Our Mood Disorders Consultation Clinic provides expert consultation for patients with treatment-resistant depression.
We now offer a nasal spray medication for treatment-resistant depression called Spravato® (intranasal esketamine).
What is esketamine nasal spray?
Esketamine nasal spray is administered through the nose and only under the supervision of medical staff in the clinic, due to potential side effects.
The nasal spray medication is:
- FDA-approved for adults with treatment-resistant major depressive disorder (MDD) or depressive symptoms in MDD associated with suicidal thoughts or actions
- Taken in addition to an oral antidepressant medication
- Helpful to patients who have tried multiple, conventional antidepressants and are still depressed
- A medication that may work faster than conventional antidepressants
What are some considerations before starting esketamine treatment?
You will need a driver to take you home after treatment. Each treatment takes at least 2 hours.
Because of the importance of close follow-up with this treatment, you must have an established psychiatric provider who you will see regularly throughout your esketamine treatments.
Esketamine has higher risks if you have any of the following conditions, but may still be an option with careful medical evaluation:
- 膀胱炎症
- 频繁的瀑布
- 心脏病
- 高血压
- 历史 of alcohol or drug abuse or addiction
- 肾脏疾病
- 肝脏疾病
- 内存问题
- 精神病
What is the treatment schedule?
| 阶段 | 每周治疗次数 |
|---|---|
| 感应 | 2 treatments per week for 4 weeks |
| Taper (if esketamine works well during the first month) | 每周1次治疗 for 4 weeks |
| Maintenance (if esketamine continues to work well for you) | 每周1次治疗 or every other week, (long term treatment) |
重要的: Each treatment requires a minimum of 2 hours of observation. Because of the side effects of esketamine, you will need a driver to take you home after treatment.
常见副作用
The common side effects may include:
- 分离或混乱
- 高血压 that comes and goes or an elevated heart rate
- 恶心或呕吐
- 镇静或头晕
You cannot use esketamine if you have:
- An allergy or adverse reaction to esketamine or any of its ingredients, or to ketamine
- Aneurysmal vascular disease, including arteriovenous malformation
- 历史 of bleeding in the brain
Refer to the Spravato website for more information.
保险指南
Esketamine is considered medically necessary in adults who:
- Have a diagnosis of major depressive disorder (MDD) in a single or recurrent episode
- Are resistant to treatment due to the lack of response or inability to tolerate 2 trials of antidepressant medications in the current depressive episode
Different insurance companies may have different requirements before covering esketamine. We encourage you to call your insurance company.
推荐服务提供者
对于我们的供应商: When referring a patient, place the referral in eD-H and indicate the following:
- Refer to the department: "LEB PSYCH MED MOOD DO"
- Refer to provider: David Eiler, MD
- In the comments field: “referring for IN esketamine”
对于外部供应商: To refer a patient for consultation, contact our Physician 连接ion Center. 请使用我们的 Outpatient Referral Form (PDF).
