Spravato Shows Lasting Results for Treatment-Resistant Depression
A new real-world study confirms that Spravato delivers durable antidepressant benefits for patients with treatment-resistant depression. The Phase IV ECHO trial enrolled 570 patients across Europe and Israel. All participants had severe and chronic depression, with average episodes lasting three years or longer. The results were presented at the 2026 European Psychiatric Association Congress in Prague.
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| Key Takeaway | Detail |
|---|---|
| Trial size | 570 patients across Europe and Israel |
| Depression severity at baseline | Mean MADRS score of 33.3 |
| Improvement at 12 weeks | 14-point reduction in MADRS scores |
| Improvement at 48 weeks | 17.6-point reduction in MADRS scores |
| Post-treatment stability | Mean score change of just 1.4 points after stopping treatment |
| Adverse events | 81.4% experienced at least one; 7.7% discontinued |
| Projected revenue by 2032 | $4.9 billion |
The adverse events figure sounds significant, but most events were mild and expected. The 7.7% discontinuation rate is the more telling number — it suggests the vast majority of patients tolerated the treatment well enough to continue.
Relief That Holds
Patients treated with Spravato’s nasal spray saw a statistically significant 14-point improvement in depression scores after 12 weeks. That improvement deepened to 17.6 points by week 48. Notably, the gains held even after patients stopped treatment. Those who discontinued Spravato showed a mean score change of just 1.4 points over a subsequent 24-week period. Most patients remained stable with no signs of relapse.
The safety profile was consistent with prior studies. Still, 81.4% of patients experienced at least one treatment-emergent adverse event. That led 7.7% of participants to stop treatment altogether.
A Gap That Demands Better Options
The stakes around these results could not be higher. The World Health Organization projects depression will become the leading cause of global disease burden by 2030. Roughly one-third of people with major depressive disorder do not respond adequately to standard antidepressants. Spravato remains the only monotherapy approved specifically for treatment-resistant depression.
J&J’s head of neuroscience for EMEA, Tamara Werner-Kiechle, called for a broader shift in how the field values mental health treatment. She emphasized that reframing mental health as a long-term investment is essential for innovation to translate into real patient access.
A Blueprint for Psychedelic Therapies
For the ketamine and psychedelic therapy community, the ECHO results carry wider significance. Spravato operates under a restricted clinical administration program, and analysts believe that pathway will serve as a model for emerging psychedelic treatments. Clinics already equipped to administer Spravato are well positioned to take on new therapies entering the space. Psilocybin-based treatments and other novel compounds are moving through trials, and Spravato’s footprint may ease their entry into the market.
Analysts project Spravato will generate $4.9 billion in revenue by 2032. The momentum behind these results signals that treatment-resistant depression is becoming a defining frontier in mental health care.
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