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(esketamine)

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This information is intended for US healthcare professionals to access current scientific information about J&J Innovative Medicine products. It is prepared by Medical Information and is not intended for promotional purposes, nor to provide medical advice.

SPRAVATO® (esketamine)

Medical Information

Use of SPRAVATO in Patients with Seizure Disorders

Last Updated: 12/03/2025

Summary

  • Patients with a current or past history of seizures, with the exception of uncomplicated childhood febrile seizures, were excluded from the SPRAVATO nasal spray phase 3 treatment-resistant depression program and, therefore, we do not have any systematically collected data on SPRAVATO treatment with this population.1-6
    • The primary reason for exclusion was to avoid confounding the safety signal.7
  • Healthcare providers should use their clinical judgment when considering SPRAVATO in patients with a history of seizure disorder.
  • A case report describes a patient with treatment resistant depression (TRD) and psychogenic non-epileptic seizures (PNES) who experienced improvement in depressive symptoms and no PNES episodes after initiating SPRAVATO.8 

Clinical Data

Case Report

Hashmi et al (2025)8 presented a case report of a 45-year-old female patient with depression first diagnosed at age 18. Over subsequent years, she was successfully treated for her mood symptoms with various antidepressants, including escitalopram, trazadone, and fluoxetine. She had recent episodes of generalized tonic-clonic seizures diagnosed as PNES, which did not respond to multiple antiepileptic medications. Due to the burden of her seizures, she experienced another depressive episode, which was treated with fluoxetine and alprazolam, with no significant benefit. She was subsequently admitted to an inpatient psychiatric facility for suicidal ideation and stabilized on fluoxetine, trazadone and hydroxyzine. After discharge, she continued to experience seizure episodes and was readmitted following a suicide attempt by overdose and later discharged on a regimen of fluoxetine, quetiapine and clonazepam. Post discharge, she reported worsening depression and frequent seizures.

Due to a history of poor response to previous antidepressant therapy regimens, she was prescribed, in addition to her current treatment, SPRAVATO 56 mg twice weekly for 4 weeks, followed by SPRAVATO 84 mg once weekly, along with cariprazine 1.5 mg once daily. Since the initiation of SPRAVATO treatment, she has not experienced any functional seizures, and her depressive symptoms have consistently improved. Her Hamilton Depression Rating Scale (HAM-D) score decreased from a pre-treatment score of 23 to a score of 7, with improvements in overall daily functioning and quality of life. No adverse effects from SPRAVATO have been reported.

Literature Search

A literature search of MEDLINE®, Embase®, BIOSIS Previews®, and Derwent Drug File (and/or other resources, including internal/external databases) pertaining to this topic was conducted on 03 November 2025.

 

References

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1 Popova V, Daly EJ, Trivedi M, et al. Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression: a randomized double-blind active-controlled study. Am J Psychiatry. 2019;176(6):428-438.  
2 Daly EJ, Trivedi MH, Janik A, et al. Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: a randomized clinical trial. JAMA Psychiatry. 2019;76(9):893-903.  
3 Fedgchin M, Trivedi M, Daly EJ, et al. Efficacy and safety of fixed-dose esketamine nasal spray combined with a new oral antidepressant in treatment-resistant depression: results of a randomized, double-blind, active-controlled study (TRANSFORM-1). Int J Neuropsychopharmacol. 2019;22(10):616-630.  
4 Ochs-Ross R, Daly EJ, Zhang Y, et al. Efficacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression-TRANSFORM-3. Am J Geriatr Psychiatry. 2020;28(2):121-141.  
5 Fu DJ, Ionescu DF, Li X, et al. Esketamine nasal spray for rapid reduction of major depressive disorder symptoms in patients who have active suicidal ideation with intent: double-blind, randomized study (ASPIRE I). J Clin Psychiatry. 2020;81(3):19m13191.  
6 Ionescu DF, Fu DJ, Qiu X, et al. Esketamine nasal spray for rapid reduction of depressive symptoms in patients with major depressive disorder who have active suicide ideation with intent: results of a phase 3, double-blind, randomized study (ASPIRE II). Int J Neuropsychopharmacol. 2021;24(1):22-31.  
7 Data on File. Esketamine. Internal Communication.  
8 Hashmi M, Mugunthan P, Jain P, et al. Case Report: Successful management of psychogenic non-epileptic seizures with intranasal esketamine. Front Psychiatry. 2025;16:1527166.