Spravato (Nasal Esketamine) Therapy for Treatment Resistant Depression

SPRAVATO® works for depression through a different mechanism than other antidepressant drugs. Conventional antidepressants increase levels of naturally occurring chemicals such as serotonin, norepinephrine and dopamine. Increasing these chemicals allows for better communication between brain cells, which positively affects mood.

SPRAVATO® blocks NMDA receptors in the brain and thereby increase levels of glutamate, the most abundant chemical messenger in the brain. Blocking NMDA receptors also activates AMPA receptors to release other molecules that help brain cells communicate with each other along new pathways. In turn, this process improves mood, thought patterns, and cognition.

SPRAVATO® has been approved as a stand alone therapy for treatment resistant depression but also can be used in conjunction with a conventional antidepressant. In the latter case, the intention is that SPRAVATO® provides rapid relief from depression symptoms until the other medication takes effect.

Usually, the treatment is given twice a week for the first month, and then if it is successful it is continued at decreased frequency in a maintenance phase for a few weeks or months with dosing and frequency determined by treatment response. Typically, this might mean a decrease to weekly treatments, then every two weeks, then monthly. Based on weekly depression scales we use to monitor you progress we will then recommend how often you should continue.

Our office offers SPRAVATO®, a nasal form or ketamine, that has been FDA approved since 2019 for adults (over 18) with treatment-resistant depression as well as adults with major depressive disorder with suicidal thoughts.

You will take SPRAVATO®nasal spray yourself, under the supervision of our healthcare provider while resting in a recliner in our office. Our healthcare provider will show you how to use the SPRAVATO® nasal spray device. While resting in the recliner we will periodically monitor your blood pressure as well as for any other side effects.

It should be noted that SPRAVATO® should be taken with your current antidepressant. Together you will have a greater chance of results regarding your current depressive symptoms.

You may be familiar with ketamine as an anesthetic that was commonly used on battlefields or as a veterinary drug. A much lower dose of ketamine is given for depression compared with the dose necessary for anesthesia.

SPRAVATO® is a different version of ketamine that can be administered intranasally and also produces rapid, effective results. SPRAVATO® is the S form of Ketamine. It is a new development, making pharmaceutical companies more likely to endorse clinical trials supporting the use of it. In 2019, the FDA approved the use of SPRAVATO® in adults for the treatment of treatment resistant depression (TRD) and major depression with suicidal ideation when used in conjunction with an oral antidepressant or as monotherapy.

Up to 33% of people with depression don’t respond to multiple kinds of conventional antidepressants. SPRAVATO® reduces depression symptoms in a majority of these people in clinical trials.

The safety and efficacy of SPRAVATO® is supported by at least 3 short-term and 2 long term studies. A 2020 study by Papakostas studied the use of esketamine in 774 subjects who were involved in 5 trials and showed that patients with MDD or MDSI who received the intranasal esketamine treatments had a better outcome than those who received placebo.

Conventional antidepressants may actually increase suicidal thoughts at the beginning of treatment, especially in children and young adults. SPRAVATO® is the only drug besides lithium that is proven to decrease suicidal thoughts.

Research also suggests that untreated depression causes long-term brain damage and is a risk factor for dementia. Studies show that people with depression have up to 20% shrinkage of the hippocampus, a region of the brain critical for memory and learning. But SPRAVATO® may counteract the harmful effects of depression.

Animal studies indicate that connections between brain cells diminish under chronic stress, but SPRAVATO®reverses these stress-related changes.

SPRAVATO® is more potent than ketamine, which allows for lower doses and potentially less side effects Both ketamine and SPRAVATO® have to be administered by a medical professional.

Ketamine must be administered intravenously up to 3 times a week. This can be inconvenient, expensive and painful as patients have to continue to return to the doctor’s office and receive a new IV injection each time. Ketamine is expensive as it is not covered by insurance.

SPRAVATO® is administered in an outpatient setting in a comfortable recliner under doctor supervision. You receive 3 doses of the medication spaced about 5 minutes apart and then you remain under doctor supervision for 2 hours until any potential side effects have passed.

The side effects for SPRAVATO® can include:

• Nausea

• Drowsiness

• Increased blood pressure

• Dissociation (sometimes called out-of-body experiences)

• Headache

The side effects tend to peak at 40 minutes and wear off within two hours of treatment. You can expect the most intense side effects during the first two treatment sessions.

Our team will closely monitor you during you treatments to ensure your safety.

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Intravenous Ketamine treatments are not covered by insurance companies because it’s experimental and not FDA approved. Therefore, you have to pay out of pocket for it.

SPRAVATO® is covered by insurance, because it is FDA approved and well-studied to be effective and safe. To be considered eligible for insurance coverage for SPRAVATO®, a person has to have tried at least two other antidepressants without benefit.

Our clinic currently accepts the following insurances for Esketamine treatments:

AETNA

Anthem

Baylor Scott & White

Beacon/Value Options

BCBS

CIGNA

ComPsych

Humana

HealthSmart

Magellan

MHN

OPTUM

United Healthcare

UMR

If your insurance is not listed above , it may still be possible we can get a single case agreement (SCA). Single Case Agreement (SCA) is a one-time contract between an insurance company and an out-of-network provider so the patient can see that provider using their in-network benefit.

Call today for further information and to schedule a consultation at 682-422-3101.

Call our office us today at (682) 422-3101 or email our intake coordinator melissa@hawkinspsychistry.org to get more information and to see if you qualify for SPRAVATO®treatments. After thorough review of your medical and psychiatric history, our medical director will determine medical necessity and pursue preauthorization with your insurances company. Unfortunately, there is no private pay option for SPRAVATO®. as this is a controlled substance. Insurance must be used.

It should be noted we only use SPRAVATO®f or individuals age 18 and older for safety purposes.

"Unlike conventional antidepressants that may take 4-6 weeks to work, SPRAVATO® can work same day within a few hours and most patients will see benefits with a week."

-Dr. Germaine Hawkins, DO

Psychiatrist & SPRAVATO® Medical Director

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