What is SPRAVATO (esketamine) for Treatment-Resistant Depression?
We see a significant improvement or reduction in depressive symptoms at Sanford SPRAVATO Clinic.
At Sanford Behavioral Health, we have a history of adapting to the needs of our patients and the community in Greater Grand Rapids, Michigan. Given the depth of our collaborative care team, we saw an opportunity to serve a larger population of patients with treatment-resistant (TRD) depression at our behavioral health campus in Marne. The Sanford SPRAVATO (esketamine) Clinic enables us to provide life-changing and potentially life-saving treatment to more patients in West Michigan. New patients seeking innovative care, those referred by an outpatient psychiatrist or their primary care provider, and current Sanford patients can utilize the Sanford SPRAVATO Clinic.
What is SPRAVATO (esketamine)?
SPRAVATO (esketamine) is an FDA-approved prescription nasal spray medication. It works by binding the NMDA receptors in the brain; the interaction between the NMDA receptors modulates glutamate signaling. Glutamate, which plays a role in depression, is a “chemical messenger” that sends messages between nerve cells in the brain.
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SPRAVATO, the only FDA-approved nasal spray for adults with treatment-resistant depression, reduces depression symptoms when two or more oral antidepressantsย haven’t worked.
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SPRAVATO can be taken with or without an oral antidepressant.
Is SPRAVATO Treatment Right for You?
The FDA has approved SPRAVATO for treatment-resistant depression, which means a client has been depressed and has been taking a minimum of two antidepressant trials for 12 weeks without improvement in symptoms. So, SPRAVATO is not a first-line approach; an individual must try other modalities and meet the criteria. At Sanford SPRAVATO Clinic, we see a significant improvement or reduction in depressive symptoms, subjectively, from patients, and objectively, from screening tools for depression like the Patient Health Questionnaire 9 (PHQ-9).”
We use a higher threshold for treatment with patients who have a history of substance use because of the potential risk of misuse. At the initial appointment, a psychiatric assessment determines whether SPRAVATO is appropriate. If SPRAVATO is not the right treatment path for you, we can still support you through our Outpatient Psychiatric Services.
Sanford Clinical Manager Hilary Fowler, MSN, PMHNP, CPNP, says, “Spravato should be taken under the auspices of a doctor’s care.ย It is not a safe practice to combine medications, alcohol, or other drugs with SPRAVATO treatment. For that reason, it is not self-administered outside the clinic at Sanford. SPRAVATO must be administered under the guidance of a REMS-qualified facility, which the FDA mandates. A REMS facility is certified to administer a drug that has a risk evaluation and mitigation strategy. Simply put, SPRAVATO is safe under the guidance of a provider when you meet appropriate criteria and when it is administered by a REMS facility that monitors results.”
What to Expect at the Sanford SPRAVATO (esketamine) Clinic
Once you call our welcoming admissions specialists, you will have a brief prescreen process, which includes questions about whetherย you have a depression diagnosis. During theย prescreen,ย we ask if you have a treatment-resistant depression diagnosis and some basic questions about yourย mental health.
SPRAVATO (esketamine) treatment criteria:
- Designated Driver:ย We also ask if you have somebody to accompany you to these treatments. We must see the driver pick the client up and take them home, as SPRAVATO may cause sleepiness or dizziness.
- Scheduling 1:ย Once you finish the prescreen, we will schedule an initial evaluation with our psychiatrist, which can be virtual or in person.
- Appropriateness:ย At the initial appointment, a Sanford provider will determine whether SPRAVATO is appropriate for you. If it is, we will begin the pre-authorization process.
- Psychiatric Care: If SPRAVATO is not the right treatment path for you, we can still support you through our Outpatient Psychiatric Services.
- Pre-Authorization: If approved for SPRAVATO, the treatment team will begin working with you and your insurance to get authorization for coverage. The timeliness of this process can vary depending on your insurance provider. We make sure you are informed throughout the entire process.
- Scheduling 2: We order medication and set your schedule. Sessions are usually two times a week for four weeks and weekly thereafter.
When you arrive for treatment:
- The first thing you will do is fill out a PHQ-9 form, which indicates the severity of a patient’s depression. You will fill out a PHQ-9 at every treatment appointment, which helps measure the efficacy of the treatments.
- We take your vitals (temperature, blood pressure, etc.), give you a drug screen and pregnancy test (if appropriate), and you will receive your doses ofย SPRAVATO (esketamine)ย CIII nasal spray.
- You will recline comfortably in a chair and self-administer your dose under the supervision of a Sanford-trained healthcare professional. Doses are 5 minutes apart, and the healthcare professional will check on how you are feeling after administering them. A trained professional will monitor you (without disrupting you) throughout, and there will be another vitals check at the 40-minute mark. Each session is 120 minutes at minimum. Vitals are taken again at the end of each session.
- We decide when you are ready to leave the healthcare setting.
- We encourage you to bring headphones so that you can listen to music during your treatment session and relax. The room is very comfortable and dark, and we may use essential oils to enhance the feeling of well-being.
- How you feel during treatment is patient-dependent. Sanford providers say they mostly see individuals who are relaxed or tired.
Response Time and Significant Results
The response to treatment is fast; usually, within 24 hours of the initial treatment, patients report a reduction in symptoms, sometimes a significant reduction in suicidality. Suicidal ideation is a danger with depression and treatment-resistant depression. Another promising benefit of SPRAVATO is its potential as an alternative to medication. Our clients can potentially come off years of medicines that have not been helpful once they become stable on SPRAVATO.
Hilary Fowler says, “The most exciting thing about SPRAVATO is that we can get clients who are unsafe and have chronic suicidality to a point where maybe for the first time in their lives, they’re having a remission or significant reduction in those feelings. I am treating a client who has been struggling with co-occurring depression for their entire life. Thus far (they started SPRAVATO treatment in November), we’ve seen a significant reduction in suicidality and self-harm urges.”
For more information on the Sanford SPRAVATO (esketamine) Clinic, CLICK HERE.
If you or a loved one is struggling with addiction, eating disorders, co-occurring mental health conditions, or daily functioning, donโt wait to change your life for the betterโ click the link below to speak with an admissions specialist today. Our programs are varied, including 3-hour, 3 times per week intensive outpatient programs.
