SPRAVATO FOR TREATMENT-RESISTANT DEPRESSION

Spravato (esketamine) is an FDA-approved prescription nasal spray used alongside an oral antidepressant for adults with treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal thoughts. Because of potential side effects like sedation and dissociation, it must be administered in a certified medical setting under supervision.

Spravato is not identical to traditional ketamine, but it is a direct chemical derivative of it. Specifically, Spravato is the brand name for esketamine, which is an isolated portion of the ketamine molecule.

• Traditional Ketamine: This is a "racemic mixture." It contains equal parts of two mirror-image molecules: R-ketamine and S-ketamine.
• Spravato (Esketamine): Scientists isolated just the S-ketamine molecule. This specific component binds more strongly to the brain's NMDA receptors, making Spravato more potent than traditional ketamine. Because it is more potent, it can be given in lower doses. 

Unlike traditional antidepressants that target serotonin, Spravato targets the brain's glutamate system (specifically NMDA receptors). It is fast-acting and can sometimes provide relief within hours or days.

Temporary side effects during treatment include  dissociation (a floating or disconnected feeling), dizziness, nausea, and a temporary increase in blood pressure. It is required for you to be monitored by a healthcare professional for at least two hours after dosing.

1. First you will meet with one of our psychiatric providers, Jeanne-Marie or Krista. They will do a full evaluation both psychiatrically and medically to determine if you are a good candidate.  Lab work may be ordered if you haven't had labs done within the past year. 
2. Once you are cleared for treatment, our office staff will initiate a prior authorization with your insurance. This usually takes about a day for Wellmark insurance and can take up to a week for others. 
3. You will be enrolled in the REMS program. This is required by law and tracks certain medications. Be on the lookout for an email requesting a signature from Spravato REMS.
4. Once all of that is complete, you will be contacted by our office to schedule your first treatment. You must be able to commit to treatments twice a week for the first month. Treatments are 2 hours. You will not be able to drive home after or for the rest of the day. We are happy to help with FMLA or leave of absence paperwork if you require it.

1. You  will not want to eat or drink (other than sips of water) at least 2 hours before your treatment.Doing so can cause nausea and vomiting.
2. Do not take any stimulant medications (adderall, methylphenadate, Vyvanse, etc) the day of your treatment. Taking it after treatment is okay.
3. When you arrive you we will need a urine sample.
4. You will be placed in one of our treatment rooms. You will sit in a recliner while staff take your vitals (blood pressure, etc).
5. You will self-administer the medication by placing the inhaler nozzle in your nose and pushing the plunger on the bottom. This will be repeated (each nostril 2-3 times).
6. You will be monitored via encrypted camera. A call button will be available if you need any assistance.
7. During the treatment, you will sit in the recliner. Most patients use this time to close their eyes and relax. 
8. After the 2 hours have passed, our staff will take a last set of vitals. 
9. Once you are okay for discharge, you will be free to leave. Please note our staff will confirm that you are not driving home from treatment.
10. You will need to have a session with your therapist (or one of ours) within 72 hours to process the treatment itself. We have therapists available if you are not established with one or would like to do your session during the last hour or after your treatment. Our therapist, Sharon is experienced in Spravato assisted therapy.