Spravato Treatment for Resistant Depression
What is Spravato?
Spravato (esketamine) is an FDA-approved prescription nasal spray for adults dealing with treatment-resistant depression (TRD). This esketamine treatment can be used alone or combined with an oral antidepressant; however, many insurance plans stipulate that continued treatment with an oral antidepressant is necessary for coverage. Additionally, for major depressive disorder (MDD) accompanied by acute suicidal ideation or behavior, Spravato is FDA-approved for use in conjunction with an oral antidepressant, providing essential mental health support through innovative therapies, including mindfulness therapy.
Is Spravato ketamine?
Spravato, also known as esketamine, is a distinct chemical derivative of traditional ketamine. It is important to note that while esketamine treatment is derived from ketamine, it differs significantly in its composition. Traditional ketamine is a 'racemic mixture,' consisting of equal parts of two mirror-image molecules: R-ketamine and S-ketamine. In contrast, Spravato focuses solely on the S-ketamine molecule. This specific component binds more effectively to the brain's NMDA receptors, making Spravato a more potent option for individuals seeking mental health support, particularly those experiencing treatment-resistant depression. Due to its increased potency, esketamine can be administered in lower doses, allowing for integration into mindfulness therapy approaches.
How does it work?
Unlike traditional antidepressants that focus on serotonin, Spravato, an esketamine treatment, targets the brain's glutamate system, specifically NMDA receptors. This innovative approach offers quick mental health support, often providing relief for those with treatment-resistant depression within hours or days. Integrating mindfulness therapy can further enhance the effectiveness of this rapid-acting solution.
What are the side effects?
Temporary side effects during esketamine treatment, which is often used as a mental health support option for those with treatment-resistant depression, may include dissociation (a floating or disconnected feeling), dizziness, nausea, and a temporary increase in blood pressure. After receiving Spravato, it is necessary for you to be monitored by a healthcare professional for at least two hours, particularly if you are also engaging in mindfulness therapy.
Walk me through everything
First, you will meet with one of our psychiatric providers—Jeanne-Marie, Krista, or Krissy—who will conduct a complete evaluation, both psychiatrically and medically, to assess your suitability for esketamine treatment. If you haven't had lab work done within the past year, it may be ordered as part of the assessment.
Once you are cleared for treatment-resistant depression, our office staff will initiate a prior authorization with your insurance. This process typically takes about a day for Wellmark insurance, but could extend to a week for other providers.
You will be enrolled in the REMS program, as required by law, which tracks certain medications including Spravato. Please watch for an email requesting your signature for the Spravato REMS program.
After completing all necessary steps, our office will contact you to schedule your first treatment. It is essential that you can commit to treatments twice a week for the first month, each lasting 2 hours. Please note, you will not be able to drive home afterward or for the rest of the day. We are also happy to assist you with any FMLA or leave of absence paperwork if you need mental health support during this time, incorporating mindfulness therapy into your journey toward wellness.
Treatment day
Before your esketamine treatment, you should refrain from eating for at least 2 hours and avoid any liquids for at least 30 minutes. Please do not take stimulant medications such as Adderall, methylphenidate, or Vyvanse on the day of your treatment; however, it's acceptable to use them afterward. A urine sample may be collected if deemed clinically appropriate or required by your insurance plan. You will be seated in one of our treatment rooms, where you will relax in a recliner while our staff monitors your vitals, including blood pressure. During the treatment, you will administer the medication yourself by placing the inhaler nozzle in your nose and pressing the plunger at the bottom—this process will be repeated for each nostril 2-3 times. Your safety is a priority, and you will be monitored via an encrypted camera. A call button will be within your reach should you need any assistance. Many patients take this time to practice mindfulness therapy, simply closing their eyes and relaxing while seated in the recliner. After the 2-hour period, our staff will take a final set of vitals. Once you are cleared for discharge, you will be informed not to drive home following your Spravato treatment. It's important that you schedule a session with your therapist—or one of ours—within 72 hours to process your experience with treatment-resistant depression. If you haven't established a relationship with a therapist, we have professionals available. Our therapist, Sharon, is well-versed in Spravato-assisted therapy and can meet with you during the last hour or after your treatment.
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What is the cost?
The cost of SPRAVATO® treatment varies depending on your insurance plan and coverage. For many patients, their out-of-pocket expense is similar to what they would pay for a regular office visit, such as a copay or coinsurance.
SPRAVATO® treatment involves both the medication and clinical monitoring, so your insurance benefits will determine your actual costs.
Our team will help verify your insurance benefits, explain your expected out-of-pocket expenses, and assist with any required prior authorizations before starting treatment.
Eligible patients may also qualify for manufacturer savings programs that can help reduce treatment costs.
We believe that understanding the financial side of treatment is important, and we're happy to help you navigate your coverage!
Why can't I drive home or the rest of the day after treatment?
SPRAVATO® (esketamine) can temporarily affect your alertness, coordination, judgment, and reaction time. Even if you feel completely normal after treatment, some of these effects may still be present, making it unsafe to drive.
For your safety, you must arrange for a trusted adult to drive you home after each treatment session. You should not drive, operate heavy machinery, or participate in activities requiring your full attention until the following day, after a restful night's sleep.
We want you to focus on your treatment and recovery without worrying about getting home safely!
Can I take a rideshare (Uber, Lyft, etc)?
Yes! We understand that arranging transportation can sometimes be challenging. Patients may use a rideshare service, such as Uber or Lyft, to get home after their SPRAVATO® treatment.
For your safety, we require patients using a rideshare service to share their live trip location with our office so we can confirm they have arrived home safely.
Our goal is to make your treatment experience as convenient as possible while keeping your safety our top priority.
What about comfort during the treatment?
Our treatment space is designed with your comfort in mind, featuring a comfortable reclining chair, soft lighting, and calming background music to help create a peaceful environment.
We also encourage you to bring items that help you feel relaxed and at ease, such as:
- Your favorite blanket or cozy socks
- Headphones and your own music or relaxing playlist
- An eye mask to block out light
- A small comfort item that helps you feel secure
Everyone experiences SPRAVATO® differently, and we understand that your comfort needs may vary. Whether you prefer listening to music, resting quietly, or simply closing your eyes, we want you to feel safe, supported, and comfortable throughout your treatment.
Our clinical team will monitor you throughout your session and is available if you need assistance.
How do I get started?
First, you will meet with one of our psychiatric providers—Jeanne-Marie, Krista, or Krissy—who will conduct a complete evaluation, both psychiatrically and medically, to assess your suitability for esketamine treatment. If you haven't had lab work done within the past year, it may be ordered as part of the assessment.
Once you are cleared for treatment-resistant depression, our office staff will initiate a prior authorization with your insurance. This process typically takes about a day for Wellmark insurance, but could extend to a week for other providers.
You will be enrolled in the REMS program, as required by law, which tracks certain medications including Spravato. Please watch for an email requesting your signature for the Spravato REMS program.
After completing all necessary steps, our office will contact you to schedule your first treatment. It is essential that you can commit to treatments twice a week for the first month, each lasting 2 hours. Please note, you will not be able to drive home afterward or for the rest of the day. We are also happy to assist you with any FMLA or leave of absence paperwork if you need mental health support during this time, incorporating mindfulness therapy into your journey toward wellness.
Please remember
Before your esketamine treatment, you should refrain from eating for at least 2 hours and avoid any liquids for at least 30 minutes. Please do not take stimulant medications such as Adderall, methylphenidate, or Vyvanse on the day of your treatment; however, it's acceptable to use them afterward. A urine sample may be collected if deemed clinically appropriate or required by your insurance plan. You will be seated in one of our treatment rooms, where you will relax in a recliner while our staff monitors your vitals, including blood pressure. During the treatment, you will administer the medication yourself by placing the inhaler nozzle in your nose and pressing the plunger at the bottom—this process will be repeated for each nostril 2-3 times. Your safety is a priority, and you will be monitored via an encrypted camera. A call button will be within your reach should you need any assistance. Many patients take this time to practice mindfulness therapy, simply closing their eyes and relaxing while seated in the recliner. After the 2-hour period, our staff will take a final set of vitals. Once you are cleared for discharge, you will be informed not to drive home following your Spravato treatment. It's important that you schedule a session with your therapist—or one of ours—within 72 hours to process your experience with treatment-resistant depression. If you haven't established a relationship with a therapist, we have professionals available. Our therapists, Barb and Sharon, are well-versed in Spravato-assisted therapy and can meet with you during the last hour or after your treatment.