Specialty Medication Clinic

Featuring Esketamine Therapy for People with Treatment-Resistant Depression

Great advances are being made in medication-based treatment for mental illness. The Specialty Medication Clinic at the Brattleboro Retreat provides qualifying people who experience certain mental health conditions with access to breakthrough medications in a safe clinical environment with medical supervision. The Specialty Medication Clinic currently offers esketamine (Spravato®) therapy for people with treatment-resistant depression.


Esketamine Therapy


What you should know about esketamine

Esketamine (Spravato®) is an FDA-approved prescription nasal spray used along with an antidepressant taken by mouth to treat adults with treatment resistant depression (TRD) or adults with major depressive disorder (MDD) with acute suicidal ideation or behavior. It is derived from ketamine, an anesthetic that has also been used to treat depression.

How does esketamine work?

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.

How is esketamine administered?

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.

How fast and effective is esketamine?

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.

What are common side effects of esketamine?

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.

How should I prepare for esketamine treatment?

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

Who should NOT take esketamine?

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
Who qualifies for esketamine treatment?

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.

What is the time commitment for Esketamine therapy?

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.

Does insurance cover esketamine?

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.

Does the Specialty Medication Clinic offer other medications?

We are looking into adding additional medications pending FDA approval.

Getting Started

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/

Specialty Medication Clinic External Provider Referral Form (for referring providers only)

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