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As of 2017 in the U.S., there were 1.4 million suicide attempts and 47,173 deaths by suicide.

Can a Nasal Spray Be the Answer to Major Depressive Disorder?

The FDA has recently approved an esketamine nasal spray (Spravato) for severe depression.

Janssen Pharmaceuticals, Inc. has manufactured a spray geared towards patients resistant to two different depression treatments.

Esketamine is a form of ketamine, which the FDA approved in 1970. Until now, patients have largely used ketamine as an injectable, general anesthetic.

Patients will squirt this fast acting nasal spray into the nostril. The lining of the nasal passages absorb the esketamine. So it acts on the N-methyl-D-aspartate receptor of the brain. Depression sufferers should use the nasal spray in conjunction with an antidepressant, if they do not respond to antidepressants alone.

Its the first drug that utilizes a new mechanism in decades to treat major depressive disorder. Not only that, it can potentially help those experiencing suicidal thoughts in a particular moment. Traditionally, antidepressants can take weeks to begin to have a significant impact.

person with depression

Clinical Trials

During Clinical Trials, scientists administered Spravato to a set of patients and the placebo version to another set. Both sets took their designated oral antidepressant alongside the Spravato or placebo.

The trial took place over the course of three 4-week trials.

In one trial, patients who were taking Spravato showed a significant improvement in depression severity compared with placebo patients. The other two trials did not show any significant results.

The Risks

As with all medications, the list of side effects is lengthy:

  • Dizziness
  • Disassociation
  • Sedation
  • Vertigo
  • Nausea
  • Vomiting
  • Anxiety
  • Lethargy
  • Increased blood pressure
  • Intoxicating sensation

Also, because this medication has the potential for abuse, the FDA is keeping restrictions on its availability.

Doctors will administer Spravato to patients in a healthcare facility, for the time being. Doctors and nurses will monitor for two hours, so patients will not be able to drive for 24 hours.


The Dosage and Cost

Initially, patients should receive the nasal spray twice a week for two weeks and then with reduced frequency after that.

As for the cost, each nasal spray should come out to about $290. Patients will be able to have two to three per treatment. The good news is that since FDA has approved the medication, insurance companies should cover most of the fee.

Mixed Reviews

Though there is a new mechanism involved, we are far from establishing it as a prescription that anyone can take.

So far the nasal spray appears to benefit those who need a quick reaction to a severe episode. It can also beenfit those who simply don’t respond well to oral antidepressants alone.

Nevertheless, risks remain because of the side effects, the concerning potential for misuse, and the benefits not being staggering.

Still, patients and doctors are hailing the new drug as a much needed change on the horizon of depression medications.

According to Dr. Michael E. Thase, a professor of psychiatry at the University of Pennsylvania, “the impact of depression is greatest for those who do not benefit from standard treatments.”

Perhaps the most significant benefit is the faster response it provides. Long term oral antidepressants take full effect after weeks or months.

Paul Gionfriddo, president of Mental Health America said that “While there are good drugs on the market for depression, this has the potential to help a significant number of people for whom there has been no effective pharmaceutical treatment so far.”

For more information on depression, visit

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