Major Depressive Disorder (MDD) is a serious mental health condition that affects how a person thinks, feels, and functions in daily life. For some individuals, depression can become so severe that it includes suicidal thoughts or actions. In these situations, timely and effective treatment is essential. Modern psychiatric care offers several treatment approaches designed to reduce depressive symptoms, improve emotional stability, and support recovery.
One treatment option that may be recommended for certain adults with severe depression and suicidal thoughts is SPRAVATO® (esketamine) nasal spray, which is used together with an oral antidepressant under the supervision of a healthcare provider.
Understanding available treatment options can help individuals and families make informed decisions about care during a difficult time.
Understanding Major Depressive Disorder with Suicidal Thoughts
Major Depressive Disorder is more than temporary sadness. It is a clinical condition that can include persistent feelings of hopelessness, emotional pain, fatigue, and loss of interest in daily life. In some cases, depression may also involve suicidal thoughts or behaviors, which require immediate attention and professional treatment.
When suicidal thoughts are present, treatment plans often focus on stabilizing symptoms quickly while also addressing the underlying depression. Comprehensive care may include therapy, medication management, safety planning, and close monitoring by mental health professionals.
Early treatment and ongoing support can significantly reduce the intensity of depressive symptoms and help individuals regain stability.
What Is SPRAVATO® (Esketamine) Nasal Spray?
SPRAVATO® is a prescription medication approved for adults with major depressive disorder who have suicidal thoughts or actions, and it is used alongside an antidepressant taken by mouth.
Unlike many traditional antidepressants, SPRAVATO® works differently in the brain by targeting the NMDA receptor, which is part of the glutamate neurotransmitter system.
Although the exact mechanism is not fully understood, research shows that this pathway may play a role in mood regulation and neural connectivity. Because of this different mechanism of action, SPRAVATO® may help reduce depressive symptoms in patients who require rapid symptom relief.
It is important to understand that this medication is used as part of a structured treatment plan supervised by a healthcare provider.
How SPRAVATO® May Help Reduce Depressive Symptoms
Clinical studies involving adults with major depressive disorder and active suicidal thoughts showed that patients who received SPRAVATO® along with an oral antidepressant experienced greater reductions in depressive symptoms within 24 hours compared with those receiving placebo and an antidepressant.
Further symptom improvements were observed over the first four weeks of treatment, highlighting the importance of following the treatment schedule recommended by a healthcare provider.
However, responses to treatment can vary from person to person. Some individuals may experience significant symptom relief, while others may require additional treatment adjustments or different therapeutic approaches.
How SPRAVATO® Treatment Is Administered
SPRAVATO® treatment is not taken at home. Because of potential side effects and safety considerations, it is administered only in certified healthcare settings under medical supervision through the SPRAVATO® Risk Evaluation and Mitigation Strategy (REMS) program.
During treatment:
• Patients self-administer the nasal spray under the supervision of a healthcare provider.
• Each device delivers two sprays, one in each nostril.
• Patients are monitored for side effects for at least two hours after treatment.
This observation period allows healthcare professionals to ensure the patient remains stable before leaving the treatment facility.
Because treatment may affect alertness or coordination, patients must arrange transportation home and should not drive or operate machinery until the next day after a full night’s rest.
The First Month of SPRAVATO® Treatment
Treatment with SPRAVATO® typically begins with an initial phase designed to stabilize symptoms.
During the first four weeks:
• Treatment is usually administered twice per week.
• Patients continue taking their prescribed oral antidepressant.
• Healthcare providers evaluate symptom improvement throughout treatment.
After this initial phase, the healthcare provider determines whether continued treatment is appropriate and may adjust the treatment schedule based on progress.
Regular follow-up visits help ensure that the treatment is working effectively and safely.
Possible Side Effects of SPRAVATO®
Like all medications, SPRAVATO® may cause side effects. Some of the most common side effects reported when used alongside an oral antidepressant include:
• Dizziness
• Nausea
• Feeling sleepy
• Feeling disconnected from thoughts or surroundings (dissociation)
• Anxiety
• Increased blood pressure
• Vomiting
• Low energy or fatigue
These effects typically occur shortly after treatment and often resolve the same day.
However, SPRAVATO® can also cause more serious side effects, including sedation, dissociation, respiratory depression, and potential misuse or dependence. Because of these risks, treatment must always occur under medical supervision.
Healthcare providers carefully monitor patients before, during, and after treatment sessions to ensure safety.
Important Safety Considerations
SPRAVATO® is not appropriate for everyone. Individuals should not take this medication if they have certain vascular conditions, a history of brain bleeding, or allergies to esketamine or ketamine.
Patients should also inform their healthcare provider if they:
• Have heart or brain conditions
• Have liver problems
• Have a history of substance misuse
• Are pregnant or breastfeeding
• Take other medications that may interact with treatment
A complete medical evaluation helps determine whether this treatment is safe and appropriate.
Monitoring Mental Health During Treatment
Even while receiving treatment for depression, it is important to monitor mental health symptoms closely. Patients and family members should watch for sudden changes in mood, worsening depression, or new suicidal thoughts and contact a healthcare provider immediately if they occur.
Mental health recovery often requires a combination of medication, therapy, lifestyle support, and ongoing care.
Consistent communication with healthcare providers ensures that treatment plans can be adjusted as symptoms change.
When to Seek Immediate Support
If someone is experiencing suicidal thoughts or feels unable to stay safe, immediate help is critical. Individuals should contact a healthcare provider right away or call the Suicide and Crisis Lifeline at 988, which provides 24-hour confidential support.
Emergency services should be contacted if someone is in immediate danger.
Seeking help during a crisis is a vital step toward safety and recovery.
Moving Toward Recovery from Severe Depression
Depression with suicidal thoughts can feel overwhelming, but effective treatment options are available. Advances in psychiatric care, including therapies such as SPRAVATO® combined with traditional antidepressants and supportive care, are helping many individuals experience meaningful symptom relief.
Recovery is rarely immediate, but with the right support system, medical care, and treatment plan, many people can regain stability, reconnect with their lives, and move forward with hope.
If you or someone you care about is struggling with severe depression, reaching out for professional help is one of the most important steps toward healing.
