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

Spravato® is contraindicated in patients with:
-aneurysms,
-uncontrolled high blood pressure,
-medical conditions in which an elevation in blood pressure would be
dangerous,
-a history of a brain bleed or stroke,
-increased pressure in the brain,
-an arteriovenous malformation,
-psychosis
-substance abuse
-who are pregnant or breast-feeding.
-some types of heart disease
-acute suicidality
-an allergy to esketamine or any components of 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.

In the office, patients self-administer the Spravato® nasal spray under staff supervision. Then they relax in the treatment room for at least two hours while being closely monitored by Magnetic Hope staff.

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.

As is the case with every medication, Spravato® can cause people to
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.

Patients need to attend a series of sessions to get the most out of their treatment. Most patients continue Spravato® for at least six months and some patients continue in maintenance for years. A typical course of Spravato® treatment involves two sessions a week for the first month, then weekly for the second month. Thereafter, the sessions are typically once or twice a month.( Most patients need to attend these additional booster sessions to prevent relapse. The monthly sessions may continue indefinitely.)

Most prescription antidepressants work by affecting the transmission of chemicals called neurotransmitters in the brain. These neurotransmitters, including serotonin, dopamine, and norepinephrine, are associated with positive sensations such as joy, motivation, and elevated energy levels.

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.

At Magnetic Hope, we understand that the cost of care is a source of concern for most people who are seeking mental health treatment. Insurance policies can be challenging to understand, and it can be difficult to determine which services are or are not covered.

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!