Spravato (esketamine) is an FDA approved medication for treatment resistant depression. It targets NMDA (N-methyl-D-aspartate) neuroreceptors, a different mode of action from currently available oral antidepressants.

Unlike most antidepressants that effect neurotransmitters such as serotonin, norepinephrine and/or dopamine, Spravato works by modulating glutamate, the most widespread chemical messenger in the brain. This helps brain cells communicate through new pathways and improves synaptic functions in brain areas responsible for mood regulation and behavior. 

Ketamine, as an NMDA receptor antagonist, offers a novel mechanism of action in the treatment of depression. It promotes the growth of denser neuronal spines in the prefrontal cortex and restores diminished synapses (Duman, Li, Liu, Duric, & Aghajanian, 2012). Esketamine, an isomer or closely related compound to Ketamine, produces similar effects and has been reported to exhibit a rapid onset of action within 24-48 hours, as opposed to weeks with intravenous Ketamine therapy (Caffrey, 2019).

Suitable: Individuals who are living with depression who have not responded well to other treatments may be candidates for Spravato treatment. The medication may also be used to help adults who are having suicidal thoughts as a result of severe depressive disorder.

Unsuitable: Individuals with aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial and peripheral arterial vessels) or arteriovenous malformation; Intracerebral hemorrhage; Hypersensitivity to esketamine, ketamine, or any of the excipients; severe liver disease.

We work with Aetna/Meritain, Anthem, Beacon Health Options, Blue Cross Blue Shield/Blue Benefit, Cigna/Evernorth, Harvard Pilgrim, Tricare/Humana, Medicare, Optum, Tufts, United Healthcare. Single-case agreement sometimes can be arranged for suitable Medicaid patients.

We strive to attain high response rate and durability for patients by delivering Spravato as part of an integrative and personalized treatment protocol. Treatment will be delivered in private treatment rooms with particular attention towards “set and setting” and its impact on patient experience and treatment outcome.

• Most commonly cited response rate is about 70% (defined as a 50% drop in the MADRS depression score) and the remission rate is about 50% (defined as a MADRS depression score of 12 or less). With a personalized and integrative approach, patients have even higher response and remission rates.

• Difference between SPRAVATO’s treatment compared to placebo can be observed within 24 hours after treatment. Most of our clinic’s patients reports improved mood and functioning within a few weeks of treatment.

SPRAVATO (esketamine) is administered intranasally in a REMS certified medical office, under direct supervision of Dr. Cao for a minimum of 2 hours during which patients are monitored closely for side effects.

Should patient chooses, psychotherapy session can be done before or after Spravato and is believed to have additional treatment benefit.

Treatment is typically twice weekly for the first 4 weeks, once weekly during the weeks 5-8, and biweekly or monthly thereafter.

• Dissociation, Sedation, Feeling drunk, anxious, or nauseous; Increased blood pressure; Irregular heartbeat or pulse

• As such, while most patient tolerate esketamine/Spravato well, FDA does require REMS certification and monitoring for esketamine/Spravato. (REMS, or Risk Evaluation and Mitigation Strategy, is a drug safety program that FDA can require for certain medications with serious safety concerns to help ensure the benefits of the medication outweigh its risks.)