Specialty Medication Clinic

Many conventional antidepressants increase serotonin, dopamine, and norepinephrine chemicals in the brain that act as messengers between brain cells. Unlike those treatments, eskatamine increases levels of glutamate, the brain’s most prevalent chemical messenger. It is thought that this improves and strengthens connections between brain cells, which can alleviate depression.

Esketamine is a nasal spray which is self-administered by the patient under the supervision of a healthcare provider. The patient is monitored for at least 2 hours due to the potential side effects. The exact mechanism for how esketamine treats depression is unknown.

According to studies, 70% to 75% of people who receive a full course of esketamine therapy experience symptom relief. This relief commonly comes within hours up to several treatments, unlike conventional antidepressants which can take weeks or longer to work.

The most common side effects are:

• Dissociation- feeling disconnected from yourself, your thoughts, feelings, space and time
• Sedation- feeling a state of calmness, relaxation or sleepiness
• Dizziness
• Nausea
• Vomiting
• Numbness
• Increased blood pressure
• Feeling anxious, happy or excited

These possible side effects are why each treatment session requires a 2-hour observation period in a private room in our clinic, in which your blood pressure will be monitored frequently. Most side effects, if any, will resolve by the end of the 2-hour monitoring session, but some effects, like fatigue, may linger for a few hours. As a result, patients must have a ride home from the session; they cannot drive themselves home or operate heavy machinery until after a night’s sleep.

It is recommended to avoid eating for two hours before, and drinking anything for 30 minutes before taking esketmine, to help avoid nausea.

Esketamine is not suited for individuals with the following conditions:

• Aneurysmal vascular disease (blood vessel disease) in the brain, chest, abdominal aorta, arms and legs
• Arteriovenous malformation
• History of bleeding in the brain
• Allergies to esketamine, ketamine, or any other ingredients in the medication
• Severe liver problems
• Esketamine is not recommended for children under the age of 18, pregnant women, or women who are breastfeeding

Esketamine is available to people who have been diagnosed with major depressive disorder for whom at least 2 medications from different drug classes have failed to provide symptom relief. Patients must be referred by a licensed mental health clinician.  Patient must be referred by a licensed mental health clinician, psychiatric provider, or medical provider who has been treating the patient.  The referring provider will continue to provide ongoing treatment while the patient is receiving esketamine therapy at The Retreat.

Prior to starting treatment, potential patients will meet with a psychiatric provider to ensure they qualify for the program and to begin the process of obtaining insurance coverage.    Once treatment begins, each medication session takes approximately 2 hours and fifteen minutes, including check-in, administering of the medication, and a two-hour observation period.

Treatment is twice a week for four weeks, then steps down to once a week for four weeks. At that point, we will evaluate your progress with you to determine next steps, which may include ending treatment or developing a weekly, biweekly, or monthly maintenance schedule.

While coverage for Spravato treatment will be determined by each individual’s insurance plan, it is typically covered by most insurance companies. The Brattleboro Retreat will determine each candidate’s eligibility for Spravato treatment.

We are looking into adding additional medications pending FDA approval.

The Retreat’s referral and admissions process is designed to be simple and convenient.  For more information call 802-258-3700.

Learn more details about the medication at www.spravato.com/

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