Who Can Take Spravato?
Rochester Holistic Psychiatry is happy to offer a new way to help with treatment resistant depression at our clinic: Spravato. Check out more about Spravato here, here, and here.
Spravato is a controlled substance, and the FDA requires that it be given through a risk evaluation and mitigation strategy (REMS) to promote the best results and minimize any problems. REMS programs keep patients informed on how to use medications as well as their medical teams on prescription protocols so that the patients can have the best care plan possible. The Spravato REMS program mandates that healthcare facilities that administer Spravato be certified to do so. Spravato is not available for purchase and the patient does not take the drug away from the facility.
The active drug in Spravato is called esketamine. Esketamine is a enantiomer of ketamine, meaning that esketamine is found in ketamine but they are not the same drug. Enantiomers can appear as mirrors of each other but will have different effects in the body because of their different chemical structures. Ketamine and its enantiomers have a background as anesthetics and sedatives, often used in veterinary practices. Ketamine also has a history as a “street” drug, frequently abused.
Much study and experimentation has been conducted to discover esketamine, its functions, its possibilities for medically beneficial use, and bring those results to suitable patients. Let’s take a look at who can take Spravato.
Spravato is only available to adults over 18 years old. We are unsure if it will ever be available to minors, but we will continue to monitor the latest research and abide by the FDA’s most current REMS program.
To receive Spravato, the patient must have major depressive disorder (MDD). They must have treatment resistant depression that has not gotten better or has stopped getting better with other treatment methods like pharmaceuticals. To be classified as treatment resistant depression, the patient must have seen no relief with at least two antidepressant medications. Spravato is taken in conjunction with at least one oral antidepressant medication. The patient must have not responded to treatment with at least two antidepressants from different classes within four weeks of evaluation.
The patient must feature acute suicidal ideation or behavior along with their depressive symptoms, like feelings of sadness, guilt, and withdrawal. These symptoms must have been moderate to severe within the last 30 days before being evaluated for treatment with Spravato.
The patient must have a baseline score on a clinical assessment such as the Hamilton Rating Scale for Depression (HAMD17), the Quick Inventory of Depressive Symptomatology (QIDS-C16), the Montgomery-Asberg Depression Rating Scale (MADRS), or the Patient Health Questionnaire (PHQ-9).
The antidepressants that may be prescribed with Spravato include these:
Escitalopram (Lexapro)
Mirtazapine (Remeron)
Amitriptyline (Elavil)
Bupropion (Wellbutrin)
Spravato is administered as a nasal spray, so it is important that the patient’s sinus system be clear and healthy. Some patients may need to take a nasal corticosteroid or nasal decongestant like oxymetazoline (Kovanaze). These should be taken at least one hour before taking Spravato.
Everyone deserves help, but unfortunately, we cannot give Spravato to people who have a history of abusing ketamine or similar drugs. We cannot accurately evaluate the efficacy or safety of this drug when it comes to the bodies of these patients.
A patient taking Spravato, along with their care team, will work with the treatment schedule for the drug. For the first four weeks of receiving Spravato, the patient will get 56 mg or 84 mg twice a week according to their care plan. Starting on the fifth week, the frequency of administration is reduced to once a week. The dosage and frequency will be consistent through week eight, and during week nine, the patient will receive 56 mg or 84 mg of Spravato once every two weeks. Dosages can be reduced if the patient experiences bothersome side effects. Patients with MDD might have a reduced treatment schedule of four weeks, whereas patients with TRD are more likely to receive the full roster.
Contact us anytime for more information on Spravato. You can use our website or call (585) 442-6960. We hope to hear from you soon
