There’s a dark corner in his room that Daniel used to retreat to when he came home from work as a doctor. His wife noticed that her once-cheerful husband had become swaddled in a smothering fog of depression. She could not understand his despair, but he disclosed, many months later, that he was bullied at work. It triggered memories of his relationship with his difficult parents, who used to take their frustrations out on him during quarrels and favored his younger siblings over him. Despite regular therapy and various antidepressants, he did not feel much improvement. Finally, he sought help from a psychiatrist at a private clinic and decided to try a new nasal spray antidepressant. After a few sessions, he told his wife he no longer woke up with the “death gloom.”
What is SPRAVATO?
Spravato is approved by Singapore’s Health Sciences Authority (HSA) in 2021 for treating treatment-resistant depression. This innovative medication is administered as a nasal spray under medical supervision. It is also approved by the US FDA.
Who is it for?
Spravato is specifically for adults with the severe form of Major Depressive Disorder (depression). It is also used for depression that has not responded adequately to at least two other antidepressants.
In Singapore, depression affects about 1 in 20 people during their lifetime. Symptoms include persistent low mood, changes in sleep and appetite, low energy, difficulty concentrating, loss of interest, feelings of hopelessness, and suicidal thoughts.
Studies show that 79.4% of patients respond to Spravato, with 52.7% achieving remission. This treatment is particularly beneficial for those at risk of hospitalisation.
How does SPRAVATO work?
Spravato works by targeting the glutamate system, a neurotransmitter pathway distinct from traditional antidepressants that usually focus on serotonin, noradrenaline, and dopamine. It provides relief within days, making it a new and effective option for hard-to-treat depression.
How is it administered?
1. Before treatment:
- Patients must fast for two hours.
- Avoid using other nasal sprays (e.g., for asthma or runny nose) on the treatment day.
2. During treatment:
- The psychiatrist administers two or three single-use nasal spray devices based on the prescribed dose.
- The administration takes only a few minutes.
- Patients relax in a quiet room; listening to soothing music is helpful
3. After treatment:
- Patients are observed in the clinic for 90 minutes for monitoring and management of side effects.
Side Effects
Common side effects may include dissociation (a sense of detachment from reality). This may be pleasant for most but unpleasant for some. Dissociation, occurring in about 2 in 5 patients, typically resolves within 90 minutes. Other side effects include dizziness, nausea, a bitter taste, and temporary increases in blood pressure (only in 10% of patients). Most patients report that the side effects become very mild by the second or third session, and they can even do their work or study while waiting in the room.
Can it be addictive?
Spravato is administered only in clinics under the strict supervision of our doctors and cannot be taken home. It is also meant for hard-to-treat or severe depression only. Therefore, the chance of misuse is very low.
Who is it not suitable for?
Spravato is not recommended for individuals with:
- Severe lung diseases like Chronic Obstructive Pulmonary Disease (COPD).
- Severe heart diseases like recent heart attacks.
Treatment Schedule
- First month: Administered twice weekly in the clinic.
- Second month: Administered weekly.
- Third month onward: Administered once every two weeks
It may be stopped after 4 to 6 months, but there is also an option for maintenance treatment.
Do I need to continue oral antidepressants?
Yes, patients are required to continue their existing antidepressants. The psychiatrist may adjust medications as necessary.
Cost of Treatment
The first month of treatment costs approximately $12,000, excluding GST. Subsequently, as the frequency decreases, the cost is reduced to $6,000 in the second month and $3,000 in the third month. Please note that prices are correct as of 1 January 2025 and are subject to change.
Some companies provide insurance plans for their staff, so it is helpful to check if these costs are covered.
Who can administer it?
Only qualified psychiatrists are authorised to prescribe and administer Spravato.
Reference
Seek Help Today
At Private Space Medical, our psychiatrists - Dr Victor Kwok, Dr Tay Kai Hong, Dr Ashwin Chee, and Dr Lee Xin Er - will provide detailed information and discuss the treatment options best suited to your needs. If you or someone you know is struggling with depression, take the first step toward feeling better. Call us today to explore how we can support your journey to improved mental health.
