Spravato® is FDA approved for treatment resistant depression in adults in conjunction with another antidepressant. Treatment resistant depression is now defined as depression that does not respond to adequate trials of two antidepressants. Spravato® has been recently approved for use in adults with major depressive disorder who have suicidal ideation. These patients do not have to fail adequate trials of 2 antidepressants, they can proceed directly to Spravato® treatment.

Like many antidepressants, we don’t know the exact mechanism of action. We do know that Spravato® interacts with the NMDA receptor, a subtype of glutamate receptor. This is different from most of the current antidepressants which interact with receptors involved with norepinephrine, serotonin, and dopamine.

Yes. It is not uncommon for patients with MDD to have other conditions like anxiety disorders, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) or a history of alcohol or other substance abuse. These patients can still receive Spravato®.

Yes, Spravato® is covered by most major insurance plans. Coverage and copay costs can be determined before patients receive their first treatment. The current out-of-pocket cost ranges from $0 to $225 per treatment. There are programs sponsored by the maker of Spravato® to help with high copays.

Spravato® treatment centers work with pharmacies certified to dispense Spravato®. Spravato® treatment is part of an FDA REMS. (Risk Mitigation and Evaluation Strategy) to manage and monitor the patients who receive Spravato®. Patients can experience sedation, dissociation, and increased blood pressure during the 2-hour in office treatment. The side effects require a 2-hour monitoring period in the office and patients cannot drive until the day after treatment.

Avance Psychiatry and Pain Management in Chapel Hill and Avance Psychiatry in Charlotte have psychiatrists who specialize in treatment resistant depression.

In Chapel Hill, Robert A. Millet, MD, was one of the first physicians in the U.S. to use Spravato® and has delivered over 6,500 Spravato® treatments.

In Charlotte, Avance Psychiatry is a Certified Spravato® Treatment Center, led by Medical Director, Sashalee Stewart, MD.

Yes. This can be done through the Avance Psychiatry website or by calling either clinic. The first visit will be a consultation to determine if Spravato® is the best medication for a patient’s depression and what other options may be available if Spravato® is not the best choice.

Patients should follow up with their regular provider to prescribe all medications except Spravato®

Treatments are twice a week for the first month and then one a week for the second month. Most patients see results within the first four treatments (two weeks of treatment). Almost all patients who are responders will notice results within the first eight treatments (four weeks of treatment).

Patients should call to schedule a Spravato® consult. New consults are usually seen within 1-2 weeks and treatment usually starts the week after the initial consultation.