Despite the lack of official approval, emerging research suggests potential benefits for patients using Spravato® for PTSD treatment. Also referred to as esketamine, a small case study revealed that when combined with psychotherapy, Spravato® treatment resulted in a clear reduction of PTSD symptoms. Clinical trials are also ongoing, such as a Yale study combining ketamine (the parent compound of esketamine) with intensive trauma-focused therapy to treat PTSD symptoms more effectively.
While studies employing intranasal esketamine administration are considered critical for characterizing its full potential for PTSD patients, more comprehensive clinical trials are needed to establish safety and efficacy specifically for this condition. Any treatment decisions should be made in consultation with a qualified healthcare provider who can assess individual circumstances and weigh the potential benefits against the current limitations in evidence.
Is Spravato® (Esketamine) FDA-Approved for PTSD?
No, Spravato® is not FDA-approved for PTSD treatment. Spravato® is currently FDA-approved only for treatment-resistant depression (TRD) and major depressive disorder with suicidal ideation. For PTSD specifically, only sertraline and paroxetine have received FDA approval.
Any use of Spravato® for PTSD would therefore be considered off-label prescribing, where a physician uses an FDA-approved medication to treat a condition other than what it was specifically approved for. While there is emerging research showing potential benefits for PTSD patients, the medication has not undergone the specific clinical trials required for FDA approval in this indication.
How Does Spravato® Work to Treat PTSD Symptoms?
While Spravato® is not FDA-approved for PTSD, research suggests several potential mechanisms by which it might help treat PTSD symptoms:
- Primary Mechanism – NMDA Receptor Blockade: Esketamine’s mechanism of action involves non-competitive antagonism of NMDA receptors, which modulates glutamatergic transmission and is implicated in the restoration of physiological glutamate signaling in the brain. Unlike other antidepressants, esketamine increases levels of glutamate, the most abundant chemical messenger in the brain, resulting in a greater impact on more brain cells at one time.
- Neuroplasticity and Memory Processing: The mechanism most relevant to PTSD involves neuroplasticity, which is the brain’s ability to reorganize and form new neural connections. Ketamine, due to its primary action as an NMDAR blocker, is known to interfere with NMDAR-dependent forms of neuroplasticity, which has led to studies suggesting a capacity of ketamine to disrupt the reconsolidation of maladaptive memories contributing to PTSD.
- Potential PTSD-Specific Benefits: The disruption of maladaptive memory reconsolidation is significant for PTSD, as this condition involves persistent, intrusive traumatic memories. By interfering with how these memories are stored and recalled, esketamine may help reduce the emotional intensity and frequency of traumatic flashbacks and related symptoms.
- Rapid Action: Unlike traditional antidepressants, which can take weeks to show effects, esketamine’s glutamate system-targeting can produce more rapid changes in brain function, potentially offering faster relief from symptoms.
While these mechanisms are scientifically plausible for PTSD treatment, most research has focused on depression, and more specific studies are needed to understand how esketamine works for PTSD symptoms specifically.
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What PTSD Symptoms Can Improve with Spravato®?
Several PTSD symptoms for military members and others may potentially improve with Spravato® treatment, though it’s important to note this is based on limited studies since it’s not FDA-approved for PTSD:
- Re-experiencing Symptoms: These include intrusive thoughts, nightmares, flashbacks, and distressing memories where individuals may feel as if the traumatic event is recurring. Research suggests that esketamine may help reduce the intensity and frequency of these intrusive symptoms by affecting memory reconsolidation.
- Overall PTSD Symptom Reduction: The most concrete evidence comes from clinical studies using standardized PTSD assessment tools.
- Rapid Symptom Relief: Research with intranasal ketamine showed significant symptom reduction occurred after only one treatment, suggesting esketamine might provide relatively quick relief compared to traditional PTSD medications.
- Comorbid Depression: Since PTSD often occurs alongside depression, studies have shown that esketamine also improved depression symptoms.
Who Is a Good Candidate for Spravato® PTSD Treatment?
Since Spravato® is not FDA-approved for PTSD, determining good candidates for off-label use and whether Spravato® is covered by insurance requires careful consideration by qualified healthcare providers. Potential good candidates:
- Treatment-Resistant PTSD: Similar to its approved use for treatment-resistant depression, the best candidates would likely be individuals who have not responded adequately to standard PTSD treatments. This includes those who have tried evidence-based therapies like trauma-focused psychotherapy without sufficient improvement.
- Comorbid Conditions: Research has investigated esketamine’s effectiveness in patients with comorbid anxiety, post-traumatic stress disorder, and substance use disorder, suggesting it may be particularly beneficial for individuals with multiple co-occurring conditions.
- Severe, Debilitating Symptoms: Candidates would likely be those experiencing severe PTSD symptoms that significantly impair daily functioning, particularly intrusive re-experiencing symptoms that haven’t responded to other treatments.
- Medical Conditions: Potential patients with an increase in blood pressure would be at risk, such as aneurysmal vascular disease, arteriovenous malformation, or intracerebral hemorrhage. Other serious medical contraindications include a history of seizures, severe hepatic disease, and cystitis.
- Psychiatric Exclusions: Individuals with psychosis, past or present abuse of ketamine, or neurocognitive disorder would typically be excluded from treatment.
- Safety Monitoring Requirements: All individuals receiving esketamine should be queried regarding suicidal ideation and suicidal behavior as part of the eligibility assessment.
Any decision about using Spravato® for PTSD must involve a thorough evaluation by a psychiatrist or other qualified mental health professional experienced with both PTSD treatment and esketamine. The off-label use requires careful risk-benefit analysis, informed consent, and close monitoring throughout treatment.
Key Takeaways on Spravato® for PTSD
- Spravato® is currently FDA-approved only for treatment-resistant depression and major depressive disorder with suicidal ideation, not for PTSD.
- Early research shows potential benefits, with a recent case series demonstrating significant PTSD symptom reduction when combined with therapy.
- Unlike traditional PTSD medications, esketamine works by blocking NMDA receptors and increasing glutamate activity, potentially disrupting the reconsolidation of traumatic memories.
- The ideal candidates would likely be individuals with severe, treatment-resistant PTSD who haven’t responded to standard evidence-based treatments like trauma-focused therapy.
- Esketamine has significant medical contraindications, including cardiovascular conditions where blood pressure increases would be dangerous, a history of seizures, severe liver disease, psychosis, and a history of substance abuse.
While more concrete evidence is needed for official FDA approval, Spravato® for PTSD, there is hope to use the medication as a treatment option for individuals grappling with PTSD. For those seeking support and guidance in navigating PTSD, don’t hesitate to reach out to Moment of Clarity in Southern California. Our compassionate team at our network of outpatient mental health treatment centers is ready to assist you on your journey to healing. Call us today at 949-625-0564 to learn more about how Spravato® could make a difference in your life.
Resources
- U.S. Department of Veterans Affairs – Clinician’s Guide to Medications for PTSD
- ScienceDirect – Esketamine facilitates psychotherapies for Post-Traumatic Stress Disorder: A retrospective case series of six patients.
- Yale Medicine – Intensive 7-day Treatment for PTSD Combining Ketamine With Exposure Therapy (PTSD)
- Johnson & Johnson – SPRAVATO® (esketamine) approved in the U.S. as the first and only monotherapy for adults with treatment-resistant depression
