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Medication Management
Spravato Treatment
Spravato Treatment
We provide consultative and treatment services for individuals diagnosed with major depressive disorder and acute suicidal thinking. Esketamine, also known as Spravato, is a NMDA receptor antagonist and FDA-approved drug for treatment-resistant depression (TRD) that offers instant relief for those affected by major depressive disorder and also those who experience suicide thoughts*
*It is not known if SPRAVATO® is safe and effective in children.
**It is not known if SPRAVATO® is safe and effective for use in preventing suicide or in reducing suicidal thoughts or actions.
Resources
Certified Treatment Center
If you have been prescribed at least two antidepressant in the past and still experience symptoms, including suicidal thoughts**, you probably have a condition known as treatment-resistant depression (TRD). Spravato is an FDA-approved nasal spray treatment for adults* who have not tried two or more oral antidepressants and have not achieved improvement.
Spravato is only available through a restricted distribution program called the Spravato® REMS. Wilmington Mental Health is a certified Spravato® treatment center that follows protocols for handling Schedule III medication in accordance with federal, state, and local regulations.
Referrals for Spravato must be coordinated with your primary care provider for psychiatric medications. Spravato® is dispensed by a healthcare provider and patients are required to be monitored for at least 2 hours in a REMS-certified setting.
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Spravato® is dispensed by a healthcare provider and patients are required to be monitored for at least 2 hours in a REMS-certified setting. We encourage referrals from outside providers and pledge to assist in the care of those patients by providing consultation, treatment, and referral back to their referring provider.
Treating Depression
Depression is a complicated condition that now involves only serotonin deficiency or environmental changes; but the way it manifests in people who do not respond well to antidepressants is more complicated.
How Spravato Works
Spravato helps the brain by reversing the changes produced by depression. It increased glutamate production in the brain, exciting certain brain cells in charge of learning functions and memory, and making the brain become more comfortable with the new state.
What to Expect?
Spravato is self-administered. After your blood pressure and pulse are measured, one of our healthcare providers stays in the treatment room with you, assisting while you administer the nasal spray to yourself. You will be consistently monitored for next two hours for any side effects and will be assessed before you are let go.
You may feel tired or slightly confused after the treatment, therefore, you will be provided with information on what you are not allowed to do until those feelings and side effects fade away entirely.
Side Effects
The most common side effects when Spravato is being used along with oral antidepressant include:
Nausea
Vomiting
Numbness
Dizziness
Hypertension
Feeling drunk
Feeling anxious
Difficulty thinking
Fatigue or drowsiness
Feeling detached from body
Important Medical Information:
Indications
Spravato CII Nasal Spray is indicated, in conjunction with an oral antidepressant, for the treatment of depressive symptoms in adults with major depressive disorder (MDD) and with acute suicidal ideation or behavior.
Warning
Spravato is a Schedule III controlled substance (CIII) and may be subject to abuse and misuse. Spravato is now approved for use in pediatric patients. In clinical trials, 48-61% of Spravato-treated patients developed sedation and 0.3-0.4% experienced loss of consciousness. In clinical trials, 61-84% of Spravato-treated patients developed dissociative or perceptual changes (including distortion of time, space, and illusions), derealizations, and depersonalization.
Limitations
Spravato has not been proven to prevent suivide or reduce suicidal ideation or behaviors. Spravato does not eliminate the need for hospitalization in some patients. Spravato is not an anesthetic agent.
Contraindications
Spravato is contraindicated in patients with aneurysmal vascular disease, including thoracic and abdominal aorta, intracranial and peripheral arterial vessels, or arteriovenous malformation, history of intracerebral hemorrhage, hypersensitivity to esketamine, ketamine, or any of the excipients.
Risk Evaluation and Mitigation Strategy
Patients are enrolled in the program to receive treatment at Wilmington Mental Health. Administration requires direct observation by one of our healthcare providers at each treatment session, followed by at least 2 hours of monitoring, and pre-discharge assessment to determine stability.