Spravato vs. Traditional Antidepressants: Which is Right for You?

Finding the right treatment for depression can be a journey filled with ups and downs, especially if you’ve already tried multiple antidepressants with little to no success. For many, traditional antidepressants like SSRIs and SNRIs have been the go-to solution, offering relief for some but leaving others still searching for answers. If you’re feeling frustrated by the lack of progress, you might be wondering if there’s a better option out there for you.

Spravato (esketamine) has emerged as a new hope for those battling treatment-resistant depression—a condition where traditional medications just don’t seem to work. But how does it compare to the antidepressants you’re already familiar with? Understanding the differences between Spravato and traditional antidepressants can help you make an informed decision about your treatment options. Let’s explore how each of these treatments works and what they might offer you on your journey to better mental health.

When we talk about traditional antidepressants, we’re usually referring to medications like SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors). These medications have been around for decades and are commonly prescribed for depression. They work by increasing the levels of neurotransmitters like serotonin and norepinephrine in the brain—chemicals that play a key role in regulating mood.

Common Medications
Some of the most well-known antidepressants include Prozac (fluoxetine), Zoloft (sertraline), and Effexor (venlafaxine). These drugs have become staples in treating depression because they’re generally effective for many people, especially when used in combination with therapy.

Advantages
The widespread use of traditional antidepressants is a testament to their benefits. For many, these medications can significantly reduce symptoms of depression, making day-to-day life more manageable. They’re also widely available, covered by most insurance plans, and come in generic forms, which makes them more affordable.

Limitations
However, traditional antidepressants aren’t without their downsides. One of the biggest challenges is the time it takes for them to start working. It can take several weeks—and sometimes even months—before you notice any improvement in your symptoms. For some, the wait can be agonizing, especially if they’re experiencing severe depression. Moreover, not everyone responds to these medications. It’s estimated that about one-third of people with depression don’t experience significant relief with traditional antidepressants, leading them to seek out other options.

Sources:

National Institute of Mental Health (NIMH) - Antidepressants: Types, Uses, Side Effects, and More
Mayo Clinic - Antidepressants: Selecting one that's right for you

While traditional antidepressants have been the mainstay of depression treatment for years, they don’t work for everyone. This is where Spravato (esketamine) comes into play, offering a different approach for those who haven’t found relief with more conventional options. Spravato is a nasal spray specifically designed for adults with treatment-resistant depression, approved by the FDA in 2019.

Mechanism of Action
Unlike traditional antidepressants that primarily affect serotonin and norepinephrine levels, Spravato targets the brain’s NMDA receptors. These receptors are part of the glutamate system, which plays a crucial role in brain plasticity and communication between neurons. By blocking NMDA receptors, Spravato increases the levels of glutamate, which helps to rapidly reset the brain’s neural circuits. This process can lead to significant improvements in mood and depressive symptoms, often within hours to days after the first treatment—much faster than traditional medications.

Advantages
The most striking advantage of Spravato is its speed. For many patients, it offers rapid relief from depressive symptoms, which can be a lifeline when other treatments have failed. It’s particularly beneficial for those dealing with severe depression where waiting weeks for a traditional antidepressant to take effect isn’t an option. Additionally, because Spravato works through a different pathway, it can be effective for those who haven’t responded to other medications.

Considerations
However, Spravato isn’t without its considerations. Unlike traditional antidepressants that can be taken at home, Spravato must be administered under medical supervision in a certified healthcare setting. This is because it can cause side effects like dissociation, dizziness, and a temporary increase in blood pressure, which require monitoring. The need for supervised administration means that accessing Spravato requires more planning and regular visits to a treatment center, which might not be convenient for everyone.

Sources:

U.S. Food and Drug Administration (FDA) - FDA Approves New Nasal Spray Medication for Treatment-Resistant Depression
National Institute of Mental Health (NIMH) - Esketamine for Treatment-Resistant Depression
Mayo Clinic - Spravato: Is this option right for you?

Deciding on a treatment isn’t just about managing symptoms; it’s also about understanding how the treatment will impact your overall quality of life. Whether you’re considering traditional antidepressants or Spravato, you might be wondering how these options will affect your daily routine, relationships, and emotional well-being.

Traditional Antidepressants
For many, traditional antidepressants gradually improve mood and energy levels, which can lead to a noticeable improvement in daily life. However, the initial period can sometimes be challenging. It’s not uncommon to experience heightened anxiety, sleep disturbances, or other side effects before the benefits fully set in. Emotionally, this adjustment period can be difficult, especially if you’re eager for relief. Patience and support from your healthcare provider are crucial during this time, as it can take weeks to notice significant changes.

Spravato
Spravato offers a faster onset of symptom relief, which can be a significant emotional boost, particularly if you’ve been struggling for a long time. Many patients report feeling lighter and more hopeful after just a few sessions. However, the dissociative effects during treatment might feel strange or unsettling at first. These experiences are temporary, but it’s important to be prepared for them and to have a supportive environment in place. Over time, as you become accustomed to the treatment, you may find that the rapid relief positively impacts your overall outlook on life, helping you re-engage with daily activities and relationships more quickly.

Adapting Emotionally
Both treatments require some emotional adjustment. With traditional antidepressants, the slow buildup of benefits means you might need to stay committed even when it feels like progress is slow. With Spravato, the rapid relief can be almost startling, and adjusting to this sudden change in mood can be an emotional process in itself. It’s important to have open communication with your healthcare provider and, if possible, engage in supportive therapy to help navigate these emotional shifts.

Ultimately, the goal of either treatment is not just to reduce symptoms but to enhance your overall well-being and quality of life. Understanding how each option might affect your daily life can help you make a choice that aligns with both your mental health needs and your emotional resilience.

Sources:

Mayo Clinic - Antidepressants: Selecting one that's right for you

When it comes to treating depression, the speed and effectiveness of relief are critical factors. This is one area where Spravato and traditional antidepressants differ significantly.

Traditional Antidepressants
Traditional antidepressants, like SSRIs and SNRIs, typically take several weeks to start working. This is because they gradually increase serotonin or norepinephrine levels in the brain, which slowly improves mood and energy levels. For some, this delayed onset is manageable, but for others—especially those with severe or treatment-resistant depression—it can feel like an eternity. Even after the initial wait, it can take several months to find the right medication and dosage, and not everyone experiences the desired results.

Spravato
Spravato, on the other hand, offers a much faster onset of action. Many patients report noticeable improvements in their mood within hours to days of their first treatment. This rapid response can be particularly beneficial in crisis situations or for those who have not found relief with other treatments. Spravato’s effectiveness in cases of treatment-resistant depression has been well-documented, making it a valuable option for those who have exhausted other avenues.

Who Benefits Most?
So, who benefits most from each treatment? Traditional antidepressants are still a solid first-line treatment for many people, particularly those with mild to moderate depression. They’re effective, widely available, and generally well-tolerated. However, for individuals with treatment-resistant depression or those who need rapid relief, Spravato offers a promising alternative. The choice between the two often comes down to the severity of symptoms, previous treatment history, and how quickly relief is needed.

Sources:

U.S. Food and Drug Administration (FDA) - FDA Approves New Nasal Spray Medication for Treatment-Resistant Depression
National Institute of Mental Health (NIMH) - Esketamine for Treatment-Resistant Depression

When choosing a treatment for depression, understanding the potential side effects and safety considerations is crucial. Both traditional antidepressants and Spravato have their own profiles, and knowing what to expect can help you make an informed decision.

Traditional Antidepressants
Traditional antidepressants, like SSRIs and SNRIs, are generally well-tolerated, but they do come with side effects. Common issues include weight gain, sexual dysfunction, insomnia, and gastrointestinal disturbances. In some cases, patients may experience heightened anxiety or agitation, particularly when starting a new medication or adjusting the dosage. Withdrawal symptoms are another concern, especially if the medication is discontinued abruptly. These can include dizziness, nausea, and flu-like symptoms. While these side effects can be managed with the help of a healthcare provider, they are important to consider, especially if they impact your quality of life.

Spravato
Spravato, while offering rapid relief, has a different set of side effects that require careful monitoring. The most notable side effect is dissociation, a feeling of being disconnected from reality, which can occur during or shortly after treatment. This effect is usually temporary and wears off within a couple of hours, but it can be unsettling for some patients. Other common side effects include dizziness, nausea, and an increase in blood pressure. Because of these potential effects, Spravato must be administered in a certified healthcare setting where you can be monitored until the side effects subside.

Long-Term Considerations
Both treatments require long-term management, but they differ in how they are monitored. With traditional antidepressants, regular check-ins with your healthcare provider are essential to adjust dosages and manage side effects. Long-term use of SSRIs and SNRIs is generally considered safe, but there can be concerns about dependency or the need for ongoing treatment to prevent relapse. Spravato, on the other hand, is typically used as part of a broader treatment plan that includes ongoing sessions in a clinical setting. The need for repeated treatments and supervision makes Spravato a more intensive commitment, but it also ensures that any side effects are managed in real-time.

Sources:

Spravato REMS - Spravato (esketamine) Risk Evaluation and Mitigation Strategy (REMS)
Mayo Clinic - Antidepressants: Get tips to cope with side effects

The accessibility and cost of treatment are practical considerations that can significantly influence your decision. Let’s compare how traditional antidepressants and Spravato stack up in this regard.

Traditional Antidepressants
One of the advantages of traditional antidepressants is their wide availability. These medications are easy to obtain, and most are available in generic forms, making them relatively affordable. Insurance plans typically cover these medications, and even without insurance, the out-of-pocket cost for generic versions is usually manageable. Additionally, because these medications can be taken at home, they are convenient and don’t require special arrangements or frequent visits to a healthcare provider.

Spravato
Spravato, however, is a more specialized treatment. Because it must be administered in a certified medical setting under supervision, access is limited to facilities equipped to provide this service. This means that patients need to plan for regular visits to their treatment center, which can be a logistical challenge for some. The cost of Spravato is also higher than traditional antidepressants. While insurance may cover the treatment, the out-of-pocket costs can still be significant, especially for those who require ongoing sessions. Financial assistance programs are available through Janssen, the manufacturer of Spravato, which can help reduce the financial burden, but it’s important to consider these factors when deciding if Spravato is right for you.

Citations:

Janssen Pharmaceuticals - Spravato Cost and Coverage
Mayo Clinic - Antidepressants: Selecting one that's right for you

Deciding between Spravato and traditional antidepressants is a personal choice that depends on your unique situation, including your medical history, the severity of your symptoms, and how you’ve responded to treatments in the past. Traditional antidepressants remain a reliable option for many, offering accessibility, affordability, and proven effectiveness for a wide range of patients. However, if you’ve struggled with treatment-resistant depression or need faster relief, Spravato presents a promising alternative with its rapid action and different mechanism of addressing depressive symptoms.

Both treatments have their benefits and considerations, from how quickly they work to the side effects they may cause and the logistics involved in accessing them. The best choice is the one that aligns with your needs, lifestyle, and health goals.

If you’re unsure which treatment is right for you, the team at Therapeutic Infusions is here to help. We can provide the guidance and support you need to make an informed decision and explore whether Spravato, traditional antidepressants, or a combination of approaches might be the most effective path for you. Reach out to us today to learn more about your options and take the next step in your journey to better mental health.