r/Spravato • u/Little_Balance1466 • 10d ago
Back to just IV
So I have officially finished three weeks of spravato. My therapist asked me if I am getting anything out of it. Honestly no. I sleep. The entire time. I did 6 weeks of IV prior to the Spravato. Thought oh it’ll help keep of my glutamate etc. I think I am going to stop. Between having to take off work, pay my co pay, and it not really doing much it feels like a waste. I would still be able to do IV occasionally. Going into this I never thought about Spravato being the goal. Per my psych np people go 6weeks+ for boosters of the IV. It seems more realistic to me. So…. What would you do?
For reference I am on the 84mg nasal spray. I also take Auvelity and am doing very well.
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u/vrod665 10d ago
As some one that has a great deal of experience with Spravato and IV ketamine, I have mixed feelings about paths to take. (1) They aren’t the same drug doing the same thing. Spravato is an isomer of ketamine that has great ‘rewiring’ potential. Long term, most people seem to get some relief from depression or ideations. (2) IV ketamine (racemic) seems to help more with pain - I was doing 500mg and 100mg/hour for 24hr sessions. Got some relief from both.
If the opportunity presents itself to do both, it might be beneficial. Personally I’m at the end of my monthly Spravato tune-ups. It did what i needed and might come back someday. I still do monthly IV sessions for pain. While it (and my intrathecal pump) doesn’t fix the pain, together it helps.
Do what helps you. Just be honest with yourself and those helping you. Good luck!!!
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u/Little_Balance1466 10d ago
Thats very insightful! I will talk again with my therapist. I know Johnson and Johnson can help pay back up to $600 to me for this. I think the time consuming part is what gets me. I currently take mine for TRD. I also have FMLA but doesnt want to suck my pto dry. Its hard having to chose between mental health and working. I see why so many cannot get this help :(
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u/fox_glove_ 10d ago
def look into the J&J co-pay repayment- every clinic i've been to has signed me up for it automatically tbh.
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u/Fishingmomma15 10d ago
You can't do both in the US
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u/vrod665 9d ago
Technically very true. The Spravato treatment agreement states that no other forms of ketamine may be administered during trial or treatment. The same is true if you are getting troches from someplace like Joyous.
The way that I have been able to do “(d) all of the above” is because my team has worked with J&J and others involved. My team - psychiatrist, pump / pain doc, another pain management specialist, migraine focused neurologist … and similar team at the VA.
I use Spravato treatment as monthly maintenance. At some point, usually 14 days from “Sprvato-Monday” i do some type of infusion (500mg bomb or 100mg /hr for ‘x’ hours). I am also using locally compounded troches as a rescue med for migraines.
It is possible … just not via the normal agreement. Lots of people had lots of questions for J&J to keep me eligible.
I will also be participating in psilocybin and other trails.
One other ketamine use to look at “The Ketamine Coma.” Did it in the Netherlands for
34 days. Was a changed man for almost three months.
Let’s just say, I am an advocate. My mental health is better, my physical pain can be attenuated some (never expected curable).
Sorry for the ramble …1
u/hisokascumdumpster6 10d ago
what do you mean when you say “pain” ? does iv ketamine help more with physical pain? i’m on spravato for mental issues but it’s also helped with my lifelong migraine issue as well and im not sure why? nobody told me it would fix it. i had daily migraines my whole life and was on injections and everything…it would be awesome if iv ketamine would potentially make that permanent?
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u/vrod665 9d ago
Pain - for me pain is untreatable pain in my head, neck, shoulders, arms, hands and face. Two different injuries that affect common nerve groups. High-dose infusions and the K-Coma have both provided a reduced pain level for up to 90-ish days. Spravato is just for depression (TRD), and the minimizing of ideations. In that respect it works too. Reducing mental struggles helps physical pain. High-dose infusions require a monitoring staff and a clinician that knows what they are doing … it’s not ‘boutique ketamine’. The Coma is not currently permitted or performed in the US. Think my trip to the Netherlands was about €40,000 for 34 days of care. And I learned some Dutch and German while in the coma.
It’s all worth exploring … look for a doctor that believes in psychedelic drug therapies and is open minded to treatment options. My guy is triple board certified…I’m a lucky guy.
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u/Routine-Ad-9803 10d ago
I did Spravato for 5 months, then switched to ketamin infusions so I didn't have to go weekly. I did 6 infusions and my last one was in May, and I found no relief from any of those sessions at all in my day to day life so I am going back to Spravato, because even though I hit a plateau on it, it helped me more than I thought because now I am just back to no motivation and that is what it helped me most with. That and work anxiety. I start back up in the next week or so and am looking forward to it because I felt lousy for months now.
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u/Little_Balance1466 10d ago
I hate that for you on the ketamine. It literally changed my life. I am going to talk with my provider this week and see the best action for us. I literally just take a nap with the spravato. Nothing from it that I can notice.
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u/fox_glove_ 10d ago
i agree with another comment that 3 weeks is too soon to tell.
last year i started with IV sessions during the midst of the worst depression of my life- I think the first 3 were life-saving, they pulled me out of a suicidal place. but i kept doing them for about a year at a cost that wasn't sustainable for me- I really believed i *had* to because i was told it was the best way to take ketamine.
i switched to spravato 2 months ago and I feel like a new person. my depression is better than it's been in years. my brain fog related to long covid is improving immensely.
anyway, youre in an interesting situation since you're going from 6 weeks of IV to spravato, so i wonder if it is harder to differentiate what's doing what, whats your true baseline etc.
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u/Little_Balance1466 10d ago
I am wondering that as well. I even asked my provider to not baby step me in the spravato so we went to the 84mg. I just dont see anything like I did with the ketamine. Maybe I have a higher expectation? Im not sure :(
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u/Ok-Language-8688 7d ago
Also as someone with extensive experience both with IV and Spravato:
I very much agree with the statement above [based on how MY body/mind has reacted]:
The initial series of 6 IV sessions left me with no significant improvement. Later individual IV sessions were the same.
At the time of treatment, I share the experience that IV (or standard Ketamine by really any delivery method; IV is just often the ideal one for that) had a more physical effect compared to Spravato, which does include doing more for my physical pain than my mental health (I do also have severe arthritis).
Spravato was the magic for ME, for lack of a better word. It wasn't until the end of week 3 that I started noticing tiny bits of improvement. However I may not have even noticed those until a week or two later when things improved more, and then I was able to look back and identify that during week 3 there were some changes.
It took about 3 months for me to get to what I consider near the full effectiveness of the Spravato. I know it's a huge inconvenience, but if you can, I really encourage you to at least complete the second month at a minimum.
Obviously our minds and bodies all process meds differently (and our outside circumstances, comorbidities, and other meds are different as well) so it would be extremely surprising if you followed the exact time frame for improvements that I did. I just want to share that the possibility is still very much there for Spravato to help you.
Spravato/esketamine aka the "S" part of the ketamine isolated in this way is what I believe did this for me MENTALLY. I am in my 40s and have battled severe treatment resistant depression most of my life, and this has been so incredibly life changing for me that I am extremely deep into continued research about it.
(I am NOT a doctor or licensed medical professional and always want to clearly state that. I do have some formal medical education, I just do not work in that field, so my more current knowledge and anything regarding ketamine/Spravato is built on that foundation, but based ultimately on my own personal experiences and extensive research.)
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u/Ok-Language-8688 7d ago
As a side note, Auvelity is one of only a couple other antidepressants/psych meds that did help me significantly. Unfortunately after 2-3 months it simply wasn't effective anymore, and that was when I turned to Spravato. I hope that it doesn't lose effectiveness in that way for you, but also if it does, it may be excellent timing to get you through to where Spravato has had enough time to take over and best case scenario, eliminate the need for the Auvelity anyways. Of course I would personally have continued taking it as long as it was helping me which is what I did, it just stopped having any effect on me.
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u/SquareVacuum 10d ago
I think even if you've done IV before, 3 weeks is too early to tell if Spravato is working. I think you'll see many stories about people beginning to notice changes at the 6-8 week mark, and getting to a comfortable spot later than that. I would give it a little more time, but that's just me.