SPRAVATO® and IM KETAMINE for Depression
SPRAVATO® is FDA approved for the treatment of RESISTANT DEPRESSION
We are proud to be one of the first SPRAVATO® Treatment Centers in the U.S. and the first in South Carolina. Since its FDA approval in 2019, we’ve seen its life-changing impact firsthand. With thousands of treatments completed, we rank among the most experienced SPRAVATO® centers in the country.
SPRAVATO® (esketamine) CIII Nasal Spray is indicated, in conjunction with an oral antidepressant (AD), for the treatment of treatment-resistant depression in adults.
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It is currently covered by BCBS, Medicare, Aetna, United, Humana, and Cigna often with as low as a $10 pharmacy co-pay for each treatment (with commercial insurance) as well as your regular specialist physician co-pay/deductible for each treatment.
For patients that do not have pharmacy coverage for Spravato® treatment, we offer in office, intramuscular (IM) ketamine. We bill your insurance for the physician/APRN/PA in office monitoring. The out of pocket IM ketamine treatment cost is $100 for the medication each session, which is not covered by insurance plans (this is in addition to billing your insurance for the in office treatment monitoring).
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Our recommended treatment protocol for major depression is 2x per week for 4 weeks followed by 1x per week for 4 weeks and maintenance treatments as needed. Patients are required to be in office and monitored by a physician for a minimum of 2 hours during the treatments and have a safe ride home. Patients cannot drive until they have a full night’s rest.
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To start treatment, give the office a call and specifically request for a Spravato®/ketamine intake appointment or have your psychiatrist/therapist/primary care doctor fax us a referral to (888)316-7716.
How Spravato Works
Esketamine (ESK), the S-enantiomer of racemic ketamine, is a nonselective, noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptor, an ionotropic glutamate receptor. However, the precise mechanism of action of ESK nasal spray in major depressive disorder (MDD) is unknown. The antidepressant pharmacologic action of ESK is thought to be similar to ketamine.
Spravato® Patient TESTIMONIAL: Grace’s Story
“I am in a better place than I have been — maybe ever.
I think that’s an amazing gift.”
— Grace K., Colorado Springs, Colorado
Grace, 29, is a real patient with treatment-resistant depression and has been compensated for her time and testimonial by Janssen Pharmaceuticals, Inc.
What does SPRAVATO & KETAMINE TREATMENT look like?
We strive to ensure that you have the best treatment session possible. To do this, we provide patients with a relaxing, therapeutic environment free from distractions and which is not overstimulating.
Our expert staff will be available throughout your 2 hour in office SPRAVATO® or ketamine treatment session to ensure that you receive the care and attention you need, as well as providing pre-care instructions, safety, and post-care advice.
Potential side effects include: increased blood pressure, nausea, sleepiness, fainting, dizziness, spinning sensation, anxiety, respiratory depression, or feeling disconnected from yourself, your thoughts, feelings, space, and time (dissociation). These side effects may occur right after treatment and typically go away the same day.
SPRAVATO® must be taken twice a week for the first four weeks. Treatment schedules will then shift to a weekly treatment every four weeks. Afterward, your healthcare provider will help you determine the best frequency for follow-up applications.
Preparing for Your Treatment
Pre-treatment preparation is one of the most important aspects of a successful SPRAVATO® or ketamine session. Coming into the clinic with an open mindset and a desire to transform negative thought patterns will aid your success.
Some helpful tips include bringing a book, tablet, or music with you to your session. Prepare a playlist of relaxing music that helps you get into the right mindset for treatment. Be open and honest with yourself about with objective for your session, setting your intentions for the session.
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Prior to treatment:
Get a full night’s sleep the night before.
Set your intentions for the session.
Advise your healthcare provider of any medications/vaccines/alcohol you may have taken before your SPRAVATO® or ketamine treatment session.
Avoid eating two hours before treatment.
Do not drink any liquids 30 minutes before your session.
If applicable, nasal corticosteroids or decongestant medications, blood pressure medications, anti-nausea medications should be taken at least one hour before SPRAVATO® or ketamine treatments begin.
Avoid controlled medications including opioids, stimulants, controlled sleeping medications, alcohol, recreational drugs, cannabis, and benzodiazepines a minimum of 12 hours before your treatment session to prevent risks and to ensure a safe, well tolerated experience.
After your Treatment
We require that you avoid driving, have a safe ride home, avoid operating heavy machinery, avoid taking care of young children alone, and avoid using controlled medications and alcohol after your treatment until the following morning.
Integration: We strongly recommend that patients be involved in psychotherapy and particularly, integration of the esketamine experience. Contact your provider at Sweetgrass Psychiatry to be established with a therapist to guide you in the days after your treatment session. Download a free integration workbook here: https://maps.org/integration-station/.
WHAT TO EXPECT
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Before Treatment
Your journey to healing begins with a comprehensive consultation and assessment. We'll carefully review your medical history, discuss your treatment goals, and answer any questions you may have.
For Spravato, we'll also verify your insurance coverage. Once deemed a suitable candidate, we'll work with you to create a personalized treatment plan and prepare you for your first session.
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During Treatment
Our comfortable, therapeutic spaces are designed to promote relaxation and minimize distractions. During your 2-hour Spravato or ketamine session, our expert staff will provide continuous monitoring and support, ensuring your safety and comfort throughout the experience.
We'll also discuss potential side effects and provide guidance on managing them.
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After Treatment
After your session, you'll need to arrange for a safe ride home, as driving or operating heavy machinery is not permitted until the following morning. We'll provide detailed aftercare instructions to ensure a smooth transition back to your daily routine.
Follow-up appointments will be scheduled to monitor your progress and adjust your treatment plan as needed.
Ask the Experts: What to Expect During Your SPRAVATO® Treatment
What are the differences between SPRAVATO
& IM KETAMINE?
While both Spravato and IM ketamine are effective for treatment-resistant depression, they differ in a few key ways:
Administration
Spravato is a nasal spray, while ketamine is delivered through an intramuscular injection.
Insurance Coverage & Cost
Spravato is more commonly covered by insurance compared with IM Ketamine.
FDA Approval
Spravato is FDA-approved for treatment resistant depression, whereas ketamine is used off-label for depression, anxiety disorders, and bipolar disorder.
Our expert team will guide you in choosing the most suitable treatment option based on your individual needs, preferences, and insurance coverage.
Room to Breathe…
Relax on our zero gravity reclining massage chairs in your own private treatment room.
Room to Hope…
Relax on one of our couches in your own private waterfront treatment room.
SWEETGRASS PSYCHIATRY
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SPRAVATO AND IM KETAMINE
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SWEETGRASS PSYCHIATRY · SPRAVATO AND IM KETAMINE ·
Meet Our Spravato® Expert
WILLIAM (BILL) RAYBURN, MD, MBA
Dr. Rayburn joined Sweetgrass Psychiatry with experience in educating and monitoring patients undertaking Esketamine (Spravato) therapy. His background and interests in new drug development, care for patients with depression, patient education, and clinical research make him a valuable addition to our group practice. His studies in his former research laboratory dealt with long-term effects from exposure to antidepressants and antianxiety medications on the fetal brain.
Dr. Rayburn is a former distinguished professor, associate dean, chair of Obstetrics and Gynecology, and chief of staff at the University of New Mexico in Albuquerque.
As a board-certified obstetrician-gynecologist, he continues to care for underserved women with complicated pregnancies.
Being a frequent invited lecturer, Dr. Rayburn is the recipient of several awards for his teaching, research, and many publications including 19 books. Current and recent past medical leadership positions have been in several national medical specialty, research, and education organizations.
Frequently Asked Questions
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Treatment-resistant depression refers to depression that hasn't responded adequately to at least two different antidepressant medications of adequate dose and duration.
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If you've been struggling with depression that hasn't improved with traditional treatments, you may be a candidate. Our team will conduct a thorough evaluation to determine if Spravato or ketamine therapy is right for you.
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While generally well-tolerated, Spravato and ketamine can cause temporary side effects such as increased blood pressure, nausea, dizziness, and dissociation. Our team will closely monitor you throughout your session and provide support to manage any discomfort.
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Each Spravato or ketamine treatment session typically lasts about two hours, including preparation, administration, and monitoring.
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The frequency of treatment will depend on your individual needs and response. Typically, Spravato is administered twice a week for the first four weeks, then weekly for four weeks, followed by maintenance treatments as needed. Ketamine treatment protocols may vary.
SPRAVATO® Important Safety Information
What is the most important information I should know about SPRAVATO®?
SPRAVATO® can cause serious side effects, including:
Sedation, respiratory depression and dissociation. SPRAVATO® may cause sleepiness (sedation), fainting, dizziness, spinning sensation, anxiety, or feeling disconnected from yourself, your thoughts, feelings, space and time (dissociation).
Tell your healthcare provider right away if you feel like you cannot stay awake or if you feel like you are going to pass out.
Your healthcare provider must monitor you for serious side effects for at least 2 hours after taking SPRAVATO®. Your healthcare provider will decide when you are ready to leave the healthcare setting.
Abuse and misuse. There is a risk for abuse and physical and psychological dependence with SPRAVATO® treatment. Your healthcare provider should check you for signs of abuse and dependence before and during treatment with SPRAVATO®.
Tell your healthcare provider if you have ever abused or been dependent on alcohol, prescription medicines, or street drugs.
Your healthcare provider can tell you more about the differences between physical and psychological dependence and drug addiction.
SPRAVATO® Risk Evaluation and Mitigation Strategy (REMS). Because of the risks for sedation, dissociation, and abuse and misuse, SPRAVATO® is only available through a restricted program called the SPRAVATO® Risk Evaluation and Mitigation Strategy (REMS) Program. SPRAVATO® can only be administered at healthcare settings certified in the SPRAVATO® REMS Program. Patients treated in outpatient healthcare settings (e.g., medical offices and clinics) must be enrolled in the program.
Increased risk of suicidal thoughts and actions. Antidepressant medicines may increase suicidal thoughts and actions in some people 24 years of age and younger, especially within the first few months of treatment or when the dose is changed. SPRAVATO® is not for use in children.
Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a higher risk of having suicidal thoughts or actions. These include people who have (or have a family history of) depression or a history of suicidal thoughts or actions.
How can I watch for and try to prevent suicidal thoughts and actions in myself or a family member?
Pay close attention to any changes, especially sudden changes, in mood, behavior, thoughts, or feelings, or if you develop suicidal thoughts or actions.
Tell your healthcare provider right away if you have any new or sudden changes in mood, behavior, thoughts, or feelings.
Keep all follow-up visits with your healthcare provider as scheduled. Call your healthcare provider between visits as needed, especially if you have concerns about symptoms.
Tell your healthcare provider right away if you or your family member have any of the following symptoms, especially if they are new, worse, or worry you:
Suicide attempts
Worsening depression
Thoughts about suicide or dying
Other unusual changes in behavior or mood
SPRAVATO® References
National Institute of Mental Health. Major depression. Updated February 2019. www.nimh.nih.gov/health/statistics/major-depression.shtml#part_155720. Accessed June 3, 2019.
National Institute of Mental Health. U.S. YLDs contributed by mental and behavioral disorders. www.nimh.nih.gov/health/statistics/disability/us-ylds-contributed-by-mental-and-behavioral-disorders.shtml. Accessed June 11, 2019.
Greenberg PE, Fournier AA, Sisitsky T, et al. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J Clin Psychiatry. 2015;76:155-162.
Department of Health & Human Services. Does depression increase the risk for suicide? www.hhs.gov/answers/mental-health-and-substance-abuse/does-depression-increase-risk-of-suicide/index.html. Accessed June 4, 2019.
Popova V, Daly EJ, Trivedi M, et al. Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression: a randomized double-blind active-controlled study. Am J Psychiatry. 2019;176:428-438.
Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163:1905-1917.
Spravato (esketamine) nasal spray, CIII [prescribing information]. Titusville, NJ: Janssen Pharmaceuticals; May 2019.
National Institute of Mental Health. Mental health medications. Revised October 2016. Accessed June 4, 2019.
Trivedi MH, Daly EJ. Treatment strategies to improve and sustain remission in major depressive disorder. Dialogues Clin Neurosci. 2008;10:377-384.
National Institute of Mental Health. Rapidly-acting treatments for treatment-resistant depression (RAPID). www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/rapidly-acting-treatments-for-treatment-resistant-depression-rapid.shtml. Accessed June 3, 2019.
Where EXPERTISE
meets EMPATHY
From meditation to medication management, we are available in-person or from anywhere in South Carolina.
Contact us at (843) 800-1303.