SPRAVATO TREATMENT

Spravato™ is the brand name for the prescription medication, esketamine. Esketamine, the S-enantiomer of racemic ketamine, is a nonselective, noncompetitive antagonist of the NMDA receptor. The NMDA receptor is an ionotropic glutamate receptor. Abnormalities in the glutamatergic-signaling pathway, along with other synapses in neurocircuitry, play a role in the modulation of moods and emotions. However, the precise mechanism of action of esketamine as an antidepressant drug is unknown.

The United States Food and Drug Administration approved Spravato™ in March 2019 for use in adults aged 18 years and older.

Spravato™ must be administered at a Spravato™ REMS certified health care center such as Cornerstone Psychiatric Care.

Spravato™ is not for use as a medicine to prevent or relieve pain (anesthetic or analgesic).

Unlike oral antidepressants, which can take anywhere from 6-12 weeks or more to show an improvement in symptoms, Spravato™ is the only FDA approved medication that clinical trials have shown to improve depressive symptoms, including suicidality, within two to four hours after single dose administration.

In addition, during the clinical trials a continuous maintenance treatment with a combination of Spravato™ with an oral antidepressant showed greater than 50% improvement in patients' symptoms, with fewer relapses and higher incidence of remission.

Patients interested in Spravato™ treatment must schedule a consultation at Cornerstone Psychiatric Care, with Jessica Shepley, MSN, APRN, PMHNP-BC, FNP-BC, CRNI who is a Spravato™ and ketamine specialist. During the initial consultation, Jessica will work on identifying whether you are a good candidate for Spravato™ treatment.

The present requirement is to have a diagnosis of treatment-resistant depression (i.e failed to show improvement in depressive symptoms with 2 or more oral antidepressants). However, your insurance company may require additional criteria.

Patients administer the Spravato™ nasal spray themselves under the supervision of a healthcare professional at a certified Spravato™ treatment center, such as Cornerstone Psychiatric Care. Following this, patients will stay at the certified Spravato™ treatment center for 2 hours so they can be monitored for side effects. You will need to plan for rides to and from the certified Spravato™ treatment center as you should not drive or operate machinery until the day after a treatment session, following a restful sleep. You may want to bring a book, a relaxing playlist, or another form of entertainment for the two hour monitoring period after treatment. Cornerstone Psychiatric Care will guarantee that all patients receiving Spravato™ will be in a comfortable and private room.  Additionally, family members can choose to be present during the full time of treatment if they so desire.

Spravato™ is taken twice a week for the first four weeks. Then, the Spravato™ treatment dosing is adjusted to once a week for another four weeks. After this, treatment is provided at either weekly or biweekly intervals.  Some patients may be able to stop Spravato™ after the first eight weeks of treatment. During the clinical trials, patients who stayed on Spravato™ longer tended to do better than those who stopped the medication sooner.

The most common side effects reported during the clinical trials for Spravato™ include dissociation, or what can be described as “an out of body experience,” dizziness, nausea, sedation, reduced sense of touch and sensation, anxiety, lack of energy, temporarily increased blood pressure, vomiting and the sensation of being intoxicated.

It is important to remember that these are not the only possible side effects, just the most commonly reported. Each patient's experience may be different. Because of the possibility of these side effects, patients must stay at Cornerstone Psychiatric Care for two hours following Spravato™ treatment. For most patients, most if not all side effects will have subsided after two hours. During the Spravato™ clinical trials, less than 5% of patients discontinued treatment due to side effects.

The pharmacy cost of Spravato™ can be as low as $0 or as high as the unmet insurance deductible cost if you have government-issued insurance. For commercial insurance plans, we work closely with a local pharmacy that offers a coupon for as low as $10 for the full length of treatment.

The cost of the office visit for your Spravato™ treatment varies by insurance plan and can be as high as the unmet insurance deductible cost.