Johnson & Johnson has published new real-world data from the ECHO study evaluating SPRAVATO® (esketamine nasal spray) in adults with treatment-resistant depression (TRD). The headline: results highlight significant symptom improvement over time—and importantly, symptom stability for up to 6 months after stopping treatment in a post-treatment follow-up group.
At Innerbloom, we pay close attention to high-quality “real-world” data because it can better reflect what care looks like outside tightly controlled clinical trials—especially for complex conditions like TRD.
What is the ECHO study (and why it matters)?
ECHO (Esketamine CoHOrt) is a large, international real-world study spanning Europe and Israel, designed to observe SPRAVATO’s effectiveness and safety in routine clinical settings. A total of 570 people entered the treatment period, and 301 continued into a 24-week (~6-month) post-treatment follow-up.
Why this matters:
- TRD patients in real life often present with greater complexity than trial populations.
- Real-world dosing and treatment duration can vary based on clinical judgment, preference, access, and tolerability.
- ECHO is described as the first real-world study evaluating durability of effect after discontinuation of esketamine nasal spray.
Key outcomes: robust symptom improvement during treatment
Depressive symptom severity was tracked using MADRS (Montgomery–Åsberg Depression Rating Scale). In the treatment period, patients experienced significant improvements from baseline:
- Week 4: average MADRS change –10.3
- Week 12: average MADRS change –14.4
- Week 48: average MADRS change –17.6
In simple terms, participants experienced significant decreases in depression symptom severity, with improvements growing stronger over time in those who continued longer-term treatment.
The standout finding: stability up to 6 months after stopping treatment
One of the most discussed ECHO findings is what happened after discontinuation for those in the post-treatment follow-up period:
- MADRS scores remained stable after stopping treatment, with an average change of –1.4 points from post-treatment baseline to week 24.
This indicates that many participants kept their symptoms stable without showing clear signs of relapse during that follow-up period—an important question for patients and clinicians managing long-term treatment plans.
Who was in the study? A clinically complex real-world cohort
ECHO also provides useful context about the population receiving care in everyday settings:
- Mean baseline MADRS: 33.3 (high severity)
- Average 3.8 prior treatment failures in the current episode
- Many had episodes >3 years
- 45.6% had substantial psychiatric comorbidities
- Around 47% were not working, reflecting functional burden
This matters because outcomes in complex, high-burden populations can help inform expectations and care models in real clinics.
Safety and tolerability: in line with what’s already known
In ECHO, SPRAVATO’s safety results matched what has been seen in previous studies—meaning no new or unexpected safety concerns were identified. Reported treatment-emergent adverse events (side effects that occurred after treatment started) included:
- 81.4% of patients reported at least one TEAE
- 7.7% stopped treatment due to an adverse event
- The most common TEAEs were dissociation (35.1%), dizziness (33.5%), and increased blood pressure (21.4%)
Innerbloom’s perspective: what this could mean for TRD care
This real-world dataset adds to a growing takeaway: for some people with TRD, treatments with novel mechanisms—delivered in a structured, supervised setting—can produce meaningful improvement. What stands out most in ECHO is the durability signal: many patients who entered follow-up stayed stable for up to six months after discontinuing treatment.
Here are a few practical implications:
- Personalized care is the norm. In real clinics, treatment duration and dosing often vary based on response, side effects, and patient preferences—suggesting that flexible, individualized pathways may be essential rather than optional.
- Durability changes the planning conversation. Stability after discontinuation raises important questions for patients and providers: who is most likely to maintain gains, how long that stability lasts, and what follow-up (or maintenance strategies) best protect against relapse.
- Access depends on infrastructure—not just prescriptions. Because administration requires in-clinic supervision and monitoring, broader availability hinges on clinic capacity, staffing, and support systems that make treatment feasible and safe in the real world.
What’s next?
ECHO significantly enhances the real-world evidence for esketamine nasal spray in treatment-resistant depression—while also clarifying the most important questions for daily care. The next step is to identify who benefits most across different patient profiles (including comorbidities, symptom patterns, and episode duration), what factors predict long-term stability after treatment ends, and which supports in real practice—from therapy integration to follow-up frequency and relapse prevention—are most effective in maintaining gains over time.
About the Author
Dr. Rivas is a ketamine specialist and board-certified acute care and trauma surgeon with over 12 years of experience in ketamine administration. Before founding Innerbloom Ketamine Therapy in 2022, Dr. Rivas served on the frontlines of emergency and trauma medicine in Santa Maria, CA, and Austin, TX. Dr. Rivas applies his extensive medical expertise to provide safe, evidence-based ketamine treatments for mood disorders, including depression, anxiety, PTSD, and chronic pain. His passion lies in helping patients find relief and rediscover hope through personalized, compassionate care.
Newy: Bridging the Gap Between Ketamine Treatment and Everyday Wellness
A supplement formulated by Dr. Rivas for enhanced brain and mood support. The formula pairs especially well with ketamine therapy by helping extend and enhance the neuroplasticity effects. That said, the ingredients are equally effective on their own, so it’s a supportive option whether or not someone is undergoing ketamine treatment. Learn more about how Newy supports cognitive function detoxification and cellular repair.
Medical Disclaimer
All content on this website, including but not limited to this article, blog posts, testimonials, and FAQs, is not medical advice and should not be considered as such. This website cannot diagnose or treat any medical condition. Only a licensed medical professional who is familiar with you and your medical history can provide medical advice, diagnosis, or treatment.
The information provided here is for educational and informational purposes only. It is not intended to replace a consultation with a qualified healthcare provider. If you are experiencing symptoms of anxiety or any mental health condition, please consult with a licensed mental health professional or your primary care physician.
If you are in crisis or experiencing suicidal thoughts, please call the 988 Suicide and Crisis Lifeline (call or text 988) or go to your nearest emergency room immediately.
Innerbloom Ketamine Therapy cannot be held responsible or liable for any actions taken by those who access our website or rely on its content. Please refer to our Terms & Conditions for more information.
Living with depression that won’t respond to traditional treatment? Contact Innerbloom Ketamine Therapy at (805) 321-8471 or visit us at 100 Casa Street, Suite D3, San Luis Obispo, CA 93405.