Clinic Happenings


  • What is Spravato?
    • Ketamine is a racemic compound made up of equal parts of its two enantiomers, (S)-ketamine and (R)-ketamine. What on earth does that mean?  Think of it this way, the ketamine we normally use in an IV for general anesthesia and in low doses to treat mental health disorders and chronic pain is made up of a pair of molecules. These two molecules are mirror images of one another, much like our hands. While they are mirror images, the molecules are not identical. The esketamine molecule is actually more potent at the NMDA receptor which is believed to be the main site of action of ketamine. Johnson and Johnson isolated the “left hand” of ketamine or, eskatemine, and created the nasal spray, Spravato. 
  • Who is Spravato for? 
    • When Spravato was originally introduced it was only FDA approved for treatment-resistant depression and came in two different strengths. Now, Spravato is FDA approved for adults with treatment resistant depression (TRD)  or depressive symptoms with major depressive disorder with acute suicidal ideation or behavior (MDSI). It also comes in a higher dose that has improved results. 
    • Spravato is only approved for use in adults who are also on an oral antidepressant.
    • Spravato may be a good option for those who have insurance as it is covered by most carriers
  • How effective is Spravato?
    • About ⅓ of people do not respond to multiple kinds of antidepressant therapy. These individuals are considered to have treatment-resistant depression. Esketamine reduces symptoms of depression in the majority of these individuals in clinical trials. 
  • Who is not a candidate for Spravato?
    • Spravato is not FDA approved for anxiety disorders (e.g. PTSD, OCD, GAD) or chronic pain
    • Spravato is not approved for anyone under the age of 18
    • Spravato is contraindicated for anyone with aneurysmal vascular disease or arteriovenous malformation, those with a history of intracerebral hemorrhage, or anyone with hypersensitivity to esketamine, ketamine, or any of the excipients (i.e. preservatives, additives, etc). 
    • Clients with other underlying conditions, uncontrolled high blood pressure, for example, may not be good candidates for Spravato. Please see our FAQs page to learn more about contraindications and side effects of ketamine which are essentially the same as Spravato 
  • How can I receive Spravato?
    • Spravato can only be given at a specially certified treatment center.. It cannot be sent directly to your home or even to a doctor’s office unless they are certified to provide Spravato under what is known as the REMS program. The Risk Evaluation and Mitigation Strategy (REMS) is a drug safety program that the FDA requires for certain medications with serious safety concerns to help ensure the benefits of the medication outweigh its risks. (Imagine is certified to provide Spravato under our sister company, Imagine therapy-mindfullness-healing PLLC.) 
    • Each client must be enrolled in the REMS Spravato program. The clinic will help with enrollment. 
  • What is the treatment plan for Spravato?
    • Because Spravato is tightly regulated, authorized clinics must follow strict protocols for administration
    • For TRD the course is as follows:
      • Initial induction (weeks 1-4): twice weekly
      • Maintenance Part 1 (weeks 5-8): once weekly
      • Maintenance Part 2 (weeks 9 and beyond): weekly or every two weeks
    • Healthcare providers are required to monitor clients for at least 2 hours following each treatment. 
    • Just like with IV treatments, you cannot drive following Spravato treatments and should not do so until after a night of restful sleep.
    • Skipping doses may result in the client being released from the program so it is important to plan your schedule accordingly.
  • How much does Spravato cost?
    • The cost of Spravato is really dependent on your insurance plan. Once the prior authorization has been performed and you are approved, we will discuss the overall cost of treatment. Currently, we can offer Spravato for BCBS and Medicare clients but prior authorization is required to ensure coverage. More carriers will be added soon!
    • Keep in mind that even though it is covered by insurance, Spravato treatments can still be expensive because the drug itself is very expensive. If you have a high deductible and high co-pays you may end up spending more on Spravato than you would for a typical IV ketamine course. We can provide a cost comparison following the prior authorization process.
    • Depending on your financial situation, you may be eligible for assistance to pay for the medication through the Janssen CarePath. For more information click the link https://www.janssencarepath.com/
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