Spravato (esketamine) for depression
What Is Spravato (esketamine)?
Spravato is considered by many to be one of the biggest breakthroughs in depression treatment since the advent of Prozac. Spravato is the brand name for esketamine which is used in treating treatment-resistant depression and acute suicidal thinking.
Spravato is FDA-approved, prescribed by a psychiatrist or psychiatric nurse practitioner, and administered in a controlled environment. It is self-administered intranasally in the office under the care and supervision of an on-site registered nurse or trained technician. The effects of Spravato are felt within hours, compared to traditional depression medication which can take several weeks to months to take effect. Spravato can serve as a catalyst for therapeutic growth for many for whom more traditional mental health interventions have fallen short.
FDA Approval and Patient Eligibility
Spravato was first approved by the FDA for use alongside other antidepressants for treating treatment-resistant depression in adults in 2019. In August of 2020, the FDA expanded their approval to allow Spravato treatment in patients struggling with suicidality. At Brooklyn Minds, we offer Spravato treatment to patients who qualify under their insurance plan’s criteria as well as to those who wish to pay privately and are deemed clinically appropriate. Though it varies between policies, most insurance companies require at least two prior trials of antidepressants and for an individual to be taking an oral antidepressant during the course of treatment with Spravato. While we can negotiate with most insurance plans to get the medication itself covered, office visits are often only covered for Cigna, United and Medicare patients, for whom we have clinicians who are in-network.
Spravato Efficacy Statistics
Spravato Efficacy Statistics
Clinical trials of Spravato treated patients showed a 69% response rate.
Spravato Efficacy Statistics
Clinical trials of Spravato treated patients showed a 52% remission rate.
Most patients undergoing Spravato treatment will begin to feel effects within four weeks, if not sooner. Learn more about Spravato efficacy.
NEW PATIENT INQUIRY
What to Expect When Getting Spravato
1. Plan Ahead
On the day of your appointment, you will be asked to fast for 2 hours prior to your scheduled arrival. In addition, you will be asked to stop consuming liquids 30 minutes before your appointment. This is because food and drink immediately before Spravato can cause an upset stomach in certain people. You will be sent a few status questionnaires to fill out by the RN administering treatment. Though not mandatory, you may want to consider bringing headphones to listen to a guided meditation, soothing playlist, or anything else that helps you feel at ease. Some people also prefer to wear a sleep mask during the sessions. If helpful, set an intention for what you hope to get out of treatment that day.
You made it! If the facilitator is not yet in front to greet you, just let reception know you’re here for your Spravato treatment and they will notify the appropriate clinicians. Use the restroom first if you haven’t, and the facilitator will take you to the treatment room to help you get comfortable.
3. Pre-Treatment Check-In
Before beginning Spravato treatment for the day, you will speak with your prescribing psychiatrist or psychiatric nurse practitioner (either in person or by Zoom) for a few minutes prior. Feel free to ask any questions you may have.
4. Blood Pressure Check
The facilitator will begin by checking your blood pressure. If everything appears to be in order, you’re ready to get started.
5. Dosing in 3 Parts
Spravato is administered nasally in 3 doses (only 2 doses for the first session), each 5 minutes apart. For example, if treatment begins with does 1 at 2:00PM, dose 2 will be administered at 2:05PM, and dose 3 at 2:10PM. Plan for the treatment to take 2 hours total.
6. Midway and End of Treatment Vitals
After the Spravato has been administered, all that’s left is to sit back and experience treatment for the next 2 hours. The facilitator will check your blood pressure again about forty minutes into treatment and will check a final time at the end of the 2 hours. Due to COVID-19, the facilitator observes via a video monitor from a nearby room and you can communicate with them at any point via the monitor. They can come into the room when needed. A physician or nurse practitioner is also on site throughout the session should any clinical emergencies arise.
7. Hooray! You did it!
After two hours, you’re done with treatment for the day. Be sure to take it easy for the remainder of the day. You’ll want to plan to have someone drive you home or use public transit and should refrain from driving for at least 24 hours.
Spravato treatment and experience varies from patient to patient. Most often, the experience is guided by patients’ own intentions and treatment goals. The facilitator will be on-site and nearby for the duration of your treatment to answer any questions you may have, or assist with other requests as needed.
Will my insurance cover the cost of the medication and the office-visit?
What can I expect to pay out of pocket for office visits?
How much does Spravato itself cost if I am paying privately?
Do you offer financial hardship or do single-case-agreements for Spravato?
How long will my first appointment be?
How frequently do I need to visit the office for Spravato treatment?
What is the experience like?
Spravato and COVID-19
We have been offering Spravato treatment throughout the pandemic so that people can continue to get the outpatient mental health treatment they need, with additional safety protocols in place. We ask anyone that has traveled or been in large gatherings to self-quarantine for two weeks before returning to the office. You will also fill out a Covid-19 screener before each visit to the office. You can read more about our COVID-19 policies on our blog.
Together we can make a difference
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