About Spravato and Ketamine Treatment
Spravato (generic name: esketamine) and ketamine are new treatment options for treatment-resistant depression that offer an exciting, different mechanism of action from traditional antidepressants. As a result, they medications can help existing treatments be more effective. There are numerous and very positive studies that have demonstrated conclusively that the two medications are effective in treating depression where other efforts have failed to fully resolve the problem. The FDA has approved Spravato specifically for treatment resistant depression.
There is also strong evidence that these two medicines are effective at reducing suicidal thoughts ("ideations"), and there is growing evidence that they may be effective in treating other psychiatric disorders as well.
Based on this evidence, we have begun using Spravato and ketamine in our office to help treat difficult depressions. However, we have elected to use protocols that may be more rigorous than other ketamine providers or clinics. This does not make treatment harder or more difficult to get. It just means we have certain safeguards that we have elected to use to improve safety and positive outcomes. These include the following.
Ketamine is administered in our offices only.
A psychiatric MD (Dr. Dull) is present on site and supervises each treatment.
Dr. Dull is there to manage any medical or emotional complications that occur during treatment. There may be exceptions ocasionally when I am not available due to illness or I have to be away. However, if I am not there, then one of our nurse practitioners will be, and I am available at all times by phone in such instances.
Spravato therapy guidelines have rigorous treatment protocols and requirements. Ketamine therapy does not have the same requirements and therefore far fewer safeguards are required. We treat with ketamine and Spravato according to the same exacting Spravato protocol.
You will meet with a medical practitioner to review your medical history, fill out questionnaires, procure appropriate lab studies and obtain insurance authorizations.
If there are no findings that would make treatment unsafe, then we will begin arrangements to procure the medication.
Once the medication is approved we will order your medication to be shipped to the office. We prefer the use of Spravato, but sometimes insurers will refuse to pay for Spravato. In that case, we can discuss whether the use of Spravato or generic ketamine makes more sense. Please do not be discouraged if generic ketamine is needed, because there is not conclusive evidence that generic ketamine is less or more effective than Spravato.
In the event it is decided that generic ketamine is preferable, we will place you in contact with a special pharmacy that prepares a ketamine compound we can then use to start treatment. The cost is substantially less than Spravato (when Spravato is purchased without insurance).
As a rule, treatment will last for 8 weeks. All treatments take place in our office and take about 2 hours each. Weeks 1-4 involve twice weekly treatments. The subsequent 4 weeks will require one treatment per week. In some instances, it is advisable to continue treatment beyond 8 weeks. In others, 8 weeks of treatment are effective. We will decide together what makes the most sense for you.
During the two hours of treatment you are here, we will monitor your well being and provide for needs that arise. We will measure you blood pressure on three separate occasions. You will have medications with you in the event your blood pressure becomes too high (rare) or you become very anxious (again, unusual). Once treatment has ended, you will need a driver to take you home. You may feel a bit tired and may notice mild impairments in concentration or coordination.
Please bring to each appointment comfort items and the medications we have prescribed. Consider also bringing ear pods/phones, a music source, a journal, a book, a blanket and pillow, and snacks. We have drinks and snacks on site, but you may have favorites that we don't have. The point is that you have available the means to allow you to relax and be unimpaired by distractions.