SPRAVATO® (Esketamine) Treatment - Hope for those who struggle with severe depression
“I feel like I am in a tunnel with no light at the end of it.”
“Getting dressed or leaving the house is an enormous effort."
“On any given day or time, I break down and cry for no reason.”
Does this sound like what you are feeling or experiencing? Have you tried talking with a therapist? Or tried different medications from your healthcare provider? …. but nothing seems to help?
You may be suffering from “treatment-resistant depression.” However, there is hope! At the Rochester Center for Behavioral Medicine, we offer a SPRAVATO® Treatment Resistant Depression Clinic that can help you feel better and engage in the activities you once enjoyed, while completing tasks of daily living.
Major Depressive Disorder (MDD) is one of the most common mental health disorders in the United States. Treatments such as psychotherapy, medication management, and lifestyle changes may help relieve symptoms. However, other individuals may have Treatment-Resistant Depression (TRD) and continue to experience symptoms such as persistent feelings of sadness, sleep disturbances, low energy, and thoughts of death or suicide despite trying multiple treatments.
SPRAVATO® is the first nasal spray medication specifically for adults with treatment-resistant depression who have tried antidepressants and augmentations but have not had success in symptom relief. As of February 2025, the FDA has approved SPRAVATO® as monotherapy for adults living with treatment-resistant depression (TRD).
Taken along with an oral antidepressant, SPRAVATO® is the first nasal spray medication that treats depressive symptoms in adults with major depressive disorder with suicidal thoughts or actions. At RCBM, we have observed an overall decline in the depressive symptoms of our patients during the first two years of treatment with SPRAVATO®.
“How can I enroll in the SPRAVATO® Program?”
There are several ways to become a SPRAVATO® patient. If you are a current patient at RCBM and are seeing a prescriber, you may discuss SPRAVATO® with your prescriber during your appointment, and they will determine if SPRAVATO® is the right course of action for you. If so, they will submit a referral form to our program. The SPRAVATO® team will review your case for eligibility, considering both medical and insurance factors, and discuss any concerns with your provider. If eligible, you will receive an email from our team detailing your case, insurance requirements, how to obtain cost information, the authorization process with insurance, and general information about SPRAVATO®.
If you are not a current RCBM patient but are seeking SPRAVATO® at our facility, you may either have your prescriber submit a Healthcare Professional Referral Form on your behalf or complete a Patient Interest Form for Spravato Treatment yourself, both of which can be found on our website. Once we receive your referral form, you will be contacted by our SPRAVATO® department via phone call. Most cases require an initial evaluation with one of our dedicated SPRAVATO® prescribers at RCBM.
You will not qualify for SPRAVATO® if you have:
- A blood vessel disease (aneurysmal disease)
- Abnormally connected veins (arteriovenous malformation)
- History of bleeding in the brain
- An active substance use disorder
- HIV
Or in addition, are:
- Allergic to esketmine, ketamine, or any other ingredient in Spravato
- Pregnant or planning to become pregnant
Clearance may be required if you have certain cardiac conditions, liver impairments, or a history of mania/psychosis.
How long are treatment sessions?
Treatment sessions are conducted in-office and last 2 hours. You will be monitored by staff throughout the session, and your vitals will be taken at regular intervals. Due to side effects of the medication, all patients are required to have a ride home from the treatment session and are prohibited from driving or operating heavy machinery for the remainder of the day and after a night of rest.
There are 2 phases of treatment: Induction and Maintenance.
· Induction indicates the start of your SPRAVATO® treatment and is as follows: 4 weeks of twice-weekly treatment with at least 1 day in between treatment sessions.
· Maintenance indicates your continued SPRAVATO® treatment and is as follows: once weekly treatment weeks 5 - 8; weeks
· 9+ weeks treatment schedule is determined by you and your prescriber and can be once weekly, once every other week, once every 3 weeks, or an alternative schedule.
Adhering to the SPRAVATO® induction schedule is essential to achieve the rapid antidepressant effects shown in clinical trials, help the brain adjust to the medication steadily and effectively, and prevent symptom relapses. Therefore, it’s essential to ensure that your schedule can accommodate the SPRAVATO® treatment schedule.
“What happens during treatment?”
The duration of your visit will take place in a private treatment room equipped with a recliner, a guest seating area, and amenities such as a blanket, pillow, fan, and sound machine. After administering the medication under the observation of a technician, you may experience an array of side effects, including but not limited to:
- Dissociation (Things may feel slowed-down or dream-like; you may feel disconnected from your body, or feel like an observer/spectator to your self)
- Sedation
- Dizziness
- Nausea
- Spinning sensation
- Numbness
- Feeling anxious
- Lack of energy
- Increased blood pressure
- Vomiting
- Feeling “drunk”
- Headache
- Feeling very happy or excited
If side effects occur, they typically appear immediately after SPRAVATO® administration and usually subside by the end of the treatment session. Less than 7% of patients discontinued SPRAVATO® treatment due to side effects in both short-term and long-term clinical studies.
A SPRAVATO® technician will obtain your blood pressure and heart rate at three different intervals during the treatment session. Blood pressure at the start of treatment and discharge must be below 140/90, as blood pressure commonly increases during sessions. A SPRAVATO® medical provider will also visit you to discuss side effects and address any questions or concerns you may have.
There are no required activities to be done during a SPRAVATO® session. Administering the medication is the extent of what is required to receive a (potential) benefit from Spravato. There are, however, activities that may provide additional benefit, such as:
- Listening to guided therapy/meditation sessions
- “Spravato playlists” on Spotify, etc.
· Patients are welcome to bring items to sessions that may help them feel more comfortable during treatment, provided they do not distract the surrounding staff or patients.
All patients must acknowledge receipt of a ride confirmation before arriving for a treatment session. Upon treatment end, patients are discharged to their ride.
You will have regular follow-ups with your RCBM prescriber to discuss the effectiveness of SPRAVATO® treatment and determine a continued treatment plan. It is recommended that you keep a journal of your experiences, both during and outside of treatment, to assist your provider with these evaluations.
Why should I have treatment at the RCBM program?
- We have private treatment rooms.
- Our program offers several amenities that many programs do not
- Our staff is kind and attentive
- Our program operates efficiently from referral through treatment
- Our patients have had great success in their treatment
Here is what our patients have said about our SPRAVATO® Treatment Resistant Depression Clinic
"It felt like it began working the first day. The excitement I felt after my first treatment, for not experiencing any of the negative side effects was amazing. Since starting, I feel much more relaxed and clear about my thoughts and emotions."
"It has helped my depression enormously. Before Spravato I wasn’t very hopeful but now I’m extremely hopeful."
"The staff is absolutely wonderful and makes treatment a pleasant time. I usually have anxiety, but the staff is so welcoming and friendly that I don't feel any anxiety when doing my treatment or calling the office."
"Well coordinated program - should be the model for other programs or eventually Spravato administration specific practices."
