Racemic Ketamine (“R”-type) is approved by the Food and Drug Administration to be used as an IV anesthetic. Ketamine treatments for Depression are not covered by insurance because it’s experimental and not FDA approved for depression.

Esketamine is the “S-type” of Ketamine administered as a nasal spray. In 2019, the FDA approved the use of SPRAVATO® (esketamine) in adults for the treatment of TRD and MDD with suicidal ideation when used in conjunction with an oral antidepressant.

The safety and efficacy of esketamine (Spravato) is supported by many short-term and long term studies. A 2020 study by Papakostas studied the use of esketamine in 774 people who were involved in 5 trials and showed that patients with MDD or MDSI who received SPRAVATO® treatments had a better outcome than those who received placebo.

Conventional antidepressants like SSRIs may increase suicidal thoughts at the beginning of treatment, especially in young adults. SPRAVATO® has been proven to decrease suicidal thoughts.

SPRAVATO® is usually covered by insurance, including Medi-Cal and Medicare, because it is FDA-approved and well-studied to be effective and safe, providing rapid relief. It may be paid under your medical or your pharmacy benefit, depending on your plan.

The SPRAVATO®withMe plan offers patients to pay as little as $10 per treatment for your SPRAVATO® medication.

If insurance doesn’t cover all of your costs, or if you have no insurance, the SPRAVATO®withMe plan can provide information about other cost support options.

If these side effects occur, they usually happen right after taking SPRAVATO® and go away the same day.

The most common side effects of include: • feeling disconnected from yourself, your thoughts, feelings and things around you • dizziness • nausea • feeling sleepy • spinning sensation • decreased feeling of sensitivity (numbness) • feeling anxious • lack of energy • increased blood pressure • vomiting • feeling drunk • headache • feeling very happy or excited

No. SPRAVATO® works differently because it affects the glutamate system in your brain, blocking certain receptors to help improve depression symptoms.

Glutamate is the most abundant excitatory neurotransmitter in the brain, facilitating communication between nerve cells. Glutamate is involved in mood regulation, learning, and cognition.

SSRIs do not affect the glutamate system.

How often do I need treatmentPatients can start with 56 mg or 84 mg, alone or in combination with an oral AD, and an individualized dosing schedule over 3 phases.

• Induction Phase: Weeks 1 to 4, usually (2) two treatments per week.

• Optimization Phase: Weeks 5 to 8, (1) one treatment per week.

• Ongoing Maintenance Phase: Once per week or once every two weeks. Other patients feel well enough to receive treatments as needed.

SPRAVATO® must be under the supervision of a healthcare provider in a healthcare setting.

• Your healthcare provider will take your vital signs prior to starting treatment, 40 minutes into the treatment session, and before you leave.

• You will take the nasal spray yourself.

• Your healthcare provider will show you how to use the SPRAVATO® nasal spray device.

• Your healthcare provider will tell you how much SPRAVATO® you will take and when you will take it.

• You should not eat for at least 2 hours before taking SPRAVATO® and not drink liquids at least 30 minutes before taking SPRAVATO®.

• We offer medication if you experience nausea and/or vomiting.

• You will need to plan for someone or a ride share to drive you home after taking SPRAVATO®.

• Your should not drive, operate machinery, or do anything where you need to be completely alert after taking SPRAVATO®. Do not take part in these activities until the next day following a restful sleep.

• SPRAVATO® can only be dispensed & administered in healthcare settings.

• Patients treated in outpatient settings must be enrolled in the program. (We help enroll you)

• It is administered by patients under the direct observation of a healthcare provider.

• SPRAVATO® can cause a temporary increase in your blood pressure that may last for about 4 hours after taking a dose. Your healthcare provider will check your blood pressure before taking SPRAVATO® and for at least 2 hours after you take SPRAVATO®.

Do not take SPRAVATO® if you: • have blood vessel (aneurysmal vascular) disease (including in the brain, chest, abdominal aorta, arms and legs) • have an abnormal connection between your veins and arteries (arteriovenous malformation) • have a history of bleeding in the brain • are allergic to esketamine, ketamine, or any of the other ingredients in SPRAVATO®.

If you are not sure if you have any of the above conditions, talk to your healthcare provider before taking SPRAVATO®.