FDA-approves nasal spray to help treat depression, local psychiatrist explains benefit to El Pasoans

El Paso News

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EL PASO, Texas (KTSM) – New approaches to treat mental illness are hitting the market at a critical time for many in the U.S. struggling with depression.

Psychiatrists and patients alike have long lamented the need for more treatment options to alleviate symptoms at a faster rate. Typically, antidepressants like serotonin selective reuptake inhibitors (SSRIs) take one to two weeks to enhance the brain’s neurotransmitters and reduce symptoms.

For many with severe depression, waiting that long could be fatal.

The FDA has approved a nasal spray  to treat patients with severe depression that is believed to also alleviate symptoms of suicidality, which Dr. Fabrizzio Delgado, psychiatrist with the clinics of Texas Tech Physicians in El Paso, tells KTSM 9 News will positively impact the borderland.

The spray, Spravato, uses esketamine (a cousin and more potent form of ketamine) that can only be administered within a certified setting. Ketamine is often used intravenously to treat major depression.

“Now we have the ability to administer it by IV, nasal spray,” says Delgado, talking about the ways esketamine is similar to ketamine, which is used to treat major depression.

“It’s a great new treatment for depression,” he says.

“El Pasoans are going to benefit because in our clinics, Dr. Rahgeb is an expert in esketamine treatment.”

Researchers found that intranasal esketamine is effective because it travel through an ion channel that provides a more efficient pathway to the brain’s neural network.

Spravato is intended to be used along with an oral antidepressant and has been found effectively treat acute suicidal ideations and behaviors for people with treatment-resistant depression. The nasal spray treats two specific and challenging subtypes of depression:

  • Treatment-resistant depression in adults
  • Depressive symptoms in adults with major depressive disorder with suicidal ideation or behavior. Additionally, Spravato was not studied nor is it approved for prevention of suicide or in reducing suicidal ideation or behavior and is not indicated to treat suicidal ideation. 

The spray cannot be purchased at a pharmacy, and must be administered while under the care of a physician at a certified treatment center in accordance with Risk Evaluation & Mitigation Strategy (REMS) . Patients must first schedule a consultation with their healthcare provider to discuss the risks for misuse and potential side effects that can include sedation, dissociation, nausea and vomiting.

Once at the REMS-certified center, the patient will self-administer the spray in each nostril while a healthcare provider supervises, which will occur twice a week for the first month and be given in tapering doses for the next few months while the patient continues oral antidepressants as prescribed.

A certified-treatment center may be the same or different location from patients’ regular healthcare provider office.

More than two million people in the U.S. have treatment-resistant depression, 65 percent of whom report significant inability to function because of their symptoms.

Up until recently, therapies to treat depression have had delayed onset of action that psychiatrists agree is dangerous for patients. The novel nasal spray provides a fast-acting mechanism that works within hours, not weeks like SSRIs.

The availability of treatments like esketamine come at a moment in which people are particularly susceptible to depressive episodes. The isolation, loss, and uncertainty sparked by the COVID-19 pandemic have also triggered mental health decline.

Primary care providers are increasingly asking patients about their mental health, specifically symptoms of depression, which Delgado says is an important step to furthering mental health de-stigmatization.

“Mental health is part of overall health, and should be included in regular screenings,” Delgado tells KTSM 9 News.

“It’s great that we’re focusing on mental health and treatment. The stigma has been there for years, but has now improved.”

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