Cruz Clinic has recently expanded our treatment modalities for depression and is now offering Esketamine treatment, also known as Spravato, under the direction of Samuel Wedes, MD.

Spravato is a relatively new antidepressant with a novel mechanism of action that conveniently comes as a self-administered nasal spray. It is FDA-approved for treatment-resistant depression and depression with suicidality – however, it does not take the place of inpatient psychiatric hospitalization.

The effects of Spravato tend to be rapid, sometimes within the first day of treatment. For others, it may take longer to see a response – up to four weeks or more. It has been shown to be safe and effective.

Treatment-resistant depression is quite common. Despite adequate trials of antidepressants and sometimes augmenting additional medications, people with treatment-resistant depression continue to struggle with symptoms including:
- Depressed mood
- Lack of interest or pleasure in activities that normally bring them joy
- Sleep and appetite disturbance
- Fatigue or lack of energy
- Difficulty concentrating or thinking clearly
- A feeling of being abnormally slowed down or sped up
- A sense of worthlessness or irrational guilt
- Thoughts of death or suicide

Spravato must be administered in a healthcare facility such as Cruz Clinic. Patients receiving Spravato have their vitals (including blood pressure and pulse ox) checked before, during, and at the end of each treatment. All patients are monitored in our comfortable Spravato suite, by our medically trained treatment staff for at least two hours following the initial administration of the nasal spray.

Side effects from Spravato typically resolve within the two hour monitoring window after receiving the nasal spray. Side effects may include:
- Sedation and dissociation, including feeling as if one is outside of themselves (depersonalization) or that one’s surroundings are not real (derealization).
- Perceptual changes can occur.
- People may see shapes and colors that are not there.
- Increased blood pressure may occur.
- In rare cases, Spravato can cause respiratory depression, or decreased drive to breathe during the two-hour treatment period.
- Spravato also has the potential for misuse and abuse.
- Like all antidepressants, Spravato may increase the risk of suicidal thoughts and behaviors in young people.
- It is important to note that people receiving Spravato cannot drive or operate heavy machinery until the following day. They are required to have a friend or family member stay with them during treatment.

Spravato is generally administered twice weekly for the first four weeks of treatment. This is considered the induction phase of treatment. After induction, patients will enter the maintenance phase, which generally requires once-weekly treatment for the first month, and then treatment weekly or every other week thereafter.

While some patients are able to stop Spravato treatment and maintain stability of their depression with oral agents and psychotherapy, others will require indefinite treatment with Spravato to maintain relief of their depressive symptoms.

If you or a loved one is suffering from treatment-resistant depression or depression with suicidality and are interested in Spravato treatment, please give Cruz Clinic a call at (734) 462-3210. You will be directed to our intake department, who will help you set up an appointment with one of our psychiatrists to review your history, the risks and benefits of esketamine treatment, and what to expect during treatment.

Once you meet with your prescriber, treatment can begin. There is no need to suffer from treatment-resistant depression or depression with suicidality any longer.