Spravato

Spravato Treatment Center

Depression is a common, but serious condition that affects how you feel, and can adversely impact daily activities such as sleeping, eating, or working.  While many patients respond to traditional therapies such as talk therapy and prescription medications , up to one third of patients do not improve even after two or more medications. This is called treatment resistant depression.  Treatment resistant depression can be debilitating for patients, and lead to thoughts of suicide and even suicide attempts.  Fortunately, Spravato (nasal esketamine) is a new FDA approved medication shown to be safe and effective in patients with treatment resistant depression, and does not require taking a daily pill.  Only certain healthcare settings and physicians are authorized to prescribe and administer Spravato. Dr. Matthew Mintz, located in Bethesda, Maryland, is an official Spravato treatment center, and can provide Spravato treatments to patients who reside in Bethesda, Potomac, Rockville, Chevy Chase, or anywhere in Maryland, Virginia, or the District of Columbia.  With a referral from your psychiatrist, Dr. Mintz can determine if you are an appropriate candidate for Spravato, assist you in getting insurance to cover the medication and treatments, and monitor you during administration of Spravato in his private medical office. Dr. Mintz is now accepting insurance for patients with Carefirst (Blue Cross Blue Shield), Aetna, and Cigna. 

What is Spravato?

Spravato (nasal esketamine) is an FDA-approved treatment for depression in patients who have not responded to two or more medications.  Spravato is a nasal spray that is self-administered in a certified treatment center.  Patients must be observed for 2 hours after administration, and must have someone drive them home after treatment.

How Does Spravato Work?

The mechanism by which Spravato  exerts its antidepressant effect is unknown.  Spravato (nasal esketamine) is thought to work through multiple mechanisms: it modulates the levels of certain neurotransmitters (GABA, Glutamate) in the brain, improves cellular communication, promotes growth of new nerve cells, and decreases inflammation.

How is Spravato different from Ketamine?

Spravato is a component of another medicine called ketamine. Ketamine was developed as a general anesthetic and has a proven safety record, having been  used in hospitals for decades.  More recently, ketamine has been found to be effective in treating depression and some forms of pain in much lower doses.  Ketamine is usually administered intravenously in clinics to treat depression, though can be administered intranasally as well.  However, even though ketamine has been shown to be effective for treating depression, it is currently  not approved by the FDA for this use. , Because it is not approved by the FDA for this use, ketamine is generally not covered by insurance. Intravenous ketamine  can be very expensive- costing up to $1000 per treatment.  Spravato (esketamine) is derivative of ketamine that is administered as a nose spray.  It is approved by the FDA and covered by most insurance companies.  Spravato can only be administered in an approved treatment center. For those patients whose insurance does not cover Spravato, Dr. Mintz is also able to provide intranasal ketamine at a very low cost.

What does it feel like when taking Spravato?

Spravato is very different from anti-depressant pills, which take days to weeks to show any effect.  Spravato can start working within minutes to hours. Spravato causes something known as dissociation, which is feeling disconnected from yourself, your thoughts, feelings, space and time.  This is not necessarily unpleasant, and patients often report feeling like being in dream-like state, or feeling like they are floating.  You may also feel sleepy or dizzy. These sensations usually wear off within the 2 hour observation period, though patients should not drive until the next day.  Improvement in depression symptoms can often be seen shortly after the first dose.

What are the side-effects of Spravato?

Side effects include dissociation; dizziness, vertigo (feels like the room is spinning), and feeling drunk; nausea and vomiting; sleepiness and lethargy; and reduced sense of touch.  Blood pressure can also become elevated, so patients with uncontrolled high blood pressure and heart failure should not take Spravato. Any side effects usually resolve within the 2 hour observation period, but someone will need to drive you home after taking Spravato.

Do I need a referral from a psychiatrist?

Yes. Dr. Mintz requires a referral from your psychiatrist or mental health professional that is managing your current depression medications.  Treatment resistant depression is a serious disease, and it is important for your psychiatrist or other mental health professional to be involved in your treatment, even if he or she is not prescribing or administering Spravato.  Dr. Mintz will ensure that you receive and safely take Spravato, monitoring any treatment effects during the course of your treatment.  Your psychiatrist will manage any of your psychiatric symptoms while you are taking Spravato, just as he or she normally would.

What is the process for starting Spravato?

Spravato can only be delivered to and administered at an approved Spravato treatment center.  Dr. Mintz is one of the few physicians in the District of Columbia, Maryland, and Virginia who is approved to prescribe and administer Spravato, and one of the very few who will accept insurance.  While Spravato is covered by most insurance companies, it is expensive and almost always requires prior approval. Thus, the process for starting Spravato is a little more complex than calling in a prescription to your local pharmacy.  The first step in starting Spravato is to schedule a consultation with Dr. Mintz, who will perform an initial evaluation to determine if you are an appropriate candidate for Spravato treatment.  Dr. Mintz will then reach out to your insurance company to obtain coverage for Spravato by your insurance, so that you only have to pay the co-pay (and using a coupon from the manufacturer, this is usually $10 per dose). Once it is determined that Spravato is approved for coverage, Dr. Mintz will order Spravato from an approved pharmacy that will send your medication to Dr. Mintz’ office.  Finally, Dr. Mintz’ staff will contact you to set up an appointment for your Spravato treatment.  Spravato is given twice a week for the first 4 weeks, then weekly. Dr. Mintz is now accepting insurance for patients with Carefirst (Blue Cross Blue Shield), Aetna, and Cigna. 

How Long Are the Sessions and How Many Will I Need?

Unlike prescription medications, Spravato works quickly, sometimes within minutes. However, the effect usually lasts less than a week. For the first four weeks, you will have two sessions a week.  After that, session will continue weekly.  After 3 months, patients can schedule sessions every other week, though in Dr. Mintz’ experience, most patients require weekly sessions.  Sessions are two hours in length due to the need to monitor you closely.  We will check your blood pressure, heart rate, and monitor you for side effects at every session.

How Much Will Spravato Cost Me?

Your cost for Spravato depends on your insurance.  There are two components to the cost of Spravato: the cost of the medication, and the cost of the administration.

Medication:  Spravato is covered by most insurance companies, but will likely require prior-authorization, which Dr. Mintz will perform.  Dr. Mintz will not only determine coverage, but will also determine your co-pay, so you know the cost of each dose before you start treatment.  For most patients with commercial/private insurance (CareFirst, United, Aetna, etc.), Janssen (the pharmaceutical company that makes Spravato) has coupons that can reduce your cost for Spravato to as little as $10 per treatment.  For patients with Medicare, Medicaid, Kaiser or no insurance, Spravato may not be covered, or the co-pay may be very expensive. For these patients, Dr. Mintz is able to administer nasal ketamine, that should cost less than $7 per treatment, even without insurance coverage.

Administration:  Spravato can only be administered in an approved Spravato treatment center, such as Dr. Mintz’ office.  Patients must be observed for 2 hours after treatment.  The initial consultation is $250 and each 2 hour treatment administration is $175.  Dr. Mintz is now accepting insurance for patients with Carefirst (Blue Cross Blue Shield), Aetna, and Cigna.  If you have Carefirst, Aetna, or Cigna you will only be responsible for paying your co-pay for each treatment (plus your co-pay for the medication).  For those with other private/commercial insurances, while you will need to pay for the consultation and treatments up front, Dr. Mintz will give an invoice that you can submit to your commercial/private insurance for reimbursement.  Once your out of network deductible is met, most patients get back this money, minus their co-pay.  Unfortunately HMO’s or Medicare will not reimburse you for Spravato administration  by Dr. Mintz.