What is Spravato® ?
It is FDA-approved in conjunction with an antidepressant for treating depression in adults who have not responded to two previous antidepressants. Many patients who take Spravato® see improvement in their symptoms within 24 hours, and some even improve within four hours of their first dose. At the present time, the safety and efficacy of Spravato® in children and adolescents has not been established. For this reason, this medication is authorized for use in adults only.
After being sprayed into the nostril, Spravato® is quickly absorbed through the nasal membrane, allowing Spravato® to enter the bloodstream and then the brain. Then the medication quickly works on brain chemicals that regulate mood.
Who can take Spravato®?
The US Food and Drug Administration approved Spravato® in combination with an antidepressant for adults (18 and over) who have treatment-
resistant major depressive disorder and no contraindications to Spravato®.
Treatment-resistant depression is defined as depression that doesn’t
improve after an adequate trial of two or more antidepressants. An
adequate trial is defined as one in which:
- The dose is maximized till it is effective or intolerable
- The duration of treatment is sufficient for the medication to have time to work (usually 4-8 weeks)
- The antidepressant caused intolerable side effects which are unlikely to get better with time
Common symptoms of major depressive disorder include:
- Feeling sad, down or blue most of the time for at least 2 weeks
- Loss of interest in activities that are normally enjoyed
- Withdrawing from partners, family, and friends
- Feeling fatigued or having a lack of energy
- Eating less or more than usual
- Sleeping less or more than normal
- Poor concentration
- Feeling irritable, angry, or anxious
- Hopeless, helpless or worthless thoughts
- Having recurrent thoughts about death or of killing oneself
Who cannot take Spravato®?
-uncontrolled high blood pressure,
-medical conditions in which an elevation in blood pressure would be
-a history of a brain bleed or stroke,
-increased pressure in the brain,
-an arteriovenous malformation,
-who are pregnant or breast-feeding.
-some types of heart disease
-an allergy to esketamine or any components of Spravato
How do I get Spravato®?
The first step is to contact Magnetic Hope for a brief screen to determine whether or not Spravato is safe for you and if we have any openings for new patients. The next step is to schedule an appointment with Dr. Richesin at Magnetic Hope, who will do an assessment and document any previous treatments you have tried for depression. She will discuss the risks, benefits, side effects and alternatives for treatment. We will ask you to gather pharmacy records verifying your medication history to satisfy insurance requirements for coverage of Spravato. We will help you register in the REMS program and contact your insurance company to determine
your coverage for Spravato®.
Most people can take Spravato®. However, Spravato® is contraindicated in patients with certain medical conditions or with allergies to esketamine. Because of the risk of sedation, dissociation and abuse/misuse, Spravato® is administered under a specific program called REMS (Risk Evaluation and Mitigation Strategies). Magnetic Hope is REMS certified.
Important requirements of the Spravato® REMS program include the following:
Healthcare settings, patients and pharmacies all have to be registered in the REMS program in order to ensure that:
- Spravato® is only dispensed and administered in healthcare
settings (medical offices or clinics).
- Patients are enrolled in the program and understand and agree
to the REMS requirements (including not driving themselves
after Spravato administration).
- Spravato® is administered by patients under the direct
observation of a healthcare provider and that patients are
monitored by a healthcare provider for at least 2 hours after the
administration of Spravato® . They then are driven home by a
family member or friend.
What happens during Spravato® treatment?
Some patients bring a book, a relaxing music playlist, or a journal for use during the session.
After Spravato® administration, some patients will experience nausea and vomiting. Because of this, patients should avoid eating for at least two hours and drinking liquids for 30 minutes before their Spravato® treatment. Dr. Richesin will prescribe patients a medication to prevent nausea to take before their appointment. Patients who take a nasal corticosteroid or nasal decongestant medicine should take these medicines at least one hour before their Spravato® treatment. Magnetic Hope staff will monitor each patient and discuss the medication effects, including both the beneficial aspects of Spravato® treatment and if there are any unpleasant side effects. Open and honest discussions with Magnetic Hope’s treatment team is an essential part of helping patients get better.
What are the side effects of Spravato® treatment?
experience certain side effects.
When a person takes Spravato® in combination with an oral antidepressant medication, potential side effects may include: sleepiness, dizziness, anxiety, nausea, vomiting, changes in blood pressure, dissociation, (in which the patient feels disconnected from time and space or from their feelings and thoughts), perceptual disturbances (time appearing to speed up or slow down; colors, and noises seem especially stimulating), and blurry vision.
Two hours after Spravato administration, Dr. Richesin will determine when a patient is safe to leave the office. At that time, the patient must have someone drive them home because of possible side effects which can affect mental alertness and motor coordination. In addition to driving, patients won’t be able to operate machinery or do anything which may require complete alertness until the day after a treatment session, following
a restful night’s sleep.
How many Spravato® treatments would I need?
How does Spravato® work to treat depression?
However, Spravato® is thought to work on the NMDA receptor and increase the neurotransmitter glutamate. Glutamate is an excitatory chemical involved in chemical messaging between cells in the central nervous system. Researchers believe that glutamate is a key element in learning, memory and mood. It is thought to increase neuroplasticity, meaning the ability of the brain to alter its structure, function and/or connections.
Is Spravato® treatment covered by insurance?
However, the good news is that several insurance providers cover Spravato® treatment. Depending on their insurance policy, some patients may only have a small copay for this service.
To find out if your insurance policy includes coverage for Spravato® treatment, please contact us directly at 205-825-HOPE. Our team can coordinate with your insurance provider to confirm your coverage and identify what your cost will be for the benefits that you’re entitled to.
If you are looking for help with depression after other treatments have failed, it’s time to consider Spravato® or TMS (transcranial magnetic stimulation). Please contact us at Magnetic Hope today. We offer personalized depression treatment in a warm and welcoming environment. Contact us today to learn how we can help!
What is treatment-resistant depression?
What makes SPRAVATO® different from oral antidepressants?
What can I expect at my first treatment?
What might a treatment center look like?
What does SPRAVATO® treat? What are the side effects?
Why is there an observation period after taking SPRAVATO®?
How often will I take SPRAVATO®?
How soon might I see improvement with SPRAVATO®?
What success have you seen with SPRAVATO®?
Would you like to know more?
At Magnetic Hope, your care is our highest priority. We are dedicated to providing you with all the necessary tools and information that will make your TMS therapy in Birmingham, Alabama as comfortable and effective as possible. Our friendly staff is available to address any of your questions or concerns every step of the way.