How Long Will I Stay on SPRAVATO® for Depression?

When you’re just starting out with any new antidepressant or therapy, you may wonder how long you’ll need to stick with it. A couple of months? A year? The rest of your life? If you’ve been approved to begin SPRAVATO® treatments for depression, these questions may be at the front of your mind. After all, the FDA approved SPRAVATO® for treatment-resistant depression (TRD) in 2019, followed by approval for major depressive disorder with suicidal ideation or behavior (MDSI) in 2020. This means that most people haven’t taken SPRAVATO® treatments for much longer than a year or two. 

The good news is that long-term studies conducted in the mid-2010s give us clues to help understand the safety and efficacy of SPRAVATO® duration beyond the initial treatment period, which can help us understand how long SPRAVATO® depression treatment can last.

What is SPRAVATO® Treatment and How Did it Start? 

SPRAVATO® is the brand name for esketamine nasal spray, a ketamine-derived depression treatment. A dissociative anesthetic, ketamine has been delivered through an IV as an off-label mental health treatment since the early 2000s. The drug is a  mixture of (S)-ketamine and (R)-ketamine, which are mirror-image molecules. (S)-ketamine, or esketamine, is more potent at lower doses than ketamine. 

Ketamine seemed to help depression patients improve at a much faster rate than oral antidepressants. It prompted researchers at the beginning of the 21st century to study whether esketamine could produce the same benefits as ketamine. 

Phase I clinical trials began in 2014, followed quickly by Phase II trials from 2014 to 2016. These trials focused on making sure that esketamine nasal spray was safe for adults to take. Phase III trials began in 2015 and continued for at least one year but usually more. These studies focused on testing both the safety and efficacy of esketamine nasal spray in patients with TRD and MDSI.

Most trials were completed by 2018, paving the way for the 2019 FDA approval, but at least one trial is ongoing. Begun in 2016, A Long-term Safety Study of Esketamine Nasal Spray in Treatment-resistant Depression (SUSTAIN-3) aims to determine the long-term safety and tolerability of nasal esketamine for depression. The study is slated to end in December of 2022, with results available sometime after that. In other words, as of 2022, some patients had been taking SPRAVATO® treatments for about five years. 

Researchers believe that esketamine nasal spray acts on two of the most abundant neurotransmitters in the central nervous system: glutamate and gamma-aminobutyric acid (GABA). This helps facilitate rapid neuroplasticity, which is believed to be how the medicine helps depression.

When combined with oral antidepressants that increase the levels of monoamine neurotransmitters like serotonin, dopamine, and norepinephrine, SPRAVATO® treatments may help you feel rapid relief from symptoms and help sustain this remission from depression. Learn more about SPRAVATO® and what your treatments can look like. 

How Long Do You Have to Stay on SPRAVATO®?

It depends. At Greenbrook’s SPRAVATO® REMS-certified treatment centers, patients who have found success with SPRAVATO® often choose to take it indefinitely after the initial treatment period. During the first four weeks of treatment, you’ll come in twice a week to self-administer your SPRAVATO® treatment dose and stay for the mandatory two-hour observation period. 

During the second four weeks, most patients take SPRAVATO® once a week. After that, treatment can continue for as long as you need it. Some of our patients keep taking SPRAVATO® once weekly. Others come in once every two weeks. Some patients only come in for maintenance doses when they notice that their depression symptoms seem to be returning. Before every single dose, you’ll fill out a depression scale to help your provider monitor how well the medication is working. 

Ultimately, the goal is for you to take SPRAVATO® as infrequently as possible while also maintaining remission from depression. You and your Greenbrook provider will communicate often, working together to create a treatment plan that fits your needs. Find out more in a nasal eksetamine spray consultation with Greenbrook.

How Your Health Affects SPRAVATO® Duration?

The amount of time you stay on SPRAVATO® will also depend on your health. If you decide to plan on becoming pregnant, or you become pregnant during SPRAVATO® treatment, tell your provider right away. Like many other antidepressant medications, SPRAVATO® can cause pregnancy complications. However, it’s still important to make sure your mental health needs are taken care of, including during pregnancy. Talk to your primary care provider or OB/GYN for support, and keep in mind that SPRAVATO® should not be taken if you are breastfeeding or planning to breastfeed. 

Other medical conditions can also impact SPRAVATO® duration. If you have any major changes in your health, communicate with your provider as soon as possible. They can give you guidance on whether or not you’ll need to discontinue SPRAVATO®.

Schedule a Consultation at Greenbrook

Our SPRAVATO® REMS-certified clinics are a comfortable and relaxing setting for your ketamine-based treatment for depression. We provide private rooms or bays for your treatment sessions yet can accommodate multiple patients at once, meaning you won’t experience delays in treatment. Your Greenbrook Care Team will attend to your needs from the beginning to the end of each session. 

We also provide TMS therapy should you prefer a medication-free option with fewer side effects. Schedule a free consultation with one of our Patient Consultants to learn more about how we can help lift the fog of depression.