Esketamine (Spravato) Treatment
Esketamine (Spravato) for Treatment Resistant Depression or Acute Suicidal Thoughts
If you’ve taken two or more oral antidepressants and you’re still experiencing the symptoms of depression, it’s likely that you have treatment-resistant depression (TRD). Spravato is the only ketamine treatment approved by the FDA for treatment resistant depression. Camden Interventional Psychiatry is a REMS certified treatment center for Spravato therapy.
How does it work?
Spravato is a nasal spray which you will administer to yourself, under the supervision of the Camden Interventional Psychiatry team.
After you’ve taken the medication, you’ll be observed for two hours. We will monitor you for possible side effects during this time and you will be relaxing in a comfortable environment.
Because of the possible side effects affecting coordination, you won’t be able to drive or operate heavy machinery until the next day. You will need to plan for rides on your treatment days.
Spravato is generally taken 1-2 times per week for the first four weeks and once a week for the next four weeks.
After the first eight weeks, many people find that coming every 2 weeks is sufficient to maintain the benefits.
How can I prepare for my treatments?
Setting an intention prior to Spravato therapy can help to focus your treatment experience. Unlike goals, intentions have to do with choosing a mindset or an attitude that reflects what you hope to gain, rather than a specific outcome. Here are some simple examples:
Self-Compassion:I see myself with honesty and kindness.
Emotional Processing:I lean into my feelings instead of pushing them away.
Mindfulness & Presence:Be here now.
Release & Surrender:I release what I cannot control.
The "Backup" Intention: I am open to whatever comes up.
Reviewing your intention right before your treatment can help you transition into a therapeutic mindset. However, once the medicine takes effect, we recommend that you release all expectations as each treatment experience will be unique and different. Think of the intention as a gentle starting point rather than a rigid expectation.
Many people find it helpful to work with a therapist prior to starting Spraavato to help clarify their intentions for treatment. Some people like to have a support person with them during their treatment. We strive to provide a flexible environment to meet the needs of all of our patients.
Journaling during the treatment can be a useful way to process any thoughts or feelings that are present, as well as to hold onto any insights that arise. It can be helpful to process these journal entries with your therapist.
Spravato treatment allows people to see things in a new, more flexible way.
How do I get started?
The first step is to schedule a consultation. At your first appointment, we will learn more about you and make sure that Spravato treatment is right for you.
We will ensure that you don’t have any medical contraindications to treatment with Spravato.
We’ll verify your insurance information to make sure that your treatments will be covered.
If we move forward with Spravato treatment, we will build a plan with you, enrolling you in the Spravato Risk Evaluation and Mitigation Strategy (REMS) program.
Your regular healthcare provider will continue to be involved with your care and will continue to manage your oral medications if you are taking any. We will provide updates to your team on your progress.
What to know about treatment days:
You may start treatment as soon as your second visit.
Be sure to bring headphones, a playlist of relaxing music, a blanket, eye covering if you prefer, and a journal for recording important insights. You will be monitored for two hours after your initial treatment.
Please arrange for someone to drop you off at the time of your appointment and pick you up 2 hours later. If you prefer to have a support person or therapist sit with you during your treatment, please notify staff ahead of time.
Avoid eating for two hours before, and drinking liquids 1 hour prior to the treatment session. Some patients may experience nausea or vomiting. We can provide you with anti-nausea medication to take prior to your appointment if you would like.
If you take a nasal corticosteroid or nasal decongestant medicine, take these medicines at least one hour before taking Spravato.
FAQs
Can Spravato benefit depressive symptoms of MDD with suicidal thoughts or actions?
SPRAVATO is proven effective for depressive symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or actions (MDSI).
In clinical studies of adults with MDD with suicidal thoughts or actions, those who took SPRAVATO and an oral antidepressant experienced a greater reduction of depressive symptoms at 24 hours compared to those who received a placebo plus an oral antidepressant.*
*Based on an overall score on a standardized rating scale.
What are the possible side effects of Spravato?
SPRAVATO® can cause serious side effects, including:
Sedation and dissociation. SPRAVATO may cause sleepiness (sedation), fainting, dizziness, spinning sensation, anxiety, or feeling disconnected from yourself, your thoughts, feelings, space and time (dissociation).
We will monitor you for serious side effects for at least 2 hours after taking SPRAVATO and decide when you are safe to leave the office.
Abuse and misuse. There is a risk for abuse and physical and psychological dependence with SPRAVATO treatment. We will monitor you for any signs of abuse and dependence.
SPRAVATO Risk Evaluation and Mitigation Strategy (REMS).
Because of the risks for sedation, dissociation, respiratory depression, and abuse and misuse, SPRAVATO is only available through a restricted program called the SPRAVATO Risk Evaluation and Mitigation Strategy (REMS) Program. SPRAVATO can only be administered at healthcare settings certified in the SPRAVATO REMS Program. Patients treated in outpatient healthcare settings (e.g., medical offices and clinics) must be enrolled in the program.
How long until I’m back to normal?
If any of the common side effects do occur, they usually happen right after taking Spravato and go away the same day.
"Happiness can be found even in the darkest of times, if one only remembers to turn on the light."
- Albus Dumbledore