How is SPRAVATO® (esketamine) different from Ketamine?

Ketamine infusions use something called Racemic ketamine. It is a mixture of two mirror-image molecules: "R" and "S" ketamine. While it was approved decades ago as an anesthetic by the FDA, it is used off-label (not FDA approved) to treat depression.

SPRAVATO® is the brand name for the drug esketamine.
Esketamine is derived from ketamine by isolating only the "S" form of the molecule. It is more potent than racemic ketamine, can be given at lower doses, and can be administered through a nasal spray. It is absorbed rapidly and takes effect quickly. No needles or intravenous catheters are needed. 

 

Esketamine is the ONLY FDA approved form of Ketamine for treatment of depression. This
means it had to pass rigorous tests of safety and effectiveness and demonstrate real results.
There is a safety program called “REMS” that we must use when treating patients with Spravatofor depression, assuring that any risks to you are minimized.

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Is SPRAVATO® a psychedelic, like psilocybin?
Ketamine and esketamine are hallucinogens. They produce an effect known as dissociation and may make it seem temporarily as though time, place and person are distorted. Most patients describe this as a generally pleasant experience. The effect peaks around 40 minutes after the dose is given and is mostly worn off after two hours. Generally, people do not experience hallucinations such as seeing or hearing things that are not there.

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How does esketamine work to treat depression?
Esketamine is different from all of the antidepressants we have had up to this point. All
antidepressants including SSRIs, SNRIs, tricyclics, MAOI, and others, work on monoamine
neurotransmitters including serotonin, norepinephrine, and.or dopamine, in some
combination. Esketamine is very different because it blocks NMDA receptors, increasing levels of glutamate and activating AMPA receptors in the brain. These neurotransmitters appear to help the brain generate new pathways and connections. We think this is how esketamine helps mood and also why patients often tell us they feel like they have a “new perspective on things” after treatment.

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Will I still need to take my antidepressant?
The clinical trials demonstrating the effectiveness of esketamine for depression included
patients taking at least one oral antidepressant. So you will either continue taking the
antidepressant you are already established on, or you will start a new one before starting

esketamine treatment. The doctor will discuss this with you at the time of your initial
assessment.

 

Can I take esketamine on my own?
Esketamine (SPRAVATO®) is administered in our treatment center under medical supervision. You receive 2 or 3 doses of the medication spaced about 5 minutes apart and then you remain under doctor supervision for 2 hours until any potential side effects have passed. During this time we will monitor your blood pressure and monitor you for any signs of side effects. For safety reasons, you do not take the medication home and self-administer it. We do not recommend or support the use of at home ketamine (such as lozenges or any other form) as the safety and effectiveness of these methods have not been studied and there are serious potential risks.

 

What are the potential side effects?
The most common side effects of esketamine are Drowsiness, Increased blood pressure, and Dissociation. Less common are nausea, dizziness, and headache. The side effects tend to peak at 40 minutes and wear off within two hours of treatment. You can expect the most intense side effects during the first two treatment sessions. There are other, less common side effects. For a complete list of possible side effects, click here.
 

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How many treatments will I need?
We recommend that you begin with two treatments per week for four weeks. After that we
reassess things and make a decision together about how to proceed. Some patients will step
down to one treatment a week for another 4 weeks, then to every other week. After the initial
4 weeks (8 treatments) each case is individual and your treatment plan will be decided together with your doctor.

 

Will my insurance cover the treatment?
Since SPRAVATO® is well studied and FDA approved as a treatment for depression, it is usually covered by insurance. Depending on your specific plan and benefits there are different ways it may be covered and there might be a co-payment that you will be responsible for. Our experienced staff will help you find out whether your plan covers SPRAVATO® treatment and what to expect as far as costs.

 

Can I drive myself to and from the treatments?

Because of the side effects of drowsiness and dissociation, you will need someone to drive you home from the treatments and you should not drive, operate machinery, or engage in any decision making or work that requires you to be sharp and alert until you have had a full night’s sleep.

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Will I have privacy during treatment?
We have designed our state-of-the-art treatment center to make your experience comfortable and private. You will be in a private “pod” with a comfortable recliner, and dimmable lighting.

Our experienced clinical staff will make you as comfortable as possible and will monitor you
along with the doctor on site throughout your treatment.

 

Do you offer ketamine-assisted therapy?
We have therapists on staff who can do individual psychotherapy after the treatment and we
are also starting a therapy group for people being treated with esketamine for depression.
These options are available if appropriate and clinically indicated.