Depression is a serious medical disorder that affects many people, and increases the risk of suicide.  Fortunately, most patients are able to be successfully treated with medication, therapy, or both.  However, there is a not insignficant subset of patients who have tried multiple medications to treat their depression, and nothing has worked.  This is known as treatment resistant depression.  As it name implies, treatment resistant depression is difficult to treat.  However, there is a new FDA approved treatment called Spravato that may help a lot of patients with treatment resistant depression.

Ketamine is an anesthetic agent that has been used for many years.  For some time now, we have known that in lower than normal doses, ketamine given intravenously can signficantly and quickly (after one treatment) reduce depressive symptoms.  In fact, ketamine infusion clinics are popping up all over the country.  However, because IV ketamine is not an FDA approved treatment for depression, most insurance companies will not pay for this.  Thus, this potentially effective treatment for severe patients may be out of reach for most, as IV ketamine can cost up to $1000 for just one dose.

Spravato is a form of ketamine (esketamine) that is given intra-nasally. Unlike IV ketamine, Spravato is approved for treatment resistant depression.  For most patients who have commercial insurance, Spravato (usually with prior authorization and a co-pay coupon card) costs only $10 a dose.  Because of some of its side effects (sedation, nasuea, increase in blood pressure) as well as its risk for abuste (ketamine is also used as a street drug), Spravato can only be adminstered under the supervision of a certified doctor in their office.  Patients are monitored for 2 hours after each dose, and they must find someone else to drive them home.

Here is video  that explains more.


Author Matthew L. Mintz, MD, FACP

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