How Does FDA-Approved Spravato® Differ From Anti-Depressants?

 How Does FDA-Approved Spravato® Differ From Anti-Depressants?

Esketamine nasal spray, marketed under the name Spravato®, is the first new approach to treating major depression in decades. 

Major depression is among the most prevalent mental disorders in our country, plaguing an estimated 21 million American adults with feelings of sadness, hopelessness, and even suicide. First-line treatment for depression is psychotherapy and antidepressant medications.

But finding relief can take trying different drugs and at different dosages. Even then, for up to 30% of sufferers, conventional antidepressant medication just isn’t effective. This condition is known as treatment-resistant depression.

At Psychiatric Consultants of Atlanta, with locations in Atlanta and Decatur, Georgia, we’re proud to offer new hope for patients with treatment-resistant depression through the recently FDA-approved Spravato nasal spray. 

Psychiatric Consultants of Atlanta is led by Byron Dr. Evans, MD, who is triple-board-certified in general psychiatry, child and adolescent psychiatry, and forensic psychiatry. Dr. Evan sees first-hand how Spravato can change lives. Here, he provides an overview of this game-changer and explains how it differs from conventional antidepressants.

Physical changes in the brain linked to depression

The brains of patients who have depression look different from those of people who don’t. Depression causes physical changes in the brain, including a shrinking hippocampus (the part you use to learn and remember things) and the prefrontal cortex (used for making plans and solving problems). 

A depressed brain is typically inflamed, especially if you’ve had an untreated major depressive disorder. Depression can also trigger structural issues in your brain that interfere with its ability to function properly. 

Your brain contains billions of neurotransmitters, chemicals that carry messages to and from your brain cells. Abnormalities in specific neurotransmitters — serotonin and norepinephrine — are associated with depression. That’s just part of the story. 

Two more chemical messengers — GABA and glutamate — play a significant role in regulating mood and the capacity for higher thinking. When the connections between your nerve cells become damaged or disconnected, it leads to depression.


Esetamine is a derivative of ketamine, used in hospitals as a general anesthetic. Ketamine IV therapy has also been used to treat depression off-label; it is not approved for mental health use by the FDA. Because esketamine, or Spravato, is FDA-approved, it is generally covered by health insurance, including Medicare, while ketamine infusion therapy is not. 

Esketamine is only administered in a medical setting and is used in conjunction with a conventional antidepressant. 

The difference between Esketamine and antidepressants

Antidepressants and esketamine alter the chemicals in your brain to relieve your depression, but they target different neurotransmitters. Antidepressants focus on serotonin and dopamine. Esketamine focuses on glutamate. Esketamine can be effective within hours versus traditional antidepressants that can take weeks or even months to work.

More than medication

In addition to Spravato, Psychiatric Consultants of Atlanta offers Transcranial magnetic stimulation (TMS) to patients with treatment-resistant depression). TMS is a non-drug therapy that uses magnetic pulses to stimulate the tissues in your brain and activate your neurons. This triggers your brain to increase the production of serotonin, norepinephrine, and dopamine, which improves your mood.

To learn more about how we can help alleviate the symptoms of treatment-resistant depression, schedule a consultation at Psychiatric Consultants of Atlanta.

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