Does Spravato work for depression?
Spravato is an intranasal esketamine spray approved for treatment-resistant depression. Clinical trials showed 50-70% of patients respond to it, but many still need ongoing treatment. Clinical data indicate it works faster than traditional antidepressants, acting within hours or days rather than weeks.
How long does esketamine take to work?
Esketamine works through NMDA receptor blockade, which quickly increases glutamate levels and promotes rapid neuroplasticity. This mechanism differs from traditional antidepressants that adjust serotonin or other neurotransmitters. The time frame for improvement varies: patients often see mood improvements within 2 hours of a single dose, but for full effect a series of treatments is required. Clinical studies show rapid relief in a supervised clinical setting.
What happens if you stop Spravato?
Many patients maintain benefit with twice-weekly sessions for four weeks, then weekly or bi-weekly maintenance. If stopped, relapse rates reach 60-70% within 6 months. Relapse risk is higher if patients discontinue abruptly rather than taper. Patients who keep it combined with oral antidepressants tend to do better than those who stop entirely.
Why are companies challenging this patent?
Janssen holds the patent for Spravato. Companies are challenging it because esketamine is a stereoisomer of racemic ketamine, which has known use in depression. Many companies seek to invalidate patents on stereoisomers if the parent compound has already been used. [1]
What alternatives exist if Spravato fails?
If Spravato fails, patients can turn to electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), or oral antidepressants with augmentation strategies. The company claims Spravato has a higher response rate in treatment-resistant depression than oral antidepressants, but clinical data shows overlap in response rates with these methods.
Can biosimilars enter before patent expiry?
Spravato is a small-molecule drug rather than a biosimilar. Small-molecule drugs have no biosimilars. All potential competitors are generics. Generic esketamine nasal spray can enter after patent expiry in 2030.