Depression is a serious medical disorder that affects nearly 1 in 10 US adults. While most patients can be successfully treated with medication, therapy, or both; at least one third of patients will not respond to two or more medications. This is known as treatment resistant depression, which as its name implies, is difficult to treat. However, there is a new FDA approved treatment that may help a lot of patients with treatment resistant depression.

Spravato (nasal esketamine) is an FDA-approved treatment for depression in patients who have not responded to two or more medications. Spravato is a nasal spray that is self-administered in a certified treatment center. Given the difficulty and importance of treating patients with treatment resistant depression, having a new medication that is safe and effective; you will think that Spravato would be a medication that most people have heard of like Prozac or Ozempic. However, that is simply not the case. In fact, most patients and even many physicians are unaware that Spravato is now available for patients with severe depression. How could that be?

First, Spravato is not like any medication where a doctor calls a prescription into a pharmacy. While Spravato is safe and effective, it must be administered in a certified treatment center where patients can be monitored for safe use. Most doctors are not set up to be an approved treatment center.  Second, the doctors who would most likely prescribe and administer these medications would be psychiatrists. However, unlike some doctors who work in large group practices, many psychiatrists work alone, in small offices and without a lot of staff. In other words, most psychiatrists are simply not set up to administer Spravato. Finally, Spravato is a controlled substance, meaning there are some concerns about abuse or addiction. While you may feel like there are too many commercials for pharmaceuticals on TV, controlled substances are not allowed to be advertised. So, patients can’t “ask their doctor” about Spravato because there are no Spravato ads on TV or in magazines.

Regardless of the lack of awareness of this medication by patients and many physicians, Spravato can be a safe and effective treatment for patients with severe treatment resistant depression.