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SPRAVATO NASAL SPRAY

Spravato is a nasal spray that is used together with medication taken by mouth to treat adults with depression that is resistant to to other treatments.

Spravato is also used to treat depressive symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or actions.

DOSING INFORMATION

Usual Adult Dose for Depression:

INDUCTION PHASE:
Weeks 1 to 4:
-Day 1: 56 mg intranasally ONCE
-Subsequent doses: 56 to 84 mg intranasally 2 times a week

MAINTENANCE PHASE:
Weeks 5 to 8: 56 to 84 mg intranasally once a week
Week 9 and after: 56 to 84 mg intranasally every 2 weeks OR once a week

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There’s good news for people with severe treatment-resistant depression: Esketamine nasal spray is a groundbreaking therapy that can provide relief from major depression within hours. “For the first time in 60 years, we have a new antidepressant therapy that isn’t just a spinoff of existing drugs,” says Adam Kaplin, M.D., Ph.D., a psychiatrist with Johns Hopkins Medicine. “For some people, esketamine therapy is revolutionary, giving them the chance to experience life without depression for the first time in decades.

WHAT IS ESKETAMINE?

Esketamine is made from a drug called ketamine, an anesthetic that has also been used for many years to treat depression. But it wasn’t until recently that esketamine nasal spray, a more potent version of ketamine, earned FDA approval specifically for use as a nasal spray for those with treatment-resistant depression.

Esketamine is derived from part of the ketamine molecule,” says Kaplin, who has studied the drug for three years. “Because it’s more potent, you can use it at a lower dose and theoretically have fewer side effects. Now that it’s available in an intranasal version and approved by the FDA, it’s more likely that insurance companies will cover the treatment. Buy esketamine nasal spray USA

WHAT IS ESKETAMINE TREATMENT LIKE?

Esketamine, like ketamine, has the potential to distort your perception during the first two hours after treatment, so it has to be administered in a clinic setting. Treatment for esketamine nasal spray is done on an outpatient basis. Buy esketamine nasal spray Netherlands

With the nasal spray, you give yourself three doses, spaced five minutes apart, under doctor supervision. You remain in the clinic under doctor observation until potential side effects have passed.

Esketamine must be used in conjunction with a conventional antidepressant. The intention is that esketamine provides rapid relief from depression symptoms until the other medication takes effect.

Usually, the treatment is given twice a week for the first month, and then if it is successful it is continued at decreased frequency in a maintenance phase for a few weeks or months with dosing and frequency determined by treatment response. Typically, this might mean a decrease to weekly treatments, then every two weeks, then monthly, etc. Buy esketamine nasal spray Belgium

WHO IS A GOOD CANDITATE FOR ESKETAMINE THERAPY?

Currently, esketamine is approved for people with treatment-resistant depression. That means you’ve tried at least two other antidepressants (for at least six weeks each) and haven’t experienced remission or at least a 50% improvement in mood. Buy esketamine nasal spray Germany

For people who haven’t had success with other antidepressants, esketamine gives them the chance to see what it’s like to not have depression,” says Kaplin. “It gives them hope that they can feel better with the right treatment.

HOW DOES ESKETAMINE TREAT DEPRESSION?

Esketamine, and its related drug ketamine, are highly effective depression treatments for a number of reasons:

Esketamine’s antidepressant function works through a different mechanism than other drugs. Conventional antidepressants increase levels of naturally occurring chemicals such as serotonin, norepinephrine and dopamine. These chemicals are messengers that relay communication between brain cells. The theory is that having greater quantities of these neurotransmitters allows for better communication between brain cells and positively affects mood. Buy esketamine nasal spray Austria

Esketamine works in a similar fashion, but unlike other antidepressants it increases levels of glutamate, the most abundant chemical messenger in the brain. The result? A greater impact on more brain cells at one time.

PEOPLE WITH DEPRESSION GET RECENT RELIEF

Common antidepressants are slow-acting. It often takes several weeks to make a noticeable difference in how people with depression feel, says Kaplin. On the other hand, esketamine immediately impacts brain cells, offering relief from depressive symptoms within hours. Buy esketamine nasal spray Finland

ESKETAMINE DECREASES SUICIDAL THOUGHTS

Conventional antidepressants may actually increase suicidal thoughts at the beginning of treatment, especially in children and young adults. Esketamine is the only drug besides lithium, a drug commonly prescribed for bipolar disorder, that’s proven to decrease suicidal thoughts, says Kaplin. Although esketamine isn’t currently approved for this purpose, the FDA is considering it. Buy esketamine nasal spray South Korea

IT IS EFFECTIVE FOR TREATMENT RESISTANT DEPRESSION

Up to 33% of people with depression don’t respond to multiple kinds of conventional antidepressants. Esketamine reduces depression symptoms in a majority of these people in clinical trials. Buy esketamine nasal spray Switzerland

The only other approved drug therapy for treatment-resistant depression is a combination of olanzapine (an antipsychotic drug) and fluoxetine (a conventional antidepressant). However, this treatment has significant long-term effects that include substantial weight gain, metabolic changes, diabetes and high blood pressure.

ESKETAMINE HELPS THE BRAIN FORMS NEW CONNECTION

Research suggests that untreated depression causes long-term brain damage and is a risk factor for dementia. Studies show that people with depression have up to 20% shrinkage of the hippocampus, a region of the brain critical for memory and learning. But esketamine may counteract the harmful effects of depression. Buy esketamine nasal spray Israel

Animal studies indicate that connections between brain cells diminish under chronic stress, but esketamine reverses these stress-related changes. “Esketamine is different than any other antidepressant in that it not only prevents the neurotoxic effects of depression on the brain, but it also seems to have a growth-promoting effect,” explains Kaplin. Buy esketamine nasal spray Brazil

DOES ESKETAMINE HAVE SIDE EFFECTS

People can experience a wide range of side effects from esketamine therapy. The most dramatic are hallucinations and feeling disconnected from yourself or reality. However, side effects tend to peak at 40 minutes and wear off within two hours of treatment. Buy esketamine nasal spray Norway

You can expect the most intense side effects during the first two treatments. Symptoms usually lessen after that. Other side effects may include:

  • Nausea
  • Drowsiness
  • Increased blood pressure
  • Feeling drunk
  • Headache

If you feel treatment for depression isn’t working, talk to your psychiatrist to see if esketamine therapy is an option for you.

WHERE TO BUY ESKETAMINE NASAL SPRAY ONLINE

Spravato is Johnson & Johnson’s ketamine nasal spray. Hello Psychonauts is the most trusted and reliable online platform to buy spravato nasal spray off-label.

WHAT IS A SPRAVATO NASAL SPRAY

Spravato is a brand-name prescription nasal spray. Esketamine or (S)-ketamine is the active ingredient in Spravato. It’s the ingredient that makes the drug work. Buy esketamine nasal spray Spain

Esketamine is an enantiomer of ketamine — which is an arylcyclohexylamine drug with an impressive range of psychoactive and antidepressant effects.

Ketamine is a racemic mixture (a 50:50 mixture) composed of equal amounts of two mirror molecules, (S)-ketamine and (R)-ketamine. Johnson & Johnson’s Spravato is the enantiopure form containing only (S)-ketamine. Buy esketamine nasal spray Poland

Ketamine is a Schedule III substance used as a general anesthetic and a dissociative drug. Patients who receive intravenous ketamine at a clinic receive both (S)-ketamine and (R)-ketamine.

Preclinical data suggests the other enantiomer (pure (R)-ketamine) could be more potent and longer-acting than esketamine and ketamine — but more research is needed.

WHAT IS SPRAVATO USED FOR?

Spravato is a prescription drug approved by the Food and Drug Administration (FDA) for two conditions:

1. Treatment-Resistant Depression (TRD)

Patients with major depressive disorder who have not responded to two or more oral antidepressants may have TRD. Physicians typically determine if a patient is suffering from TRD based on their history of antidepressant use. Buy esketamine nasal spray Portugal

2. Major Depressive Disorder (MDD) With Suicidal Ideation or Behaviors

MDD is also known as clinical depression. Spravato is also used in patients with MDD who have suicidal thoughts or behaviors. Buy esketamine nasal spray Italy

For both TRD and MDD, Spravato is prescribed alongside another oral antidepressant. It can be taken short or long-term.

The patient administers the drug through the nose under the guidance of a doctor at a certified healthcare facility. This drug is approved for use in adults but not in pediatric patients (children).

SPRAVATO SIDE EFFECTS

You may expect to feel some of the following side effects after a Spravato treatment:

  • Nausea and vomiting
  • Sleepiness
  • Dizziness
  • Dissociation
  • Cognitive impairment
  • Vertigo (feeling like the room’s spinning when it’s not)

There’s an increased risk of Spravato causing suicidal thoughts and behaviors in adults ages 18 to 24. The risk is highest during the first months of treatment or whenever the dosage is changed.

CLINICAL TRIALS ON SPRAVATO

There are a few clinical studies that show promising results for Spravato treatment.

Treatment-Resistant Depression (TRD) Clinical Study 

1. A Four-week Spravato Study for TRD

clinical study that lasted four weeks showed that Spravato reduced symptoms of treatment-resistant depression in diagnosed patients.

The study was conducted on two groups. One group was given Spravato alongside an oral antidepressant. The other group was given a placebo and an oral antidepressant. Buy esketamine nasal spray Saudi Arabia

The depression symptoms were measured on a scale of zero to 60, and the Spravato group showed a 4-point improvement more than the placebo group. The biggest improvement was noticed within the first 24 hours of taking this drug.

A 4-week Spravato treatment is known as the Induction Phase. During this phase, the patient is administered two or three devices of esketamine (28 mg each) twice a week for a total of four weeks. Buy esketamine nasal spray Ireland

2. A Year-long Spravato Study for TRD

Following the 4-week trial, people who noticed a significant improvement in depression symptoms enrolled in a year-long study.

Similarly to the 4-week study, the year-long trial investigated Spravato versus placebo in two groups. The study found that Spravato reduces symptoms of depression.

Patients who took the drug had a 51% to 70% lower chance of relapsing to severe depression compared to the placebo group.

This extended treatment phase is known as the Maintenance Phase, where the dosage is personalized for each patient based on the outcome of previous treatment. Buy esketamine nasal spray Australia

Major Depressive Disorder (MDD) Clinical Study 

One 4-week clinical study compared the effects of Spravato nasal spray (plus standard of care) versus placebo (plus standard of care) in two groups of patients diagnosed with moderate-to-severe MDD who had active suicidal ideation and intent.

The study found that the depressive severity score in patients who administered Spravato was lower (less severe depressive symptoms) than in the placebo group. Buy esketamine nasal spray Canada

The study also revealed that Spravato plus standard care didn’t relieve patients’ suicidal severity within 24 hours after the first dose compared to the placebo.

NASAL KETAMINE

In the past, snorting ketamine was the go-to for most recreational users — but the tides are shifting, and nasal ketamine is working its way into the medical system.

Ketamine (AKA “special K”) is a type of dissociative drug developed in the 1960s as a replacement anesthetic for phencyclidine (PCP) — which at the time was the standard anesthetic used during surgery.

Today, ketamine is used for far more than just anesthesia. It’s one of the most popular (and only legal) psychedelic substances used in a conventional medical setting. Buy esketamine nasal spray Sweden

Millions of people around the world use ketamine recreationally too. In lower doses, it produces feelings similar to being drunk on alcohol, while higher doses are profoundly psychedelic (see our piece on K-holing on ketamine for more information).

The most common way of using ketamine recreationally is via insufflation — which is just a fancy way of saying, “you snort it.”

Insufflation has always had a negative connotation because of its link to the illegal drug world. But things are changing.

Johnson and Johnson recently launched a new ketamine nasal spray designed to treat depression and other mood disorders. They call it Spravato.

Here, we’ll explore why snorting ketamine has been stigmatized and why researchers and doctors alike are reintegrating this practice into the modern medical model. Buy esketamine nasal spray Romania

BENEFITS OF NASAL KETAMINE

The areas where nasal ketamine’s benefits have been meaningfully explored are the following: treatment-resistant depression, anxiety disorders, acute pain management, adjunct anesthesia medication, and palliative care. Buy esketamine nasal spray France

Let’s review each of these fields in order to understand ketamine’s benefits and assess the state of the research.

Treatment-Resistant Depression & Anxiety Disorders

The potential of formerly maligned psychoactive drugs, like psychedelics, dissociatives, and empathogens, to meaningfully alleviate and even cure depressive and anxiety-related symptoms is one of the most exciting frontiers in modern medicine. Buy esketamine nasal spray France

Many of these compounds are now being researched for their therapeutic potential, and when it comes to ketamine, the body of evidence is becoming increasingly difficult to deny.

Hundreds of primary studies as well as systematic meta-analyses, have now confirmed ketamine’s significant ability to improve depressive symptoms in patients who exhibit treatment-resistant depression (TRD). Due to the nature of TRD, this is an extremely encouraging development, as many of these patients have had no meaningful response to other forms of treatment.

These benefits are also present for other mood-related ailments like generalized anxiety disorder (GAD), social anxiety disorder (SAD), and even bipolar disorder. Buy esketamine nasal spray Malaysia

The research highlights the fast-acting response of ketamine’s benefits but also points out its transient nature. Patients feel improved symptoms in less than four hours, but after a 7-day period, they tend to report diminished benefits. These results suggest that multiple doses of ketamine might be more effective than single-dose treatments, but more research is still needed.

KETAMINE FOR PAIN MANAGEMENT TREATMENT

Most papers also mention the fact that long-term research on ketamine’s safety and efficacy is sorely lacking, which means they’re hesitant to call for ketamine’s mainstream adoption until more is known. Buy esketamine nasal spray UK

At this point, it’s clear that ketamine research needs to focus on producing long-term data, the benefits and characteristics of single-dose vs. multiple-dose treatments, how to make ketamine’s benefits more long-lasting, and the viability of combining ketamine with other medications and forms of treatment like, for example, therapy.

IV ketamine infusions are still an ‘off-label’ treatment when it comes to mood disorders, but a nasal ketamine product has been given the green light by the FDA and is now commercialized under the name Spravato.

However, Spravato is only indicated in conjunction with a more traditional oral antidepressant, like an SSRI, for example, and cannot be taken home. It can only be utilized in a medical facility under the presence of a doctor.

KETAMINE FOR PAIN MANAGEMENT TREATMENT

The analgesic potential of ketamine is more widely accepted than its mood-based benefits, and the FDA has approved ketamine for pain management purposes.

The evidence for ketamine’s analgesic benefits is quite substantial. However, because the pain response is quite complex and many different types of pain exist, it’s important to understand the subtleties in the clinical literature. Buy esketamine nasal spray Mexico

Ketamine is most effective at reducing pain-related symptoms in conditions of chronic pain, especially neuropathic chronic pain, but when it comes to acute and non-surgical pain, it has proved less effective.

At the moment, there is no nasal ketamine-based product for pain management. Ketamine for pain is almost exclusively utilized through intravenous infusions in medical settings like a hospital or specialized clinics and under the supervision and management of medical professionals. Buy esketamine nasal spray Russia

In fact, the research on nasal ketamine applications for pain seems to be quite sparse when compared to other areas of interest, although there is evidence for nasal ketamine’s potential application in pain management.

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The general conclusions that can be found in the literature are similar to those in depression and anxiety-related studies. Ketamine has a fast-acting and robust effect on pain symptoms. The transient nature of the effects is still present, but some patients do experience sustained pain relief after only one session. There appears to be a high variability when it comes to the number of ketamine sessions needed to experience long-term relief. Buy esketamine nasal spray Philippines

A secondary point, though no less important, has been the suggestion that ketamine’s pain management benefits should be given more consideration in light of the many problems that arise due to the use of opioid painkillers. As the opioid epidemic has laid out in a disastrous fashion, these medications carry considerable risk, both in the development of addictive behaviors and in the likelihood of severe side effects like respiratory depression.

It’s likely that a nasal ketamine product might soon be developed, but we can’t speculate with any degree of certainty.

Adjunctive Anesthesia

Nasal ketamine is used as an adjunct medication for anesthesia in certain situations, especially when IV administration is not feasible or preferred, such as in pediatric patients with difficult venous access or other specific situations.

After it was originally rolled out, the medical community began to move away from ketamine as an anesthetic agent primarily due to its propensity to depress the nervous system, an effect that can lead to dangerous conditions such as respiratory depression. Buy esketamine nasal spray Turkey

However, recent research has demonstrated that when ketamine is used in conjunction with other anesthetic agents, its safety profile improves, and it becomes a lot better suited to handle certain situations.

Research has found that intranasal ketamine assists doctors with a variety of preinduction measures related to pediatric surgery. For example, nasal ketamine leads to better cooperation on the part of the child and allows for a more pleasant and rapid separation from the parents. It also does not cause significant delays in postanesthetic recovery or delayed discharges home. Buy esketamine nasal spray Croatia

In general, it has been found that ketamine, by itself or with another medication like midazolam, provides excellent conditions for the induction of anesthesia in pediatric patients.

Palliative Care

Palliative care refers to the many different types of medical interventions designed to provide relief from symptoms and improve the quality of life of patients with serious, often terminal, illnesses.

The specific benefits and uses of nasal ketamine in the context of palliative care will be highly dependent on the individual patient’s conditions and symptoms. Nasal ketamine could, for example, be utilized as a way to reduce depressive feelings in the face of a terminal diagnosis or to help manage pain symptoms arising out of painful medical procedures like chemotherapy.

Nasal Ketamine vs. IV Ketamine

The two formulations which take up the breadth of medicinal ketamine research are nasal and intravenous infusion. Both methods of administration have been proven effective and have different strengths and weaknesses.

Here are some of the benefits of nasal ketamine when compared to IV ketamine:

Ease of Administration

Nasal ketamine is administered as a spray or mist that goes into the nasal passage. This is a fairly simple method that pretty much anyone can do, even children or the elderly. In certain situations, IV access can be difficult to achieve, and easier methods like nasal ketamine may be required.

Reduced Risk of Complications

IV infusions always carry the potential to develop certain complications like infection of the injection site and other such things. Nasal ketamine sidesteps these problems altogether. Buy esketamine nasal spray Greece

Potential for Self-Administration

As stated before, IV ketamine infusions require the presence of medical staff and are almost exclusively carried out in specialized medical settings. This can prove to be a significant hassle as patients have to move locations, and IV ketamine infusions can last for hours. Nasal ketamine allows patients to access ketamine’s benefits without so much trouble.

Potential for Titration

Nasal ketamine may be more amenable to titration, or adjustment of dosage, compared to IV ketamine, as it can be administered in smaller incremental doses. This may allow for more precise dosing and optimization of the treatment regimen for individual patients.

Lower Cost

In some cases, nasal ketamine therapy may be more cost-effective compared to IV ketamine therapy, as it may require less equipment and monitoring and may not necessitate the presence of a healthcare professional for administration. Buy esketamine nasal spray Japan

FAQS ABOUT NASAL KETAMINE

Answering the most common questions we receive around the intranasal application of ketamine.

1. How Does Ketamine Work?

Ketamine works by interacting with various receptors in the brain and central nervous system, primarily N-methyl-D-aspartate (NMDA) receptors, which are involved in the transmission of pain signals and play a role in the regulation of mood, cognition, and perception.

Ketamine is thought to exert its effects through a complex mechanism of action, which includes blocking NMDA receptors and inhibiting the reuptake of certain neurotransmitters such as glutamate, dopamine, and norepinephrine. This leads to a decrease in excitatory neurotransmission and an increase in inhibitory neurotransmission, resulting in the characteristic dissociative and analgesic effects of ketamine.

Additionally, ketamine has been found to have unique effects on the default mode network (DMN) in the brain, which is a network of brain regions involved in self-referential thinking and rumination. Ketamine has been shown to transiently disrupt the normal activity of the DMN, leading to alterations in perception, consciousness, and subjective experience.

The exact mechanisms by which ketamine produces its antidepressant effects, which have been observed in some clinical settings, are not yet fully understood and are an active area of research.

2. What are the Side Effects of Ketamine?

Ketamine is a potent medication that can produce a range of side effects.

Common side effects of ketamine include dissociation, which can involve a feeling of detachment from one’s surroundings, altered perception of time, space, and self, and sensory distortions. Ketamine can also cause sedation and drowsiness, and many users also complain of headaches.

Dizziness, vertigo, and nausea are also common ketamine side effects, particularly during or shortly after administration.

Ketamine can cause an increase in blood pressure and heart rate, which may be a concern in patients with pre-existing cardiovascular conditions but is otherwise considered normal.

3. Is Spravato a Prescription Drug?

Yes, Spravato (esketamine) is a prescription medication that requires a valid prescription from a qualified healthcare professional. It’s an FDA-approved nasal spray formulation of esketamine, which is a type of ketamine, for the treatment of the major depressive disorder (MDD) in adults who have not responded adequately to other antidepressant treatments.

Spravato is a controlled substance and is only available through a restricted distribution program called the Spravato REMS (Risk Evaluation and Mitigation Strategy) due to its potential for abuse and adverse effects.

It should only be used under the supervision of a healthcare professional in approved healthcare settings.

4. How Much Does Nasal Ketamine Therapy Cost?

The costs associated with nasal ketamine therapy, such as Spravato, can vary depending on several factors. One of the main costs is the medication itself, which may be priced per dose or per treatment session and can vary depending on the dosage and frequency of administration.

Additionally, there may be administration costs, which include fees charged by the healthcare professional or clinic for administering the medication, as well as any associated monitoring, assessments, or procedures.

Other medical costs may also be incurred, such as pre-treatment evaluations, follow-up visits, laboratory tests, and other medical services that may be required as part of the treatment protocol.

It’s important to note that insurance coverage for nasal ketamine therapy can vary depending on the specific insurance plan, and patients are encouraged to check with their insurance provider to understand their coverage and potential out-of-pocket costs. Some clinics may offer financial assistance programs, discounts, or payment plans to help make the therapy more affordable for patients.

5. Will I Get High if I Use Nasal Ketamine for Pain or Depression? What Are the Effects?

The use of nasal ketamine for pain or depression. When administered under the supervision of a qualified healthcare professional and according to approved protocols. It is typically aimed at therapeutic effects rather than recreational use. Also, the dose typically utilized for recreational purposes is significantly higher than the therapeutic doses utilized in ketamine therapy.

As such, if dissociative effects do appear. They are typically less intense than those that a recreational user might experience. In order to hedge against this possibility. The dosage and administration of nasal ketamine will be carefully controlled by professional medical staff.

However, it’s important to understand that the subjective effects produced by ketamine are highly subject to individual variation. What feels like an incredibly overwhelming experience might, to someone else, be far more tolerable or even enjoyable. Ketamine is a highly popular recreational drug, after all.

The ketamine high is referred to as ‘dissociation’ because users often feel disconnected. From themselves and the world, even from their own thoughts and sensations.

Another notable effect is euphoria, which is marked by an uplifted mood, increased sociability, and an overall sense of well-being. Users may feel more relaxed, carefree, and uninhibited.

Ketamine can also induce visual and auditory distortions. Leading to changes in perception, such as altered colors, shapes, and patterns. Sounds may become distorted, distant, muted, or echoed.

Physical sensations can be affected as well, with ketamine causing a numbing effect. Where users may feel disconnected from physical sensations, including pain. Additionally, ketamine can impair motor coordination, resulting in a loss of balance, unsteady movements, and difficulty speaking or moving.

6. Is Ketamine Addictive?

As a dissociative psychedelic compound, ketamine displays a very limited potential for addictive behavior. This is a general attribute that extends to all psychedelics in general. For a variety of reasons, these compounds are far less addictive. Than stimulant or depressant drugs like cocaine and alcohol, respectively.

The nature of psychedelic experiences. Which can oftentimes be incredibly overwhelming and emotionally draining. It has consistently shown itself to have very little correlation with addictive behavior. This, of course, does not mean that a person cannot become psychologically addicted to psychedelics. Especially if they’re using these compounds as a means to escape their real-life problems.

However, the widely held conclusion is that psychedelics do not cause symptoms of physical dependence. Nor are they the type of drugs that encourage people. They develop unhealthy habits based on reward and pleasure.

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