Spravato Q & A
What is Ketamine?
Ketamine was originally developed in the 1960s and FDA-approved for use in anesthesia in 1970. It has been on the World Health Organization’s Essential Medications List since 1985. It works as an NMDA receptor antagonist which strongly effects the neurotransmitter glutamate. Changes in glutamate along with other neurotransmitters can signal the formation of new connections as well as re-wiring of existing connections between nerve cells in the brain; a change commonly referred to as neuroplasticity.
What is Spravato?
Medical professionals are finding more and more uses for ketamine. In 2019, the FDA approved the medication Spravato (esketamine nasal spray). Esketamine is a different version of racemic ketamine that is administered intranasally.
The FDA has only approved of two indications for Spravato and it must be used in conjunction with an oral antidepressant:
- Treatment-resistant depression in adults.
- Adults with Major Depressive Disorder with acute suicidal ideation or behavior.
Where can I find Spravato?
Spravato should only be administered in a REMS-certified Spravato Treatment Center. Our facility is a REMS-certified facility. The FDA requires that Spravato be administered in a REMS-certified facility and that the patients remain in the office for at least two hours on treatment days.
Is Spravato right for me?
Every new patient is evaluated in the same way in our practice and all routes of administration of ketamine are discussed. Some considerations unique to Spravato include:
- The medication is very expensive. You may be eligible for insurance coverage or patient co-pay assistance programs if you are taking an oral antidepressant and have treatment-resistant depression or Major Depressive Disorder with suicidal ideation or behavior.
- The initial treatment protocol requires treatment two days/week for weeks 1-4, then treatment one day/week for weeks 5-8. You will need to take time off of work and have a driver take you home after each treatment. Maintenance therapy with this medication requires treatment once per week or once every other week. This is a significant amount of time to take off of work and some patients are not able to follow this protocol.
- Prior authorization must be done by your primary care provider or psychiatrist. We do not complete prior authorization requests in this practice.
- Compared to the bioavailability of IV ketamine (100%) and IM ketamine (93%), the bioavailability of Spravato is approximately 45%.
More information about Spravato can be found on their website: https://www.spravato.com
How soon after a ketamine treatment will I feel better? How long does it last?
Patients receiving ketamine treatments can report “feeling better” during the ketamine treatment and can often sustain that feeling well after the medicine has been metabolized and eliminated from the body. “Feeling better” can be a subtle change and you may notice an improvement in your day-to-day function before you notice an improvement in your mood or pain. This effect has been reported to last from a few hours up to several weeks. When used in conjunction with other treatment modalities, the results can last up to several months or longer. Ketamine therapy is not a cure; however, it can be used to facilitate long-term change and transformation. Ketamine therapy is often paired with additional psychological support before, during and after the actual medicine session. Ketamine therapy used together with psychotherapy can help strengthen the benefits from ketamine therapy alone.
How safe is ketamine therapy if done in a physician office setting?
Ketamine is often referred to as a “dissociative” anesthetic and it has been used with a wide margin of safety in a variety of medical settings for more than 50 years in adult and pediatric anesthesia as well as in veterinary medicine. How ketamine is used and by whom determines how safely this medication can be used in the outpatient setting. Advanced training on how work with ketamine can vary considerably amongst ketamine clinics and providers. Dr. Stefany Wolfsohn is a board-certified anesthesiologist with additional mental health, trauma and psychedelic medicine training. She has administered ketamine to tens of thousands of patients over the span of her anesthesia career and to thousands more in her ketamine clinic. She has maintained ACLS certification, equipment for monitoring as well as a crash cart with emergency airway equipment and medications for all services performed in the practice.
How does ketamine therapy get incorporated into a comprehensive treatment plan?
Anyone can call to inquire about ketamine infusion therapy. Before initiating treatment, a plan must be set in place to optimize the possibility of successful treatment. At Ventura Center for Advanced Therapeutics, all patients start with a consultation before treatment is offered. During this time, a medical and mental health assessment are done and previous medical records are reviewed. Patients are given mental health screening inventories to help evaluate the presence and severity of common symptoms treated with ketamine. A complete mental health evaluation needs to be done prior to your consultation by the referring provider. Information about ketamine therapy, routes of administration, informed consent including risks / benefits / alternatives to ketamine therapy, treatment protocols, and adjunctive therapies are discussed. Communication with new and/or your existing mental health providers is established to coordinate care. A supportive family member or advocate is also encouraged to participate in this process.
Are there side effects with ketamine therapy?
Patients are monitored closely throughout the infusion process and additional psychological support is provided to help patients navigate challenging ketamine therapy experiences should they arise. The presence of medication side effects depends on the dose of ketamine given and the frequency of use. In general, the side effects of ketamine therapy are mild and not every patient experiences them. Some side effects are anticipated and can be easily treated at the time of infusion such as anxiety, headache or nausea. Other side effects that could occur during a treatment include increased heart rate and blood pressure, respiratory depression or a deeper level of dissociation than intended. Although all patients are pre-screened to assess the likelihood of these side effects from occurring, on the rare occasion they do occur, treating them with oral or IM medications can be effective. The most common side effect following ketamine treatment is feeling tired for a few hours. Long-term side effects are not commonly reported by experienced ketamine providers and it is important to choose a ketamine provider who is maintaining a high standard of care.