Ketamine has been used safely as a surgical anesthetic since 1970. Research showing its benefit as a safe, rapidly-acting antidepressant medication has been published since the early 2000s. In the last several years, we have seen more and more studies showing its safety and effectiveness in treatment-resistant depression (TRD). In 2017, the leading psychiatric journal, JAMA Psychiatry, published formal treatment guidelines on the use of ketamine in the treatment of mood disorders. A purified form of ketamine for intranasal use, esketamine (brand name Spravato), was FDA-approved for TRD in March 2019.

What is Spravato® (esketamine) CIII nasal spray?

Spravato®, also known as esketamine, is a prescription medicine often used in conjunction with an oral antidepressant to treat adults with treatment-resistant depression as well as those with major depressive disorder (MDD). It is not yet known if Spravato® is safe and effective in children or for use in preventing suicide or reducing suicidal ideation.

How is Spravato® administered?

Spravato® is administered as a nasal spray and is inhaled through the nostrils. Patients can administer the nasal spray themselves but this must be done under the supervision of a healthcare provider. At our office, medical doctors and nurses will be supervising.

How long are appointments?

Appointments where Spravato® is administered are 2 hours long at the Mental Health Center, as patients are monitored by our healthcare staff.

How much do appointments cost?

There is a charge of $500 for each appointment where Spravato® is administered. With a total of 12 induction visits over the course of two months, the total cost of treatment is $6,000.

Does insurance cover the medication? What is the cost of the medication?

Spravato is covered by most health insurance plans (though occasionally requires a co-payment), and generic ketamine is so inexpensive, our office doesn’t charge for it. The main costs incurred are for the monitoring, which unfortunately is not covered by insurance in the case of IV or Spravato.

Are there long-term side effects of ketamine treatment?

Side effects lasting longer than 24 hours after treatment are very uncommon. The main side effects within 24 hours of a treatment are typically not unpleasant: feelings of calm, mild balance or coordination issues (hence recommendation not to drive until the next day), and loosened inhibitions. Prior to treatment, we will have a detailed discussion before formally obtaining your consent to move forward with the procedure.

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