Our practice is pleased to announce the availability of Spravato (intranasal Esketamine) for the treatment of severe depression and persistent suicidal ideation. While Prozac, Paxil, Zoloft, Celexa, and other similar medications work by targeting neurotransmitter serotonin, this innovative FDA-approved treatment option targets neurotransmitter glutamate, which is generally also depleted in patients with major depressive disorder.
Recently, research in this area has shown to have great promise in off-label treatment of severe depression, PTSD, OCD, drug and alcohol addiction, and other psychiatric diagnoses. This success led to extensive research in this treatment modality, which in turn led to the development of an intranasal form of this medication (Esketamine) that has recently received FDA approval.
Rather than being a first-line treatment, Esketamine is used when other antidepressants don’t work. It is usually not utilized to treat mild to moderate depression, since these mental health conditions can be effectively managed with medications alone, or by a combination of medications and psychotherapy. However in some patients with moderate depression who for any reasons are unable to tolerate therapeutic doses of conventional antidepressants (or who has failed multiple treatments in the past), this treatment modality can successfully be utilized together with other prescribed medications. Esketamine has also been used in some cases of bipolar disorder, but it is not indicated for patients with active psychosis, mania, or for patients with unstable cardiovascular disease. It is not indicated to use in children.
The doses of Esketamine used in psychiatry are a fraction (10-25%) of the doses of similar medications used in anesthesia procedures, and therefore this can be effectively used in an outpatient setting. Even in smaller doses, however, this medication is a potent psychotropic agent, and therefore cannot be used by patients at home. Patients must come to the clinic and be monitored for the development of potential side effects. In addition to safety, this cutting-edge practice aims to prevent Esketamine misuse or abuse.
The psychiatrists at CLTCP are experienced in this treatment method, and are committed to making it safely and effectively available to those patients who need it.
Safety and Side Effects:
Potential side effects of Esketamine include a dissociative experience, a brief increase in blood pressure, dizziness and nausea. Patients are advised not to drive for the rest of the day of treatment, but they are OK to drive after restful night of sleep. They should make the necessary arrangements for transportation after each treatment.
There is extensive safety data when it is used sporadically for anesthesia. There is also good data on the safety of using it for several years for pain control, at doses comparable to those used for the treatment of psychiatric disorders. There is also significant evidence that long-term abusers may develop serious side effects such as cystitis (a painful inflammation of the bladder) and cognitive problems. However, abusers typically use between 1,000-5,000 mg several times a week. Psychiatric patients will rarely receive more than 168 mg a week.
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