Spravato: Side Effects, Insurance Coverage, and How It Compares to IV Ketamine
Exploring Spravato: What to Expect from This FDA-Approved Depression Treatment
Spravato, a treatment for treatment-resistant depression (TRD), has been making waves in the mental health field as a more accessible alternative to traditional ketamine therapy.
While its FDA approval has opened doors to insurance coverage and wider availability, it also comes with specific protocols, potential side effects, and unique experiences that set it apart from IV ketamine.
In this blog, we’ll explore the most common Spravato side effects, its insurance coverage options, how long its effects last, and how it compares to IV ketamine to help you decide if it’s the right treatment for you.
Understanding Spravato: A New Approach to Depression Treatment
As mentioned in our other blog posts on ketamine treatment, the FDA will not officially indicate ketamine for mental health treatment, leading to a lack of insurance coverage.
The evolution of Spravato: from Ketamine to Esketamine
After hundreds of research studies and clinical trials were published showing evidence of ketamine’s antidepressant effects, pharmaceutical companies rallied to find a way to designate it as a treatment for depression officially.
This led to the birth of Spravato.
Classic ketamine is referred to as racemic ketamine. It is a 50-50 mixture of two different molecules that are mirror images of each other.
The pharmaceutical company Janssen took racemic ketamine into the lab, extracted one molecule, and abstracted that molecule into its own formulation, thereby inventing a new substance called esketamine.
Since it does not have the exact same chemical structure as racemic ketamine, it is considered a brand-new drug developed solely for mental health treatment.
Janssen branded this new esketamine drug Spravato and packaged it in spray bottles for intranasal administration.
Is Spravato covered by insurance?
Spravato received official FDA designation as a medication indicated for treatment-resistant depression. Insurance companies were then able to offer full or partial coverage.
How much does Spravato cost?
Patients' out-of-pocket amount depends on their specific insurance plan, deductibles, and co-pays.
Clinics that provide Spravato almost always have an insurance specialist on staff to find out if you are covered, help you obtain prior authorization, inform you of your out-of-pocket expense, and help you with basic navigation through the insurance process.
Spravato vs. IV Ketamine: Key Differences in Treatment and Experience
When racemic ketamine (aka classic ketamine) is used off-label for mental health, the indication and administration protocols are basically at the discretion of the treatment team.
This provides room for individualized care, creativity, and nuance under the expertise and wisdom of the providers. Spravato, however, comes with rigid FDA criteria for approval, and rigid regulations for scheduling and dosing.
To be approved for Spravato by insurance companies, you must be diagnosed with TRD (treatment-resistant depression) and must be currently taking antidepressant medication. You are expected to also have had two previous antidepressant trials across two different classes, and the trials must have been “of adequate dose and duration” with less than 50% reduction of depressive symptoms.
What is the treatment schedule for Spravato?
Once approved for Spravato treatment, you must follow a predetermined schedule:
Induction phase - two sessions per week for four consecutive weeks
Optimization phase - one session per week for the next four consecutive weeks
Indefinite maintenance - one or two sessions per week, or less frequently, as needed
Spravato is administered only under supervision in clinics that have received special designation by the FDA. It is never prescribed for at-home use.
There are only two possible doses, 56mg or 84mg, as the nasal spray devices are pre-filled, and the providers can never deviate from these two pre-packaged amounts.
Once the medicine is in your system, the official protocol is that you must be monitored at the clinic for two hours before being discharged home.
What is the experience of Spravato?
Perhaps the most significant difference between IV ketamine and Spravato is the experience itself.
With proper and careful dosing, most IV ketamine patients have the potential to experience dissociation, visuals, profound insights, emotional breakthroughs, feelings of connectedness with the universe, and generally powerful or transformative journeys.
For Spravato, the experiential effects are much more random and unpredictable. It has been described as more of a “dopamine rush,” with the most common effect noted as being an increased sense of clarity.
How long does Spravato last?
As compared to IV Ketamine, Spravato tends to be more subtle, less intense, and less somatic. Some people enter powerful altered states during their Spravato sessions, others feel a “calm and floaty” sensation, and others feel not much at all.
The Spravato experience lands on a wide spectrum between two extremes, with no predictability as to where on the spectrum you will land.
Does Spravato work?
However, even patients who feel “not much at all” during Spravato are still receiving benefits. Research studies and clinical trials of Spravato have shown valid evidence pointing to remarkable efficacy in alleviating depressive symptoms, much more so than the classic antidepressant pills that have been circulating for decades.
For this reason, combined with the affordability provided by insurance coverage, Spravato is a novel and alternative treatment course that is certainly worthwhile to pursue.
Choosing the Right Clinic for Your Spravato Treatment
Choose your Spravato clinic carefully and wisely.
Spravato is marketed by Janssen and by the FDA as a biological antidepressant treatment, with no significance at all put on the experiential component.
In fact, the FDA considers dissociation to be a negative side effect.
Subsequently, many Spravato clinics have sprung up all over the country and are owned by medical providers who have no knowledge of, or interest in, altered states of consciousness.
Many anecdotal accounts provided by Spravato patients talk of being put in large rooms filled with other people also undergoing treatment, under fluorescent lighting, with phones ringing and people talking, staffed by inattentive medical workers.
Luckily, there are some clinics and solo providers that administer Spravato with the goal of truly maximizing efficacy, providing the privacy and therapeutic setting that can lead to deeper healing. This often entails staff who encourage patients to take advantage of their two-hour “break from reality” by turning inward during the medicine, letting go, processing and releasing emotions, and any other self-care techniques they wish to employ.
If you are interested in Spravato, it would be beneficial to do some research to find a site that operates in this healing type of environment.
Stella Center offers Spravato treatment in New York City; visit their website to learn more.
More notes on ketamine:
Amanda Vogel is a board-certified Psychiatric Mental Health Nurse Practitioner with over 16 years of clinical experience working in behavioral health and emergency psychiatry. She received her Bachelor of Science degree from New York University and her Master of Science degree from Stony Brook University. In 2019, she helped initiate, design, and operate the ketamine infusion service for psychiatric inpatients at New York-Presbyterian Hospital/Weill Cornell Medical Center. Convinced of this medicine’s potential to catalyze true healing, she has moved into working with ketamine as her primary focus. Naturally inclined toward humanistic care, she approaches her work every day with empathy, curiosity, and compassion.