Spravato is FDA approved to treat adults 18 & over with treatment resistant major depressive disorder or those with major depressive disorder exhibiting acute suicidal ideation or behavior. Spravato is a self-administered nasal esketamine spray. It is always administered under the supervision of a health care professional. The spray mechanism itself is very similar to a nasal spray that would be used for a common cold or allergy symptoms.

Spravato targets the N-methyl-D-aspartate receptor to help reduce symptoms of depression in adults with treatment-resistant depression. The mechanism by which Spravato works is unknown but has been studied in a clinical program involving short- and long-term trials across more than 1,700 patients with treatment resistant depression that compared Spravato plus an oral antidepressant to a placebo nasal spray plus an oral antidepressant. These studies evaluated the efficacy and safety of Spravato, both short and long term for up to one year.

The main difference between Spravato and Generic Ketamine is that Spravato is FDA approved while generic ketamine, also known as compounded ketamine, is created at a compounding pharmacy and has not been approved by the FDA. Both Spravato and Generic Ketamine target the same receptor mentioned above and have shown to have very similar therapeutic effects. They are both administered as a nasal spray and all monitoring procedures stay the same for both medications. Generic Ketamine is NOT covered by insurance. However, the out-of-pocket cost is only around $50-$70 for a months' worth of medication. We typically only offer Generic Ketamine to patients who do not have insurance coverage for Spravato.

The total number of sessions is around 15 (can range also between 12-18) over the course of 2-3 months. This can vary depending on the patient and their treatment plan. All patients are evaluated by their clinician at the end of the treatment course to see if more sessions are needed. The typical schedule is listed below: Month 1 - 2x weekly Month 2 - 1x weekly Month 3 & beyond - taper/maintenance schedule determined by clinician.

Patients are not allowed to operate a vehicle to and from the office on the day of their appointment. They must arrange a ride due to the possible side effects that may affect mental alertness and motor coordination. Avoid eating at least two hours before the session and avoid drinking liquids 30 minutes before to limit nausea or vomiting. If patients take a nasal corticosteroid or nasal decongestant medicine, they must take these at least an hour before Spravato/Ketamine. Patients may wish to bring a book, blanket, headphones, iPad, or any other form of entertainment to each session as they will be in the office for a minimum of two hours during the treatment.

The length of treatment is around 2 hours. They will have their own room during the treatment with comfortable seating. The medication is self-administered; however, they will be monitored by an MD/NP. About 40-60 minutes into the treatment, an admin will come into the room and take the patient's blood pressure. Towards the end of the 2 hours, the patient's clinician will come in to do a final BP check and clear them to go home as long as they are feeling okay.

Our staff will work with you and your insurance company to determine if insurance will cover all or part of the cost of Spravato. Many insurance companies will cover a significant portion of Spravato treatment for FDA approved diagnoses. In many instances insurance requires authorization, and our staff will submit all necessary documents on your behalf. Medicare does not require any authorization. We offer generic ketamine treatment for patients without insurance coverage and have sliding scale options.

Increased blood pressure Bladder problems Dizziness/spinning sensation Nausea and/or vomiting Problems with thinking clearly and/or feeling disconnected from yourself, your thoughts, feelings and things around you Fatigue Feeling sleepy Lack of energy Feeling drunk Feeling anxious Decreased feeling of sensitivity (numbness) Feeling very happy or excited *Patient must notify clinician or staff immediately if they are experiencing any of these*

Clinical studies have shown improvement of depressive symptoms were demonstrated at four weeks of Spravato use with an oral antidepressant. Not all patients will respond to Spravato/Ketamine and the long-term side effects of treatment are unknown. We cannot know for sure whether it will be beneficial to you. If your condition does improve, it is possible that it will worsen again when the treatments are stopped.

Janssen is the company that manufactures and monitors our use of Spravato medication. Please see the link below for more information about Janssen.