Treatments

Our cutting-edge treatments include Transcranial Magnetic Stimulation (TMS) and intranasal esketamine (Spravato®), both of which have shown promise in alleviating symptoms.

We are patient-centered and closely collaborate with both patient and provider to tailor treatment plans to those struggling to find relief from depression, anxiety and OCD.

Spravato® Esketamine

Spravato®
Esketamine

For many patients with treatment resistant depression who may be suicidal, Spravato® can provide relief within hours. Spravato® is self-administered as a nasal spray under close supervision.

The active ingredient in Spravato®, esketamine, calms the part of the brain that’s responsible for anxious, self-critical, ruminative thoughts, called the default mode network.

What is Spravato® esketamine?

Spravato® is the first FDA-approved esketamine therapy found to work for treatment-resistant depression with almost immediate effect (24 hours or less). It has also been shown to reduce reduce suicidal thoughts and feelings.

Esketamine works differently to typical anti-depressant medications becuase the mechanism of action is thought to to involve the modulation of glutamate, a neurotransmitter that plays a key role in synaptic plasticity.

How to take Spravato®

Spravato® is a nasal spray that is self-administered by the patient in the office while being monitored for at least two hours. Spravato® is administered two times per week for the first four weeks, and if effective, is administered every one to two weeks thereafter.

Treatment plans

Ongoing maintenance treatments seem to be necessary to prevent relapse. Therefore, many patients find success by starting with Spravato® to get better quickly and then switch to TMS for longer-lasting relief.

Because Spravato® is FDA-approved, it is covered by most insurance plans. We provide a comfortable and private environment for treatment and can help with securing preauthorization approval.

Spravato®
Esketamine

What is esketamine (Spravato®)?

Intranasal esketamine (brand name Spravato®) is an FDA-approved nasal spray antidepressant. Intranasal esketamine is a derivative of ketamine, which has been shown to provide very rapid (within hours), profound relief of depression.

Isn’t ketamine a horse tranquilizer drug or a drug used among the nightclub crowd?

Ketamine is a medicine used in anesthesia. More recently, it has shown potential as a new antidepressant. Like many anesthetics, ketamine is abused by some people.

How effective is esketamine for depression?

Intranasal esketamine works in about 50-70% of depressed patients who have failed 2 or more antidepressants.

What should I expect from an esketamine treatment?

FDA and U.S. Drug Enforcement Administration (DEA) regulations require that patients self-administer intranasal esketamine at a certified clinic, and then be monitored for 2 hours at the clinic for any side effects.

Are there any restrictions when taking intranasal esketamine?

FDA regulations require that patients not drive home from an intranasal esketamine treatment, and recommend that they do not drive until the next day after a restful sleep. There are no restrictions on non-treatment days.

What does an intranasal esketamine treatment course involve?

Intranasal esketamine involves an initial course of 2 treatments per week for 4 weeks (8 treatments). If patients are better at the end of 8 treatments, they have the option of transitioning into maintenance treatment, which is typically 1 treatment every 1-2 weeks.

How does intranasal esketamine work?

The exact mechanism of ketamine and esketamine is not completely understood, but unlike other antidepressants that tend to target serotonin, dopamine or norepinephrine, esketamine affects the glutamate (information-processing) system.

Is intranasal esketamine safe?

Intranasal esketamine seems to be safe for use in the short- and medium-term, with current studies showing no significant lasting side effects out to 2 to 3 years. However, esketamine is a very new treatment, and longer-term safety data do not exist. While there is no evidence currently that esketamine or ketamine cause significant long-lasting problems, because it is a relatively new treatment, it is important to understand that there may be problems that we have not yet discovered. This risk must be considered when deciding whether to have esketamine or ketamine treatments.

Does esketamine have any side effects?

Most patients find esketamine treatments to be very easily manageable and even pleasant. However, side effects during the 2 hours of monitoring may include: feeling mildly intoxicated, dissociation (feeling separate from one’s body), anxiety, nausea, increased heart rate and blood pressure. Most of these side effects go away by the time a patient leaves the clinic – some patients may feel tired or slow for the remainder of the day. Most patients do not have side effects between treatments.

Will my insurance cover intranasal esketamine? How much does it cost?

Most insurances now cover esketamine, but specific details vary may by patient plan. Intrnasal esketamine is an expensive treatment when not covered by insurance, or if you have a high deductible plan. But there are savings programs (https://www.spravatohcp.com/patient-supportavailable) from the manufacturer to help reduce the cost. Our clinic helps patients to receive the most insurance coverage possible. Some costs are not covered by insurance.

Does intranasal esketamine treat anything other than depression?

Currently, esketamine is only well-studied and FDA-approved for treating unipolar depression. Like ketamine, esketamine may help pain conditions as well. There is not enough evidence to tell whether esketamine helps other psychiatric conditions.

How long does intranasal esketamine take to work?

Intranasal esketamine can provide rapid relief within the first 1-2 weeks, although some patients require the full 4-week course to see improvement.

How long do the effects of esketamine last?

Like all ketamine treatments, intranasal esketamine seems to require maintenance treatments to stay better. Most patients require at least 1 treatment every 2 weeks to stay better.