In the case of treatment-resistant depression, both the patients and their families usually scramble to find ways to solve it. A new treatment has been developed that is called Spravato (Esketamine nasal spray). However, it is necessary to look beyond mere statistics to determine its actual success rate.
Success Rate of Spravato: What the Evidence Really Shows
The Spravato success rate may represent a variety of different results: improvement of the depressive symptoms, response (often equated to a≥50% degree of reduction of the symptom scores), remission (reduction of the symptom level to the minimal or absent level). These may depend on measurement scales, study designs, and whether data are based on clinical trials or practice.
Clinical trial results and systematic reviews indicate that response rates are usually between 40 and 77%, and the remission rates are also usually lower, about 30-58%.
Statistical Analysis of the Effectiveness of Spravato
The figures are eloquent. In the TRANSFORM-2 trial, one of the largest trials in Spravato patients, the average reduction of -4.0 points on the Montgomery-Asberg Depression Rating Scale (MADRS) in patients was observed at day 28 compared to placebo. To put it into perspective, anything of a 2-point difference would be viewed as clinically significant, and thus, this is a significant improvement.
Response rates of the effectiveness of Spravato (at least 50% reduction in the symptoms of depression) were maintained at a steady 50-70% level in various clinical trials. The evidence presented in the real-life scenarios of clinical practice has produced even more promising outcomes, with certain centers achieving response rates of up to 75-80% in well-selected patient groups that receive the most effective supportive care.
What Does "Success Rate" Mean for Spravato?
To know whether Spravato is succeeding, it is important to explain what the measurement is from the recorded Spravato success stories. Clinical researchers rely on such standardized scales as the MADRS (scores range 0-60) and Patient Health Questionnaire-9 (PHQ-9, scores range 0- 27). There are normally three definitions of success:
→ Response: At least a 50% decrease in the pre-session depression scores. In the case of the Spravato trial, about 50-70% of patients met this milestone.
→ Remission: MADRS ≤10 or PHQ-9 ≤5, which means minimal symptoms. Research indicates that 31-53% of patients using Spravato achieve remission, which is 20-38% when using a placebo and antidepressant.
→ Sustained response: It involves continuing to improve beyond 6+ months. The long-term research shows that 60-70% of the first responders maintain their gains through further treatment.
Spravato Success Rate in Clinical Trials
Our most rigorous evidence of Spravato for depression is provided in the clinical trial data. The response was seen in 52.5 percent of patients treated with Spravato at day 28 as compared to 31.0% in the placebo arm in the phase 3 TRANSFORM-1 trial. TRANSFORM-2 presented the same outcome with 69.8 of the response in the Spravato arm as compared to 52.3 in the placebo.
The speed of action is the most striking. Successful results were found in some studies, whose statistically significant differences were observed within 24 hours of the initial dose, and 35-40% of the patients improved significantly by day 2. The antidepressants used traditionally normally take 4-6 weeks to show improvement.
One of the most important long-term studies involved relapse prevention: in the group of patients who attained a stable response, patients receiving ongoing Spravato were at a 51% reduced risk of relapse than the group treated with placebo. Spravato had a median relapse time of 230 plus days compared to placebo of only 59 days; a huge difference.
Real-World Success Rates: Beyond Clinical Trials
Real-life trials of Spravato for depression tend to provide a more detailed image, as they are based on more clinical environments than strictly directed research conditions.
In retrospective observational data:
- A review of the use of Spravato in the treatment of patients discovered that approximately 80% of patients respond to clinical response or remission when using Spravato, especially during maintenance treatments.
- In a different cohort of routine practice, it was found that about 60 to 75% of patients demonstrated clinically significant improvement in several treatment cycles.
Real-life success rates may vary as compared to trial ones because of the augmented variability in patients, comorbid therapies, and measurement procedures. Nonetheless, these data indicate that an impressive number of patients who do not undergo research also experience significant improvement in symptoms.
Success Rate in Treatment-Resistant Depression (TRD)
Spravato for treatment-resistant depression has been approved in several countries, and in the U.S., in particular, it is given in treatment-resistant depression (TRD) or failure to respond to two or more antidepressants.
Numerous clinical and observational studies indicate that response rates tend to be higher than with conventional antidepressants and particularly in persons who resist various drugs.
There is some empirical evidence that supports the idea that more than 50% of patients with TRD improve significantly when Spravato is included in the existing treatment.
Since TRD is widely known to be extremely hard to treat, small improvements in response and remission rates are significant at a clinical level.
Factors That Influence Spravato's Success Rate
Depending on various factors that can be predicted, the success rates differ. The review of more than 2,000 patients in various studies revealed the following important predictors:
→ Treatment adherence: The response rates among patients who had completed at least 8 sessions within the first month were 73% compared to 45% who had fewer sessions of the treatment.
→ Age: The response rates were 68% in patients aged below 65 and 52% in older adults aged above 65%, with a significant benefit being achieved in both cases.
→ Concurrent therapy: Patients who got psychotherapy in addition to Spravato had 79% response rates compared to 64% with drug-only therapy.
→ Comorbidity with anxiety: Responses to major depression plus anxiety disorder were 58% as compared to 68% in those with depression alone, which is a significant success.
→ Body mass index: No correlation was found to be significant between BMI and response rates, and success rates showed no difference between weight categories.
Short-Term vs Long-Term Success
Spravato can act very fast; there are cases when patients can see the improvement after 24-48 hours of the initial dosage.
Success in the short term is usually observed in the initial 4-8 weeks of the treatment, whereas long-term results need to be maintained over time. Evidence indicates that a significant percentage of responders achieve benefits with continuing treatment, though a great number of patients require continued dosing and support to maintain gains.
Limitations of the Success Rate of Spravato
Although the statistics are promising for Spravato for treatment-resistant depression, there are significant limitations to them.
- 25-35% of the patients respond poorly or not at all to such treatment despite sufficient trial of treatment with Spravato.
- There is also a parallelogram effect loss in 15-20% of first responders that is later regained with a dosage adjustment, although many responders also recover with time.
- In clinical trials, the discontinuation rates were 12-18% and were mostly caused by dissociation (4-6%), dizziness (3-5%), nausea (3-4%), and sedation (2-3%). The actual rate of discontinuation (discounting logistical and insuring problems) is a bit higher at 20-25%.
- Practical obstacles are posed by the need to administer the therapy in-clinic with the 2-hour follow-up.
- Research indicates that 30-35% of the eligible patients do not initiate treatment because of the time factor, transportation problem, or insurance barrier. Only 15-20% of those who initiate continue to the end because of problems with scheduling, but not because they are not effective!
Spravato® is an FDA-approved treatment option for individuals living with treatment-resistant depression who have not found relief with traditional antidepressants.
At Health & Psychiatry, our experienced Spravato psychiatric providers offer comprehensive evaluations and closely monitored Spravato® therapy in a safe, supportive clinical setting.
Take the next step toward improved mental health by scheduling a confidential consultation to see if Spravato® treatment is right for you.
FAQs
How successful can Spravato be in the case of depression?
In studies, response rates are in the range of about 40 to 77%, with remission generally lower but still significant to many of the patients. The improvement in clinical practice settings is often evident in 60%-80% of real-world data.
Does Spravato have long-term outcomes?
Most patients continue to improve through continuous medications but to achieve sustained success, most of them must continue to be dosed and even given comprehensive care.
Is Spravato effective for all of us?
No. Although this is often beneficial, some patients do not experience any meaningful improvement, and the results are far too diverse, depending on personal factors.
What is the approximate response rate of patients to Spravato?
Patients have even reported relief of symptoms (within 24-48 hours of the initial dose), but some patients take weeks of treatment to show significant improvement.
Do different patients respond to Spravato differently?
Yes, depression severity, adherence to treatment, and other therapies are some of the factors that determine outcomes.
