What sprays are available to relieve depression?

Currently, there is no nasal spray in the world that has been officially approved by the drug regulatory authorities and is specifically used for immediate relief of the acute phase of common depressive episodes. The relevant products that you can search for are either still in the clinical trial stage, or are off-label trials of drugs for other indications, and they must not be purchased and used by yourself.

I have been in a psychiatric outpatient clinic for nearly 6 years, and I have met no less than 20 patients who came to ask about this kind of spray. Most of them were too uncomfortable during the attack - it was like being suddenly pushed into ice water, the whole world was stuffy, and my mind couldn't turn. I didn't even have the strength to raise my hand to pick up my mobile phone to call for help. I just wanted to find something that could help me immediately. This feeling is completely understandable, but I really advise everyone not to try it randomly. At present, the only approved nasal spray that is related to "rapid relief of depressive episodes" is the esketamine nasal spray Spravato approved by the US FDA in 2019. Its approved indications are refractory depression and depressive episodes accompanied by acute suicidal ideation. It is a strictly controlled psychotropic drug and can only be used in medical institutions under the full supervision of medical staff. It must not be taken home and sprayed on your own. There was a 27-year-old patient with refractory depression who had tried three kinds of oral antidepressants before but with no good results. During that attack, he lay frozen on the floor of the rental house for almost three hours. His family searched for this drug and wanted to find a reseller to buy it. Fortunately, they came to the outpatient clinic first. If he sprayed it at home, if the dose was not well controlled, it would easily lead to hallucinations, sudden rise in blood pressure, and in severe cases, it could induce mental disorder. He later used it twice in our outpatient clinic according to the regulations, and stayed for 2 hours after each spray. It is true that the overwhelming feeling of near-death subsided in about an hour, but this is not a panacea. Two other patients of the same type only experienced slight relief after using it, and another one suffered from headache and nausea for most of the day after spraying.

Nowadays, many people on the Internet are hyping the so-called "happy nasal spray" and "depression first aid spray", as well as homemade serotonin nasal spray and oxytocin nasal spray circulated in niche circles. Basically, they charge IQ taxes and even harm people. Serotonin itself cannot directly penetrate the blood-brain barrier through the nasal mucosa. Those self-made sprays that claim to replenish serotonin either add placebos or secretly add banned stimulant ingredients. Previously, a sophomore girl used the so-called "antidepressant nasal spray" purchased on behalf of the agent. After the spray, her hands shook and her heartbeat spiked to 140. She was sent to the emergency room for gastric lavage overnight, only to find out that an excessive amount of pseudoephedrine was added to it. As for oxytocin nasal spray, there are indeed studies showing that it may have a certain auxiliary effect in relieving depressive episodes accompanied by social avoidance, but it is still in the clinical trial stage, and the effects vary greatly among individuals, and it is not enough to be used by civilians.

Of course, this is not to say that this road is unworkable. Nasal mucosal administration does not need to go through the first-pass effect of the liver, and the onset of action can be as fast as intravenous administration. For acute depression, which "suffers the whole person in a few seconds", it is indeed a very promising drug administration direction. There have been many related clinical trials in the past few years. Maybe in the next 3 to 5 years, safer products with a wider range of applications will be launched. But before that, if you really encounter an acute attack of depression, don’t look for random sprays all over the world. If you have short-acting anti-anxiety drugs such as lorazepam and alprazolam that were prescribed by the doctor before, take one pill according to the doctor’s prescribed dosage, find a quiet place to sit down in a dark place, and focus on the breathing at the tip of the nose. It is much more reliable than randomly trying unknown things.