What is Spravato®?

Spravato® (Esketamine) is the first FDA approved prescription nasal spray for treatment of Treatment Resistant Depression (TRD) and Depressive symptoms in adults with suicidal actions or thoughts. It is used along with an oral antidepressant. 

What is ketamine? 

Ketamine is also used in a compounded formulation as an off label nasal spray or sublingually to treat patients with TRD.

Both Esketamine and  Ketamine and related formulations are thought to  work differently than other antidepressants,  by targeting  the NMDA (n-Methyl-D-Aspartate) receptors in the brain.  

What is Treatment Resistant Depression?

TRD is generally defined as depression that has failed to respond to “treatment as usual”. In other words, there has been inadequate response to use of antidepressant medications at adequate doses for an adequate amount of time, in the current depressive episode. In these instances ketamine therapy  is a safe and effective alternative that can bring rapid relief.

TRD with SI is severe depression with acute suicidal ideation. Use of ketamine can provide rapid relief from suicidal thinking.

Is ketamine right for me?

If you suffer from depression, then ketamine might be right for you. We invite you to call for an intake screening. In general you will have had to have had trials of at least two different antidepressants in two different classes for ketamine treatment to be considered. If screening suggests that ketamine might be right for you, we will schedule you for a comprehensive evaluation with either Dr. Johari or Dr. Graham-Brown. Prior to your meeting with the doctor, we will set up a patient portal account  through which you can provide information about your history and symptoms. During the consultation, the doctor will review your history, determine if Ketamine is right for you and further educate you about this treatment.

Does insurance cover ketamine?

Esketamine (Spravato®) is FDA approved for treatment of TRD and TRD with SI. It is covered by most insurance. If this treatment is right for you, our team will work with your insurance company to get prior authorization for treatment with this medication. There is usually little or no cost to you.

What to expect in treatment

Spravato® (Esketamine) is administered by nasal spray and must be given under the supervision of a doctor in a REMS- certified site. Stepping Stones Psychiatry, LLC is a Spravato® REMS- certified Healthcare setting.  

Stepping Stones Psychiatry LLC has several attractive and quiet areas where patients receive treatment. You will sit in a recliner that is screened off from other’s to ensure privacy. We provide a list of tips to aid in having a comfortable treatment session. These are discussed prior to starting treatment

Treatment  is administered twice a week for four weeks, and then weekly for four weeks. Treatment following the first eight weeks is customized according to patient response and need.

Each treatment session lasts for two hours during which our  staff will monitor your BP and comfort throughout the treatment.

Following administration of treatment patients can experience a sense of sedation, sleepiness, disconnection and dissociation. 

Patients may not drive until they have had a restful night sleep after administration of ketamine. They will need to be taken home by a responsible adult.

What is Spravato® REMS (Risk Evaluation and Mitigation Strategy)?

A REMS is a strategy to manage known or potential risks associated with a drug and is required by the FDA to ensure that the benefits of the drug outweigh its risks. SPRAVATO® (esketamine) nasal spray CIII is available only through a restricted distribution program called the SPRAVATO® REMS because of the risks of serious adverse outcomes resulting from sedation and dissociation caused by SPRAVATO® administration, and abuse and misuse of SPRAVATO®. SPRAVATO® is intended for use only in a certified Healthcare Setting. SPRAVATO® is intended for patient administration under the direct observation of a healthcare provider, and patients are required to be monitored by a healthcare provider for at least 2 hours. SPRAVATO® must never be dispensed directly to a patient for home use.

Stepping Stones Psychiatry LLC offers both Spravato® (Esketamine) and Ketamine therapy for the treatment of Treatment Resistant Depression.