Interventional Psychiatry Services
Middlesex Health’s Interventional Psychiatry team is proud to develop tailored treatment plans that can help people experience a life without depression.
According to data from the National Institute of Mental Health (NIMH),nearly one in five Americans will experience a major depressive episode at least once during their lifetime. Some estimates suggest that approximately one-third of these adults struggle with treatment-resistant depression (TRD), or depression that does not respond to traditional antidepressant medications.
Esketamine therapy (Spravato) consists of a nasal spray containing a chemical cousin to ketamine, which has proven to be an effective therapy for people with treatment-resistant depression.
Spravato is distinct from other, more common antidepressants, such as Prozac and Zoloft, because it operates via a different mechanism in the brain. While other antidepressants modulate a group of chemicals in the brain called monoamines, esketamine targets glutamate, which is found to be in abundance in the brains of people with depression. The resolution of symptoms can occur within days rather than weeks, as with other common antidepressants.
For some people, esketamine therapy is revolutionary, giving them the chance to experience life without depression for the first time in decades.
Currently, Esketamine Therapy is approved for people with treatment-resistant depression. That means you've tried at least two other antidepressants, for at least six weeks each, and haven't experienced remission or at least an improvement in mood.
Before Your Treatment
- Please make sure you arrive on time and have a safe ride to and from your appointment. You will not be able to drive until the following day.
- Nausea is a common side effect, please do not eat anything within 2 hours of your appointment. Do not drink anything within 30 minutes of arrival.
- When you arrive, we will ask you to urinate to empty your bladder.
- The nurse caring for you will take your vital signs and walk you through the process of administering the medication. You will self-administer the medication, but the nurse will be sitting with you during this time. If you are receiving more than one dose, these will be given 5 minutes apart.
- Following administration of the medication, you will be relaxing in one of our reclining chairs with access to a TV. We ask that you bring headphones if you would like to listen to your own music. This can be helpful to block out other noises as noise sensitivity is common.
- We will have blankets available for you to use, but you may bring your own from home if this is more comfortable for you.
- Dry mouth is also common, so we encourage you to bring your own lollipops to ease this symptom. Please select brands without gum inside.
- Your nurse will be reassessing your vitals after 40 minutes, and again before you leave.
- A common side effect after receiving the medication is a feeling of dissociation, similar to an out-of-body feeling. These symptoms are generally mild and will resolve before you leave. Your nurse will be there to treat and take care of you.
After the Treatment
- The staff will make sure you get to your ride safely.
- You may feel sleepy for the rest of the day, this is normal. You must make sure you are not driving or participating in any activities that require you to be alert until the next day.
Esketamine Therapy is self-administered via a nasal spray at our clinic. The frequency, number of doses, and the potency of each dose will be determined by your doctor.
Patients do not get addicted. This does not mean that Esketamine is risk-free. The drug will always be administered under observation and care of a trained health professional at one of our clinics, and the patient will not be allowed to drive until the day after treatment.
If you suddenly stop using this medication, you may have withdrawal symptoms (such as cravings, tiredness, poor appetite, anxiety). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal symptoms are more likely if you have used esketamine for a long time or in high doses.
Esketamine (Spravato) is almost always covered by insurance, including Medicare.
Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT) is a medical treatment for patients with severe major depression or bipolar disorder that have not responded to other treatments. In this procedure small electric currents are passed through the brain, intentionally triggering a brief seizure while the patient is under general anesthesia. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.
Are there any side effects of ECT?
When you wake up after treatment, you may feel confused. This is partially due to the anesthesia and partially due to the treatment. In most people, the confusion passes within an hour. You may also have a headache the day of the treatment. A pain reliever, if necessary, usually helps. Other side effects, such as nausea, typically last only for a few hours.
You may have some memory loss until you complete all of your treatments. This memory loss should gradually reverse itself over the course of several weeks. Because of the short-lived side effects on your memory, it is important that you postpone any major decisions until a week or two after the ECT course. It is also important that you do not drive during your course of ECT.
These risks must be balanced with the consequences of ineffectively treated severe psychiatric disorders.
How many treatments will I need?
People undergoing ECT need multiple treatments. However the number needed to successfully treat severe depression can vary. Your provider will help you determine the proper number of treatments.
1 Specialty Care Location