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Spravato™ or Esketamine was FDA approved for use in treatment resistant depression on March 5, 2019. This is an intra-nasal form of ketamine which was shown to be effective in conjunction with an antidepressant in treating severe and debilitating depression labeled as treatment resistant depression or TRD. The medication is not yet available for use and can only be administered under the supervision of a psychiatrist in a setting that has been approved by the manufacturer to give this product. Patients will not have direct access to the medication as it will only be available through a restricted program.
There are some drawbacks to this product in contrast to intravenous ketamine that is offered at our clinic. The concentration of medication is less than what is seen with the intravenous ketamine which could potentially lead to less benefit. Also, the dose that is given is a fixed amount so there is no easy way to modify the dosing of it on a customized basis which can be done with intravenous administration. It is also mandated that the patient be monitored in an office setting for potential side effects for at least two hours after the administration of this product. Lastly, it is uncertain as to how challenging it will be to obtain pre-authorization from insurance carriers for approval of this product.
In summary, it is currently uncertain as to when the product will be available for patient use and how difficult it will be to obtain authorization from insurance carriers for its use.