Spravato (Esketamine) Treatment Program in Cranston

Spravato® (esketamine) is an FDA-approved prescription nasal spray for certain adults with depression. It is administered in a certified healthcare setting under the supervision of trained clinical staff. Spravato works differently from traditional antidepressants by acting on the brain's glutamate system, including NMDA receptor pathways.

For adults with treatment-resistant depression (TRD), Spravato may be used either by itself or together with an oral antidepressant. It is also FDA approved, together with an oral antidepressant, for depressive symptoms in adults with major depressive disorder (MDD) who have acute suicidal ideation or behavior.

Spravato treatment takes place at SCP: Psychiatry, Behavioral Health, and Weight & Wellness (SCP). Patients self-administer the nasal spray under staff supervision and remain in the clinic for monitoring after each dose. Blood pressure is checked before treatment and again after dosing, and patients are observed for at least two hours. Discharge occurs only after the clinical team determines that the patient is stable and ready to leave.

Temporary side effects can include dissociation or changes in perception, dizziness, sedation or drowsiness, nausea, vomiting, increased blood pressure, anxiety, headache, or a feeling of being 'drunk' or disconnected. Because Spravato can affect alertness, judgment, and coordination, patients may not drive themselves home after treatment.

• Initial screening to gather basic clinical and demographic information.
• Review of psychiatric, medical, and medication-treatment history.
• Collection of relevant records from the referring or current treating provider, when applicable.
• Clinical consultation to determine whether Spravato is appropriate and safe for the individual patient.
• Insurance benefit verification and prior-authorization support when required by the patient's health plan.
• Scheduling of treatment once clinical and administrative requirements are completed.

Eligibility is determined individually. SCP may review the patient's diagnosis, prior antidepressant treatment, current medications, blood pressure, cardiovascular and neurologic history, substance-use history, pregnancy status, and the patient's ability to safely participate in outpatient treatment and post-dose monitoring.

Spravato is not appropriate for everyone. Certain vascular conditions, a history of intracerebral hemorrhage, or allergy to esketamine, ketamine, or product ingredients are contraindications under the FDA prescribing information. Other medical or psychiatric conditions may require additional review.

Spravato is the brand name for esketamine, an FDA-approved prescription nasal spray used for certain adults with depression. It is a Schedule III controlled substance and is available only through a restricted safety program called the SPRAVATO REMS.

Adults with treatment-resistant depression may be candidates after a clinical evaluation. Spravato is also approved, in combination with an oral antidepressant, for depressive symptoms in adults with MDD who have acute suicidal ideation or behavior. Insurance plans may apply additional authorization criteria.

Not always. For treatment-resistant depression, current FDA labeling allows Spravato to be used as monotherapy or together with an oral antidepressant. For depressive symptoms associated with MDD and acute suicidal ideation or behavior, Spravato is used together with an oral antidepressant.

For treatment-resistant depression, the FDA-recommended schedule generally begins with twice-weekly treatment for four weeks, followed by weekly treatment for weeks five through eight. Beginning in week nine, treatment is typically once weekly or every two weeks, individualized to the least frequent schedule needed to maintain response. Your clinician determines the appropriate schedule.

Patients must be monitored for at least two hours after each dose. Because there is also time needed for check-in, pre-dose assessment, administration, and discharge, patients should plan for the visit to last longer than the minimum two-hour monitoring period.

No. Spravato can impair attention, judgment, thinking, reaction time, and coordination. Patients should arrange transportation home and should not drive or operate machinery until the next day after a restful sleep.

The FDA prescribing information advises patients to avoid food for at least two hours before treatment and liquids for at least 30 minutes before treatment. If you use a nasal corticosteroid or nasal decongestant on a treatment day, it should generally be taken at least one hour before Spravato.

Commonly reported effects include dissociation, dizziness, nausea, sedation, vertigo, increased blood pressure, headache, anxiety, vomiting, and feeling intoxicated or disconnected. SCP monitors patients during each treatment session and determines when it is safe to leave.

Spravato carries important safety risks, including sedation, dissociation, respiratory depression, increased blood pressure, and the potential for abuse or misuse. For that reason, it must be administered in a certified healthcare setting with post-dose observation.

No. Esketamine is chemically related to ketamine, but Spravato is a specific FDA-approved intranasal medication with its own dosing, labeling, and REMS requirements. It is different from intravenous, intramuscular, oral, or compounded ketamine treatments.

Spravato is approved, together with an oral antidepressant, for depressive symptoms in adults with MDD who have acute suicidal ideation or behavior. The FDA labeling states that its effectiveness in preventing suicide or reducing suicidal ideation or behavior has not been demonstrated, and treatment does not replace hospitalization when hospitalization is clinically necessary.

Many health plans provide coverage when their clinical criteria are met, but requirements differ by insurer and plan. SCP can verify benefits and help submit prior-authorization documentation when required.

Patients and referring clinicians can contact SCP to begin the screening process. The SCP team will explain what records are needed, review eligibility, and coordinate the next steps for consultation and, when appropriate, treatment.

Clinicians may refer patients to SCP for Spravato evaluation. Helpful records include the most recent psychiatric or office note, current medication list, prior antidepressant trials, relevant medical history, and insurance information.

Spravato has a boxed warning for sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors in pediatric and young adult patients taking antidepressants. Spravato is not approved for pediatric patients. Treatment is available only through the SPRAVATO REMS and requires administration and monitoring in a certified healthcare setting.