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Esketamine (Spravato) Therapy

Esketamine Therapy at Butler Hospital

FDA-approved Esketamine, marketed as “Spravato”, offers hope to adults battling treatment-resistant depression (TRD) and Major Depressive Disorder (MDD). Derived from Ketamine, it's a self-administered nasal spray used in combination with prescription antidepressants and delivered under the supervision of professionals who have both medical and psychiatric training.  

Esketamine works by blocking NMDA receptors and boosting glutamate levels in the brain while prompting brain cells to forge new communication pathways to quickly alleviate depressive symptoms.  Patients undergoing Esketamine are monitored before, during, and after dosing and may experience symptoms such as dissociation, feeling “loopy”, transient increase in blood pressure, nausea, or drowsiness; all which generally resolves within 2 hours.  In clinical trials between active and “placebo” Esketamine, the treatment response in the active group experienced great symptom improvement.  

Furthermore, published reports showed that the individuals in the active group were able to sustain the positive effects of treatment over time. This treatment may be covered by your insurance and the dedicated team at Butler Hospital will assist in the administrative steps to seek coverage on your behalf.

Contact Information

Butler Hospital
345 Blackstone Boulevard
Providence, RI 02906
P: (401) 455-6632

Determining Eligibility:

To learn more about Esketamine treatment at Butler Hospital, call: (401) 455-6632 or submit your information to BRAIN@CareNE.org for a team member to contact you within 48 hours.

For Referring Providers:

For clinicians, if you would like to refer your patient for consideration of Esketamine, please download and complete this form and fax to (401) 455-6686.
When referred or seeking treatment with Esketamine, the following steps are taken:
  • Initial phone screen to gather basic information
  • The patient receives an Esketamine (Spravato) information packet for completion
  • Review of patient and clinician-submitted medical documentation to determine preliminary eligibility
  • Outpatient consultation/evaluation visit with our providers
  • Our clinical team will perform benefit verification and help process insurance pre-authorizations for treatment coverage
Typical Eligibility Requirements for Esketamine Insurance Coverage
  • Adults - 18 and older
  • Current primary diagnosis of (nonbipolar) Major Depressive Disorder, without psychotic features
  • No recent substance use
  • No significant neurological disorders or uncontrolled blood pressure
  • Ability to remain safe for treatment as an outpatient
  • History of inadequate response or intolerance to different antidepressants
  • Transportation to and from the clinic must be provided by a responsible adult

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Are you a candidate for Esketamine (Spravato)?

Esketamine (Spravato) FAQ

What is Esketamine/Spravato?

Esketamine, marketed under the brand name Spravato, is the first FDA-approved treatment version of a drug commonly known as “Ketamine” for treatment-resistant depression. It is taken as a nasal spray that is self-administered in our clinic.

Patients may experience a range of side effects, including feelings of dissociation, nausea, drowsiness, temporary increase in blood pressure, or feeling “loopy.” However, these side effects tend to peak at 40 minutes and wear off by the end of the dosing visit.  

If I am a good candidate for Esketamine, what happens next?

You will be scheduled for a consultation with one of our providers; during which we will review your medical history, clinical history, and current symptoms. We will ask you to complete an EKG and lab work (both can be done at Butler Hospital) and submit any necessary paperwork on your behalf to the insurance company for prior authorization. Upon approval, a member of our team will schedule the first visit with you.

What is the treatment schedule like?

The standard treatment consists of three phases:

  1. Induction: Twice weekly for the first 4 weeks
  2. Continuation: Once weekly for the subsequent 4 weeks
  3. Maintenance: Frequency varies based on clinical improvement, ranging from weekly to monthly.
How long does an Esketamine treatment take?

The visit typically lasts about two hours to monitor for any adverse reactions.

What are the potential side effects?

While effective, Esketamine requires close supervision due to potential side effects including,

  • Feelings of dissociation (peaking within 40 minutes).
  • Euphoria
  • Dizziness
  • Nausea

Other, rare side effects include respiratory arrest or risk of abuse and dependence.

Are there dietary restrictions before treatment?

Avoid eating for two hours and refrain from liquids 30 minutes before your appointment.

How does Esketamine differ from Ketamine?

Esketamine (Spravato) is a more potent form of Ketamine, administered intranasally, and has shown efficacy in targeting depressive symptoms and reducing suicidal thoughts.

Can I continue my antidepressants with Esketamine treatment?

Yes, Esketamine treatment can be used in conjunction with your on-going medication regimen. Some drugs may interact with Esketamine so our providers may advise to hold a certain medication prior to your dosing visit. Any decisions regarding your medication with be communicated with your outpatient prescriber for coordination of care.

Is Esketamine covered by insurance?

Esketamine may be covered by your insurance, but coverage can vary depending on your specific plan. Our team will assist in determining possible co-payments for treatments and seek out insurance pre-authorization on your behalf if Esketamine is covered and appropriate for you.