler, more comfortable option for patients who are suffering from depression.
Spravato has a novel chemical mechanism of action. Traditional antidepressants work by augmenting the levels of serotonin, norepinephrine, or dopamine in the brain through what is known as reuptake inhibition. Spravato works on a completely different neurochemical system. It is known as an NMDA-receptor antagonist which regulates glutamate, a neurotransmitter distinct from those previously targeted by antidepressants.
Ketamine can cause feelings of euphoria and dissociation. It can also cause sedation and a temporary increase in blood pressure (on average 10 points). For these reasons Spravato has to be administered in a doctor’s office that has been certified by the FDA mandated monitoring program for the medication.