Nasal Esketamine

Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment  Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.

Learn how long it takes for different depression treatments to work such as antidepressants, TMS therapy and nasal esketamine.

SPRAVATO® is self-administered at REMS-certified SPRAVATO® treatment centers under the supervision of a health care provider. REMS stands for Risk Evaluation and Mitigation Strategy. SPRAVATO® is a brand name for esketamine nasal spray , a Schedule III controlled substance derived from ketamine. This medication can cause brief sedation and dissociation in people who take it, and it has the potential to be abused. That’s why the esketamine nasal spray is only distributed to providers under the REMS program.

Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for esketamine nasal spray treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT). What will it be like to add SPRAVATO® treatment to your treatment plan? Preparing for SPRAVATO® treatment, also called esketamine nasal spray , can help you feel more at ease and ready for what your first day of treatment will bring. Getting Started with the SPRAVATO® Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether you’re a fit for esketamine nasal spray. Alternatively, you can schedule an esketamine nasal spray consultation with a treatment center that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS) for administering SPRAVATO® treatment. SPRAVATO® is FDA approved for treatment resistant depression (TRD) and major depressive disorder with suicidal ideation or behaviors (MDSI). Note that SPRAVATO® is not a replacement for hospitalization for those currently high at risk. At Greenbrook’s REMS-certified SPRAVATO® treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine spray treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make nasal esketamine spray treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine spray provider before beginning treatment. If the medication is deemed a good fit, you’ll receive a SPRAVATO® prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard antidepressant along with your SPRAVATO® treatment. There are two important regulations to note when it comes to preparing for SPRAVATO® treatment: Each SPRAVATO® treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your nasal esketamine spray treatment schedule. In addition, if you’re wondering what to bring for the nasal esketamine spray treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During SPRAVATO® Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real SPRAVATO® sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each nasal esketamine spray treatment. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook’s Care Team is readily available if you need assistance. How to Prepare for After your SPRAVATO® Treatment Process Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after SPRAVATO® treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll be taking nasal esketamine spray treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine spray treatment patients begin feeling relief from depression symptoms within hours of their nasal esketamine spray treatment. Other Tips in Preparing for Your SPRAVATO® Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each nasal esketamine spray treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for your nasal esketamine spray treatment. Schedule A Free Consultation To get started with nasal esketamine spray treatment, we offer free consultations at Greenbrook . If your doctor thinks you should avoid nasal esketamine spray treatment, transcranial magnetic stimulation (TMS) is a drug-free, FDA-cleared option for you to consider. Learn more about how TMS works .

If you’re planning to try SPRAVATO® for treatment-resistant depression (TRD), knowing the typical SPRAVATO® treatment schedule can help you figure out how to adjust your daily life to accommodate treatment. SPRAVATO® is the brand name for esketamine nasal spray, and it’s one form of ketamine. Like ketamine, esketamine can cause you to feel dissociated, sleepy, and dizzy in the hours after you receive a dose. You’ll need a ride home–and probably a long nap!–after each visit to your local Greenbrook location . At Greenbrook, we work with you to map out an esketamine nasal spray treatment schedule that works for you. Your SPRAVATO® Treatment is Unique to You SPRAVATO® treatment is usually the most time-intensive during the first four weeks. Whether your provider refers you to Greenbrook or you come to us on your own, your Greenbrook psychiatrist or psychiatric nurse practitioner will review your medical history and evaluate your symptoms. If our provider believes esketamine nasal spray is a good fit, they will build an esketamine nasal spray treatment schedule and dosage plan based on your needs. If you’re wondering, “How long will I have to take SPRAVATO®?,” the answer is that your treatment duration will depend on how much the symptoms are improving as you progress. After the first month of SPRAVATO® treatment, your Greenbrook provider will evaluate how well it is working and determine if any dosage adjustments are needed. How Often Can you Expect to Take SPRAVATO®? During a typical SPRAVATO® treatment schedule, you’ll take two doses a week for four weeks. Before each treatment, your provider will give you a depression scale to fill out. This helps them—and you!—understand how the treatment is working throughout your esketamine nasal spray treatment schedule. Your provider will then confirm that the dose kit belongs to you and show you how to self-administer the sprayer. Each sprayer contains two sprays for a total of 28 mg of esketamine nasal spray. Your prescription can vary depending on which of the two FDA-approved indications you’re taking it for: treatment-resistant depression (TRD) or major depressive disorder with acute suicidal ideation or behavior (MDD). If you’re being treated for TRD, you will self-administer medication from two sprayers for a total of 56 mg. After the first treatment, you will take 56 or 84 mg of SPRAVATO®two times per week for the first four weeks of your SPRAVATO® treatment schedule. In weeks five through eight, you’ll take either 56 or 84 mg weekly. By the ninth week and beyond, your Greenbrook provider will evaluate whether you need a 56 or 84 mg dose once a week or once every two weeks. Your total esketamine nasal spray treatment duration after this point will vary based on your symptoms and response to treatment. Those being treated for MDD will self-administer 84 mg of medication on their first day of treatment. Patients will continue taking an 84 mg dose twice a week for the first four weeks. After this, a Greenbrook provider will work with the patient to determine the next steps. Some people continue taking 84 mg of SPRAVATO® while others go down to 56 mg. It’s important to note that esketamine nasal spray is not a substitute for hospitalization related to suicide.  How to Speak to Your Doctor About SPRAVATO® While you don’t need a doctor’s referral to begin a SPRAVATO® treatment schedule, we encourage you to speak with your provider about whether the treatment is right for you. It can feel awkward to bring up medication, but you and your doctor are a team. Together, you’re working to figure out how best to manage symptoms of depression. Ask them if they think esketamine nasal spray could benefit you . During this conversation, discuss any history of alcohol or substance abuse and tell your provider whether you are pregnant or plan to become pregnant. SPRAVATO® should not be taken if you are pregnant or breastfeeding. Other health conditions, such as blood vessel disease, a ketamine allergy, or a history of psychosis, can make taking SPRAVATO® dangerous for you. Your doctor will go over your current and past medications and conditions to determine if esketamine nasal spray is right for you. If your doctor doesn’t think esketamine nasal spray is a good idea based on your medical history, FDA-cleared transcranial magnetic stimulation (TMS) may be an option. Learn more about how TMS works . Questions You Should Ask Your Doctor About SPRAVATO® At Greenbrook, our providers are always prepared to answer any questions about esketamine nasal spray. We recommend asking the following questions: How can I know if esketamine nasal spray is working? What do I do if I don’t feel esketamine nasal spray is working? If you struggle with side effects or feel that esketamine nasal spray isn’t working, your doctor may adjust your dosage or esketamine nasal spray treatment schedule. Please share your questions and concerns with the provider who cares for you at Greenbrook—they’re here to help. Schedule A Free Consultation If you have tried at least two antidepressants without success, you may qualify for esketamine nasal spray. Thanks to its FDA approval, SPRAVATO® treatment at certified centers is covered by insurance. At Greenbrook, we’ll handle the paperwork so that you can focus on your treatment. We offer esketamine nasal spray consultations to help you get started. Schedule your free consultation today.

Have you ever thought about how long a medication stays in your system after you take it? Most medications must be taken regularly because they don’t last forever in our bodies. Oral antidepressants, for example, must be taken every day. Ketamine therapy, on the other hand, is given less often than once per day, whether it is ketamine given through an intravenous injection (IV) or in the form of esketamine nasal spray. The benefits of either ketamine-based treatment usually stick with you in-between doses, even though the medication is no longer in your system for much of that time. Ketamine is eliminated from your body in two phases. The first phase is called the redistribution phase. During that phase, the amount of ketamine in your bloodstream rapidly decreases over the first 45 minutes or so. After that, the remaining ketamine in your body is eliminated more slowly, with a half-life of around 2.5 or 3 hours. That means half of it is eliminated in each half-life. After a few half-lives (say, 12 hours) practically all of it is gone. Does Ketamine Show Up on Drug Test? Ketamine does show up on drug tests. That said, many standard drug panels do not screen for ketamine. If you’re trying to determine, “How long does ketamine stay in your system?” note that the body metabolizes it within a day or two. It’s the metabolic process that leaves behind metabolites. TTraces of these metabolites can show up on drug tests days and even months after a ketamine dose. Employers and other organizations who may require a drug test often use five-panel tests that can detect amphetamine, cocaine, opiates, phencyclidine (PCP), and tetrahydrocannabinol (THC). Others may use seven-panel drug tests that screen for the five previously mentioned drugs with the addition of benzodiazepine and barbiturates. Expanded test panels can detect eight to 12 drugs, including all of the aforementioned substances along with ecstasy (MDMA), hydrocodone (Vicodin), oxycodone (OxyContin), methadone, methaqualone, and propoxyphene. Ketamine doesn’t show up on this list because it’s not standard practice to test for it, even in a 12-panel drug test. However, a drug test that does detect ketamine can be ordered. Ketamine can show up in saliva samples for up to 24 hours, in blood samples for up to 72 hours, and in urine samples for as many as two weeks. A hair test can detect ketamine for a month or longer. If you find yourself facing a ketamine drug test and are undergoing ketamine IV therapy or esketamine nasal spray treatment, talk to your provider. They can give you advice on how to handle the situation. How Long Do Ketamine Effects Last? Ketamine side effects only last during the time the medication is in your system. The more potent side effects, such as dissociation, sedation, and nausea, usually dissipate within one to four hours. Drowsiness can persist for around seven to 12 hours, which is why many providers may recommend going home and resting for the remainder of the day following ketamine or esketamine therapy. If you are still feeling side effects the day after treatment, contact your provider for assistance. Fortunately, the positive effects ketamine and esketamine can have on depression symptoms last longer than any side effects. Ketamine IV therapy patients may receive treatment twice a week for four weeks, with maintenance doses every two to six weeks thereafter. Patients taking esketamine nasal spray for treatment resistant depression (TRD) or major depressive disorder with suicidal ideation (MDSI) also start out with two treatments a week for four weeks. This is often followed by one treatment a week for four additional weeks and maintenance treatments every week or two after that. In short, once you enter the maintenance phase of ketamine treatment, you may only have to come in one or two times a month to continue experiencing the positive effects of ketamine . Is Ketamine Therapy for Everyone? No. If you have a history of psychosis or have family members with a history of psychosis, ketamine therapy may not be for you. Blood vessel and cardiovascular diseases can make ketamine treatment risky, too. Anyone who is pregnant or breastfeeding, or is planning to breastfeed or become pregnant, should avoid taking any form of ketamine. Ask your doctor if ketamine IV therapy or esketamine nasal spray may be right for you. Keep in mind that ketamine IV therapy is not FDA-approved for treating depression or any mental health conditions, which means insurance does not cover it. Esketamine nasal spray, on the other hand, is covered by insurance because it is FDA-approved for hard-to-treat depression, and for depression with suicidal thoughts. . If you don’t qualify for esketamine nasal spray, transcranial magnetic stimulation (TMS) may be an option. TMS is a medication-free, FDA-cleared depression treatment that uses gentle magnetic pulses to stimulate areas of the brain. Learn more about how long TMS therapy lasts after each treatment and how TMS works . At Greenbrook TMS, we offer TMS and esketamine nasal spray treatment in a clean, comfortable environment. Schedule a free consultation today to find out if you may benefit from TMS or esketamine nasal spray treatment.

Deciding to try ketamine treatment for depression can feel promising, especially if you’ve been using antidepressants for years and are ready to explore how an alternative treatment might help you. Excited as you may be, you might also wonder, “How exactly does ketamine work for depression?” It’s perfectly understandable to want more information on how ketamine works compared with standard antidepressants. There’s a reason that the FDA approval of nasal esketamine spray is a groundbreaking step forward for mental health. So, how exactly does ketamine work in the brain? The Science Behind How Ketamine Works for Depression Researchers aren’t 100% sure how ketamine works in the brain, but what they do know is fascinating. The answer partly depends on how depression has affected a person’s brain. Depression can cause you to lose synapses, the points of contact that allow nerve cells to communicate with each other. Research has shown that ketamine can help synapses begin to regrow within 24 hours after treatment. The more synapses regrow, the more relief a person feels from symptoms of depression. Ketamine also acts on the glutamatergic system. Glutamate is an excitatory neurotransmitter that helps nerve cells, particularly those involved in mood regulation, communicate with one another. Ketamine increases glutamate signaling, helping stimulate those weakened connections. It also acts on gamma-aminobutyric acid (GABA), a neurotransmitter thought to help regulate anxiety, fear, and stress. How Ketamine is Different from other Antidepressants Unlike antidepressants, ketamine targets amino acid neurotransmitters and monoamine neurotransmitters, whereas standard antidepressants only affect monoamines. Amino acid neurotransmitters like GABA and glutamate account for roughly 80% of the neurotransmitters in the central nervous system. Monoamines like serotonin, epinephrine, and dopamine—which help regulate mood, pleasure, and learning—make up the other 20%. Selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and cyclic antidepressants all work to increase monoamine levels in the central nervous system. While they can be effective, they often take anywhere from two to six weeks to work. For some people, these monoamine-targeting antidepressants never work at all. You may be wondering, “How long does ketamine take to work for depression?” Ketamine acts much more quickly than standard antidepressants, often within just hours or days of starting treatment. While it’s not a quick fix for everyone, many patients report feeling markedly better shortly after they begin ketamine IV therapy or esketamine nasal spray. Researchers believe this is partly because ketamine targets amino acid neurotransmitters and monoamines. If you’ve tried two or more oral antidepressants with little to no success, you may be a good fit to try ketamine for depression. Keep in mind, however, that the FDA currently requires you to take an oral antidepressant along with SPRAVATO®, the only FDA-approved, ketamine-based depression treatment How to Speak to Your Doctor about Ketamine If you feel as though antidepressants aren’t helping, talk to your doctor about esketamine nasal spray. While some doctors may feel reluctant to prescribe ketamine IV therapy since it is not FDA approved for treating depression, they should be willing to explore esketamine nasal spray . SPRAVATO® is made with a form of ketamine called esketamine. It is FDA-approved for treatment resistant depression (TRD) and major depressive disorder with suicidal ideation (MDSI). Because of this, treatment is covered by insurance. You don’t need a referral from your primary care provider to begin SPRAVATO®. At Greenbrook, we offer nasal esketamine spray consultations to determine whether SPRAVATO® is right for you. Our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners can recommend and prescribe SPRAVATO® based on their evaluation of your mental and physical health. We do encourage you to keep your primary care provider and/or psychiatrist in the loop, however, as this gives you the ability to make informed decisions about treatment. Certain conditions, including pregnancy and a history of psychosis, may mean esketamine isn’t a good fit. Esketamine can also come with notable side effects, including dissociation, sedation, nausea, and a temporary spike in blood pressure. At Greenbrook, you’ll be carefully monitored during the mandatory two-hour observation period following each esketamine treatment session. If your provider does not think esketamine nasal spray is right for you based on your medical history or past reactions to ketamine, transcranial magnetic stimulation (TMS) is an excellent, drug-free option.  Schedule a Consultation at Greenbrook Our SPRAVATO® REMS-certified clinics are a comfortable and relaxing setting for your ketamine-based treatment for depression. We provide private rooms or bays for your treatment sessions yet can accommodate multiple patients at once, meaning you won’t experience delays in treatment. Your Greenbrook Care Team will attend to your needs from the beginning to the end of each session. We also provide TMS therapy should you prefer a medication-free option with fewer side effects. Schedule a free consultation with one of our Patient Consultants to learn more about how we can help lift the fog of depression.