Major depressive disorder (MDD) is a serious and life-threatening condition. Over 16 million people in the United States and over 300 million people worldwide have depression, and patients with MDD may be unable to work, maintain relationships, attend to self-care, and in the most severe cases may become hospitalized or attempt or commit suicide. About 30 to 40% of patients with MDD fail to respond to first-line treatments including oral antidepressant medications of all classes (selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), etc.) and/or psychotherapy. In addition, the onset of treatment response for these modalities, even when effective, often takes at least four weeks, leading to greater suffering, expense, and risk. Spravato (esketamine) is the S-enantiomer of racemic ketamine, and is a non-selective, non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor, an ionotropic glutamate receptor.
The doses of Esketamine used in psychiatry are a fraction (10-25%) of the doses of similar medications used in anesthesia procedures, and therefore this can be effectively used in an outpatient setting. Even in smaller doses, however, this medication is a potent psychotropic agent, and therefore cannot be used by patients at home. Patients must come to the clinic and be monitored for the development of potential side effects. In addition to safety, this cutting-edge practice aims to prevent Esketamine misuse or abuse.
Potential side effects of Esketamine include a dissociative experience, a brief increase in blood pressure, dizziness and nausea. Patients are advised not to drive for the rest of the day of treatment, but they are allowed to drive after restful night of sleep. They should make the necessary arrangements for transportation after each treatment.
There is extensive safety data when it is used sporadically for anesthesia. There is also good data on the safety of using it for several years for pain control, at doses comparable to those used for the treatment of psychiatric disorders. There is also significant evidence that long-term abusers may develop serious side effects such as cystitis (a painful inflammation of the bladder) and cognitive problems. However, abusers typically use between 1,000-5,000 mg several times a week. Psychiatric patients will rarely receive more than 168 mg a week.
We encourage you to follow the links below. Educate yourself about Spravato through the literature and informative videos on the Spravato websites. Initiating treatment with Spravato is a more involved process than some other treatment options. Please review and decide if the process is something that is feasible for you before you schedule your consultation.