Spravato
Treatment
What is Spravato?
Spravato is the brand name for esketamine, a nasal spray approved by the FDA for the treatment of depression that has not responded to other antidepressant medications. It is taken together with an oral antidepressant rather than on its own. Esketamine works differently from conventional antidepressants, and for that reason it is sometimes an option when several medications have already been tried without adequate benefit.
Spravato is also FDA-approved for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior, in addition to other care. It does not take the place of emergency treatment.
Mechanism
How does esketamine work?
Most antidepressant medications act on serotonin, norepinephrine, or dopamine, and they are taken daily. Esketamine acts on a different signaling system in the brain, and it is given as a supervised dose in the office rather than as a daily medication. That difference is the reason it is considered when several medications working through the usual pathways have already been tried without adequate benefit.
Candidacy
Who is Spravato for?
Spravato is intended for patients with treatment-resistant depression, which generally means depression that has not responded adequately to at least two antidepressant medications taken at an adequate dose for an adequate period. Insurance coverage typically requires that those trials be documented.
Spravato is not the right choice for everyone. Certain medical conditions, including aneurysmal vascular disease and a history of intracerebral hemorrhage, make it unsuitable, and we review your treatment history, medical conditions, and other medications before recommending it.
Treatment day
What to expect on a treatment day
You will self-administer the nasal spray in our office under the supervision of our care team, following the instructions we provide. After the dose is given, you will remain in the office for at least two hours. During that period we will check your blood pressure, beginning about 40 minutes after the dose, and we will monitor how you are feeling before you are released.
Certain rules apply to every treatment day. You should not eat for two hours before your appointment and should not drink liquids for 30 minutes before it, which reduces the chance of nausea. You must arrange a ride home, because you may not drive after a treatment session. You should not drive or operate machinery until the following day, after a full night of sleep. We also ask that you plan a light schedule for the remainder of the treatment day.
A course of Spravato follows a standard schedule. During the first month, treatment is given twice weekly. During the second month, it is given once weekly. After that, treatment continues either weekly or every other week, depending on your response and on our assessment of what is needed to maintain it.
You will continue taking an oral antidepressant throughout treatment, and that medication is managed as part of your ongoing care with us. How long treatment continues is a clinical decision that we will review with you at regular intervals.
If you would like to find out whether Spravato is right for you, schedule an appointment today by calling 972-332-5922 or booking online.
Safety
Side effects and safety
The most common side effects are dissociation, which is a temporary sense of detachment from yourself or your surroundings, along with sedation, dizziness, nausea, and a transient rise in blood pressure. These effects generally begin shortly after the dose, reach their peak within about 40 minutes, and resolve during the monitoring period. This is the reason the monitoring period exists.
Because sedation and dissociation may occur, you will not be permitted to leave the office until our care team has determined that you are ready. We will review the full list of potential side effects, along with the medication guide, before your first treatment session.
Setting
Where treatment takes place
Because of its risk of sedation and dissociation, esketamine may only be administered at a certified treatment center under a program the FDA requires, called a Risk Evaluation and Mitigation Strategy, or REMS. Lakeridge Psychiatry is a certified Spravato treatment center. The medication is not dispensed to patients and is not available at a retail pharmacy — it is given here or not at all.
Cost
Insurance and cost
Coverage for Spravato generally requires documented trials of at least two antidepressants at an adequate dose and duration. We assemble that documentation and submit the prior authorization ourselves, and we tell you where it stands. If you are paying out of pocket, we provide a written quote before the first dose.
Every dose is taken in our office.
Schedule
Getting started
If you would like to find out whether Spravato is right for you, schedule an appointment today by calling 972-332-5922 or booking online.
Referring clinicians: information about our Spravato referral process is available on the For Referring Clinicians page.