Spravato for Major Depression

We truly live in groundbreaking times as we have seen major advancements in the field of psychiatry over the last few decades. Since the 1990’s, the most notable advancement was the introduction and use of Selective Serotonin Reuptake Inhibitors (SSRI) for Major Depressive Disorder (MDD) and many other psychiatric disorders. This treatment was revolutionary as many of the previous treatments had a wide range of intolerable adverse side effects. This provided much hope to patients, families, and even physicians. However, it turned out that SSRI treatment was not as effective as we thought it would be. Thus, MDD continued to be problematic as incidence and prevalence rates continued to increase. This led scientists and researchers to start exploring other options to help battle this burdening disease.  

Fast-forwarding time, this concern led to two new treatment modalities: Transcranial Magnetic Stimulation (TMS) and Esketamine (Spravato) for MDD. TMS is a non-invasive neuromodulating procedure, and Spravato is a nasal spray used in conjunction with an oral (pill) antidepressant. Both treatments are truly novel as they work in completely unique ways compared to the gold standard treatment, which includes oral antidepressants alone. Both treatments have complex and novel mechanisms of actions, and in fact, we still do not know the precise mechanisms of actions. This is advantageous as we can use this fact to research TMS and Spravato as new treatment advancements in other debilitating psychiatric disorders.  

Spravato currently has two FDA-approved indications as of 2019: Adults with treatment-resistant depression and MDD with suicidal thoughts or actions. This approval is relatively new as of just 2019. We do not know exactly how it works mechanistically for depression and this fact can be taken advantage of when studying future advancements and indications. The future treatment indications are vast and promising, that range from potential use in pain management, insomnia, general psychological distress, and post-traumatic stress disorder (PTSD). All these potential treatment indications have ongoing clinical research that are showing some positive results thus far, but none have any FDA indications or approvals yet.  

TMS treatment was initially FDA-approved for treatment-resistant Major Depressive Disorder in 2008. Similarly to Spravato, we do not know exactly how it works mechanistically for depression and this fact can be taken advantage of when studying future advancements and indications. TMS gained FDA approval for chronic pain associated with headaches in 2013. In 2018, the FDA approved TMS for Obsessive-compulsive disorder (OCD). Future treatment indications are also vast that range from potential use in PTSD, Tourette’s disorder, Generalized anxiety disorder (GAD), Bipolar disorder, Chronic pain syndrome, movement disorders (such as Parkinson’s disease), and alcoholism. All these potential treatment indications have ongoing clinical research that are showing some positive results thus far, but none have any FDA indications or approvals yet.  

The potential of these treatments is extremely exciting and promising as there are still many people suffering from these diseases and disorders. We at CBH will be sure to update you on any future updates on TMS and Spravato treatment. Please stay tuned.