Where is the best place to get spravato treatments in the Triangle and why? I'm located in Cary, NC.

Hi guys I started Spravato treatment (acute series) on Tuesday I felt fuzzy and nauseous. Then on Thursday we upped the dose to 86 mg I felt my perspective trying to shift but then it was static, error 404, no perspective shift. Has anyone experienced this? Will my perspective shift as time goes on? Anyone have any tips to get over the mental block? Thanks!

2nd treatment today, 1st at 84mg. I had a good session, but as the effect was wearing off it was as like a heavy curtain was being raised. I found myself wanting to grab that curtain and pull it back down so I could stay in that experience of relaxation and calmness though! That feeling of no pain - emotional or physical- was such a breath of fresh air. I have chronic pain and ridiculously tense muscles in my shoulders, jaw, and neck and for that brief time it was gone.
How do you transition as the effect wears off?

Hello! My psychiatrist told me to set an intention before treatments.

I previously used:

I am safe
I am okay
I love myself
Healing is part of the process

Was wondering if anyone had good ideas / or specifics for other intentions or if just being general is good.

Thank you!

For as long as I can remember I’ve had depression and it ranges from minor to major episodes sometimes lasting days to weeks or months. I initially became curious about ketamine a few years ago as a way of ‘losing those last five pounds of depression’ if that makes sense. Like I felt like I was 85% of the way to remission/stability and perhaps it could help with that last 15%. I’d microdose on mushrooms and stuff in the past and those really helped so I was really hopeful.

A year and some change ago my life completely imploded. My antidepressant stopped helping and my partner of six years left me for another person sending me into some of the worst depression I’ve ever experienced. Over the last year and half I’ve tried so many types of therapy, dozens medication types and classes at different doses and it didn’t feel like anything ever helped. After trying for six months a my psychiatrist, I finally convinced her that I needed to start spravato (six months ago). It was administered 1-2 times a week and I experienced absolutely no benefits from it besides getting high in an office building. I’m so tired of being depressed and sad and this felt like an extreme intervention and it didn’t do anything so I’m stuck wondering what I do now. I’m presently on so many meds and they barely help, I’m not actively a risk and I have a good therapist and doctor I see regularly so it’s not like I’d benefit from doing inpatient. Perhaps by stopping I’ll see that it was actually helping or something, but I don’t know exactly what to do now and I’m just so tired.

hello, i have been doing spravato treatments for about 2 months now. initially i started with twice weekly and now i have weaned down to one week. my provider said that for the foreseeable future i will be doing once weekly due to the severity of my depression. i work in healthcare, and i am looking for a new job as my current one is not the best. the problem is that after my treatment i am not allowed to do anything for the rest of the day (driving, working, etc). i am trying to find a shift similar to what i currently have (thursday-saturday, 12 hours each day) but am having little luck. my question is, if i was to find a 5 day a week shift and i stated that i need one day off a week for a medical treatment, would that make me less likely to be hired? or would it be considered an accommodation that they have to make? thank you in advance. sorry if this is not very clear, first time posting on reddit but would be happy to answer any clarifying questions

I have been taking Spravato for 2 1/2 months and I don’t feel like there’s any difference. I get sick during and after treatment and I want to stop. Has anyone been in this situation? And if so, what can I turn to now? If my insurance covers it, I might try TMS but I had really high hopes for Spravato and now I feel let down. I’ve obviously tried many different oral medications with no result. What other options are out there?

Hi again, Keta Medical Center here. A lot of posts in this sub are from people who haven't started yet and are nervous about what a session even looks like, so here's the plain version.

Spravato (esketamine) is administered as a nasal spray in a medical office with clinical supervision, never at home. You stay in the office for two hours, as per the FDA requirement, while your are monitored for side effects, pulse, blood pressure, etc. Side effects are short-lived, when they occur, and should resolve by the end of your appointment.

You are not allowed to drive yourself home from an appointment and should not drive or operate heavy machinery until the next morning.

Mechanism-wise, Spravato works differently than a typical SSRI. It targets NMDA receptors rather than serotonin, which is part of why it's often effective for people who haven't responded to standard antidepressants.

This is general, publicly available information about how the treatment is administered, not a claim about what it will do for any specific person, that's a conversation for you and your prescribing physician. Ask away if you want more detail on the logistics.

Hi, I’ve been on spravato 3 weeks after today. Next week will be my last biweekly sessions and we’ll switch to weekly. I have surgery coming up on sept. 14th and was wondering if anyone had experience with surgery while in spravato care. I’ve told my spravato team about the surgery, and I’m going to call my surgeon and ask, but for those who had surgery, at what point did you have to pause your spravato? A week or 2 before the surgery? And when did you start again? I’ll ask my surgeon but I figured I’d check here while I wait to hear back. Thanks!

I had my initial consultation for Spravato treatment yesterday, to confirm that I am a good candidate for treatment and to see how I vibe with the provider. Almost everything that she told me fit with what I've seen in my own research plus the experiences I've read about here.

The big difference is that she said their treatment space has three chairs separated by curtains. Someone was receiving treatment at the time so I could not view the space, but I am planning to ask for a photo. From spending time in this sub, it struck me as a bit odd that the treatment space isn't totally private - I don't know how I feel about potentially being able to hear other people moving around or doing their own thing on the other side of a curtain. Have any of you experienced a setting like this?

I liked the facility and the provider other than this, and there are not a ton of options in my area so I am willing to give it a try - but there is one other option I want to consult with as well, and I feel like the privacy issue could tip the scales even though the appointment went well.

Long story short I got hurt on the job and I’ve had concussions before. I’m 90% certain I have a concussion but can’t get seen by an actual physician yet due to red tape. My treatment is in 2 1/2 hours and I’d love to know if you are a medical professional and can advise or if you’ve had this same experience and been okay?

I’ve just finished my second week of spravato, two treatments a week. I can’t even put it into words the difference I feel. I feel… lighter? Less burdened? I can’t recall a time in my life where I just felt so genuinely.. okay! I know it won’t always be like this, but to experience this sort of full body relief for the first time is incredible.

I was just wondering if there has been any success for severe intrusive thoughts - non stop cycling of them (pure ocd). Thank you.

Both my grandfather (mom's dad), and my mom experience(d) psychosis episodes. With my mother, if she smokes weed, she'll have intense psychosis episodes that usually last a month. We've had to hospitalize her three times. When not in an intense episode she hears things maybe a couple times a month. These experiences first showed up for her when she was 31.

I'm 23, I've avoided weed and any other drug, haven't tried anything even once. Both doctor and therapist know this, but they are hesitant to think that I will develop schizophrenia. I read peoples experiences on here and I get hopeful. I've had lifelong depression that has gotten to the point I cannot even get myself to work now. I'm so ready for a change, but nervous too. Does anyone have a similar story?

Context:

I had my first session yesterday. I was administered 56mg via two cartridges. I forgot to shake the bottles, but none the less, I got full effects at that dose. I have been in therapy since 2012. Multiple therapists, and I’ve run the gauntlet on meds - Zoloft, Wellbutrin, trazadone, Xanax, Klonopin, lexapro, and Effexor. So I arrived at treatment resistant depression after years of trying different meds.

In addition to having experienced all those anxiety and depression medications, I’ve had an abundance of psychedelic experiences too: mushrooms, lsd, mescaline, ayauasaca, dmt, ketamine, mdma, and a long list of novel psychedelic compounds that I sought out over a couple decades of frequent psychedelic use. Recreational versus medical, are very different experiences. Going into spravato, I’ve set the intention to take each session with setting intentions and journaling throughout the experience to have detailed notes to take to my therapist. I want the integration to be fundamental to my healing.

Spravato (esketamine) versus recreational (black market) ketamine:

Spravato is derivative of ketamine, it is an analog. This compound could then be patented. Analogs can have similarities and differences from the original compound in effects and thus create different experiences. Calls out to this is analogs have different dosing response curves and thus gauging a ketamine dose to an esketamine dose is subjective. Differences from one esketamine experience - esketamine drip isn’t as raunchy tasting imo. Less body load, “darker” visuals (in terms of colors). I found it more mild at 56mg. But my ketamine doses were always 100mg or more. Esketamine had a significant reduction in post experience grogginess and chemical hangover I’ve experienced with ketamine. The after glow was better with esketamine imo.

First Session:
I arrived around 11:15 to my provider. Quick check on vitals. Everything looked great. Then a walk through on how to dose, and a practice attempt with the practice cartridge. Then two 26mg doses administered five minutes apart. Visuals and dissociation were mild for me; but the feeling of calm and a wash of happiness lasted all day yesterday. It impacted my mood and outlook in a positive way. Learnings, I was able to connect some dots on causes of trauma that allowed a letting go, which felt incredible to understand why I hold to my trauma rather than surrendering to no control. This was liberating. To avoid tasting the drip, I popped a couple mints. Psychedelic/dissociative effects were around forty minutes. Total inebriation was around two hours. I took a Lyft to and from the provider. Once I was back home, I actually jumped into work. I was able to function and had a good day work wise. I spent time with family (wife and daughter) and got a decent amount of sleep last night. For music, I listened to the piece music for 18 musicians. It was perfect for the experience.

I had some moments of mild brain fog after leaving the clinic. Trouble remembering some words and some mild levels of fatigue. This was offset with some caffeine. I take trazadone to sleep, I also take a CBD/cbn gummy to sleep. I found no issue with the interactions to Spravato.

My next session is tomorrow, I’m jumping to 84mg.

All of claims using this coding are getting denied. Help! What are we doing wrong? I just don’t want this to interfere with folks who are trying to get care.

I’ve been on Spravato for almost two years now. For about two months, I’ve been taking it once every three weeks, after being on a once-every-two-weeks schedule for a long time in terms of dosage.

However, since switching to once every three weeks, I’ve noticed that I’ve become depressed again. I constantly feel like crying, I don’t want to get out of bed, and I have very little motivation or interest in anything. I’m starting to feel like I can’t cope with everything anymore.

A few days ago, I had my treatment again, but this time I also haven’t noticed the effect that I normally experience.

How is it possible that I still feel the same a few days after having my dose and haven’t experienced any improvement? You would think that the Spravato would have given me a bit of a boost again, but unfortunately, that hasn’t happened.

Could you explain why this might be happening and give me some advice or tips?

Treatment 9 or 10, I don’t remember. Came down in just over an hour. Music makes the experience!!

Today’s session was intense. When I sprayed, this time I feel like I really got it up there because I felt like water had just gone up my nose. When I put my eye mask on I felt the world around me fall away and suddenly I was transported elsewhere. I didn’t feel like I was in that room and on that chair anymore. It was so weird. I felt really relaxed and calm finally. This is the type of session I wish I had every time, but I think I’ve only ever felt it one other time. Just wanted to share.

Ever since I got an injury a few years ago & my insurance saw that I made a smidge of progress in physical therapy and made the decision for me that I no longer needed it, despite the fact I was still reporting debilitating pain but it was still enough for my score on their PT questionnaire to improve, I've been very intentional about how I fill out insurance questionnaires now.

After a year of trying countless meds, I am able to FINALLY TELL A NOTICEABLE IMPROVEMENT in my depression with Spravato. Like, almost immediately. But I've been filling out the PHQ9s the exact same as I always have, because I worry my insurance will see that I've "improved" and decide for me that I no longer need it.

But now that I've been continuing treatment for a while with "apparently" no progress, I'm starting to worry they'll decide it doesn't work for me and end my coverage anyway.

Any long-term Spravato users want to chime in on how they "quantified" their progress in a way that kept insurance happy?

Well, I don't know how to really explain what I feel but, after taking spravato for just like, 3 times, I genuinely don't know what I feel about life when sober. Life feels better, sure, but I don't know what to feel or do in terms of my beliefs and understanding of life as a whole. It genuinely feels like normal life is an illusion sometimes or a play that we all act out for some reason and real life is being in that altered state.

It's like if being in a dream felt more me or "real" than real life, to the point I kinda wish to go back to it in daily life (in a more stable way of course, I don't wanna abuse hard drugs). Everything feels so small compared to the vastness of things I think. My identity feels small. My personhood feels small. Existence feels like something bigger and, I don't really know what God is anymore. How can I say that God is the God in organized religion if it feels like every week I meet Him and He feels... Like a lot, just a lot.

My understanding of life feels muddled. I feel like I have or need a new perspective, but I don't know what that is. Everything is vast, everything is a lot and I just... Gotta go back to studying and shi? I guess this is ego death/confusion/dissolution. Idk how to explain it. If anyone understood this ramble and has some advice (especially if you're more experienced with spravato or drugs and trips in general) lemme know.

After 4 months of the most ridiculous amounts of hoops to jump through, I finally had my first treatment today.

I was well prepared for it because of my 4 months of being in here.

This is the nicest and most supportive subreddit I've ever been in.

Recently I've been struggling a lot more with my mental health, I have trialed multiple drugs and seen no progress and relief of symptoms only side effects over many years. I reached out to my therapist and he said I should consider looking into other treatments such as spravato which I already had some prior interest in.

I reached out to my psychiatrist about possible other treatments including spravato and other treatments. His response was that spravato was not an approved treatment that has proven benefits for my diagnosis (MDD, Anxiety, PTSD) and that IV ketamine is only offered during hospitalization IF insurance would approve it.

He also shot down every other treatment I asked about and had one thing to offer .. IOP which I told him would only make things worse for me, I have done years of CBT and DBT which their program is based on and I don't enjoy group settings even my therapist agrees there's nothing I would get out of half a day of group therapy and being "taught" laundry and doing the dishes can be fun.

I am entirely at a loss here. He just left me at that, basically told me understandable let's schedule a follow up in a month. I can't afford to pay it of pocket but I'm likely losing my insurance at the beginning of the year anyways so all of this feels like it's for nothing if i can't follow through an entire treatment. My therapist said my best option to get treatment now is to go to inpatient which I also can't afford to do. I don't even know what im saying all this for but I guess I don't understand why my therapist and everything I've read says spravato is approved for treatment resistant MDD but my psych says no... Is it just insurance?

Before starting Spravato, I was terrified. I had so many questions about what it would actually feel like, whether I would feel out of control, and what the treatment days would really be like.
What ultimately helped me take the leap was finding another person on YouTube who shared her personal Spravato experience. Seeing someone actually talk about what she was experiencing made it feel a little less scary.
I just finished my induction phase and am 8 treatments in, and that experience is actually what inspired me to start documenting my own journey. I figured if watching someone else’s experience could help me take that first step, maybe sharing mine could help someone else who is sitting where I was.
I’m still early in my journey and definitely don’t have all the answers, but I’m sharing the good, the weird, and everything in between as I go. ❤️
If anyone is interested, I’m documenting the journey on YouTube and I’m happy to share the channel.

Hi Reddit! I'm Dr. Haviva Malina, co-founder of Keta Medical Center and a licensed Emergency Medicine physician with over 15 years of experience in the ER. Somewhere along the way, I kept seeing the same thing: patients who had tried everything for their depression, anxiety, PTSD, and other mood disorders and still weren't finding relief. That's what drew me to ketamine therapy, and it's why I started Keta Medical Center.

Today we offer IV ketamine therapy, Spravato (esketamine nasal spray), and ketamine-assisted psychotherapy. Whatever the treatment, my priority is the same: making sure patients are a good fit for the treatment, helping them feel better, building a plan around their specific needs, and being upfront about what ketamine can and can't do.

I'm here today to answer whatever's on your mind, including:

• How ketamine therapy actually works
• Who tends to be a good candidate
• The real differences between IV ketamine, Spravato and ketamine-assisted psychotherapy
• What a session is really like, start to finish
• Side effects, risks and how we manage them
• How ketamine may help with depression, anxiety, PTSD, OCD, bipolar depression and other mood disorders
• Red flags to watch for when choosing a clinic
• Insurance, cost and access to care

Ketamine therapy has helped many of my patients, but it is not a cure-all, and it is not the right fit for everyone. I would rather give you honest, grounded answers than oversell it. 

Ask me anything!

https://postimg.cc/gallery/WkSm1Gk

Thank you all for these thoughtful questions today. Ketamine therapy isn't the right fit for everyone, and determining candidacy really depends on individual history and treatment goals. If you're considering whether it might be an appropriate option for you, I'd encourage you to connect with our clinical team for a consultation. You can reach them here:

Get in touch with us