The Ketamine-Spravato Treatment Pathway for Depression: Case Studies
Read about patients’ real-world journeys using ketamine and Spravato in the depression-care pathway in my latest professional newsletter.
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To refer your patient for I.V. Ketamine or intra-nasal Spravato, please fill out the form below. You will receive a call back within one working day.
To discuss urgent or complicated cases, please call the office directly on (646) 830-0131 to set up a same-day call with Dr. Levin.
Read about patients’ real-world journeys using ketamine and Spravato in the depression-care pathway in my latest professional newsletter.
Ketamine can be started within about 24 hours if we safety requirements are met.
It takes about 5 days before Spravato can be started.
Treatment Resistant Depression (adequate trials of two or more medications at
sufficient dosage) or suicidal ideation (passive or active). Spravato is administered
through a refulated REMS program [https://www.spravatohcp.com/about-
spravato].
Ketamine is not FDA approved and is given as an off-label medication. While used
primarily for Treatment Resistant Depression and suicidal ideation, there is also latitude
to use it more broadly for e.g., PTSD, OCD etc.
EKG, recent blood tests including a comprehensive electrolyte panel and CBC. We
require sign off from the patient’s PCP or internist in cases of pre-existing conditions
given that ketamine is an anesthetic agent. Past treatment records are very helpful in
this regard. We do an in-office u-tox prior to treatment and can also do the EKG.
Yes, all patients are required to sign informed consent.
Hypertension is often seen. For this reason, we do vitals every 15 minutes and require
poorly controlled hypertension to be treated prior to treatment. An unpleasant
dissociative experience can also occur. We monitor carefully for this and provide a
supportive environment. One unpleasant dissociation is not a predictive for future
dissociations; generally, the dissociation becomes less intense with subsequent
treatments. Here is the full list of side effects.
Safety is our top priority. We adhere to the American Psychiatric Association’s ketamine
guidelines published in JAMA Psychiatry entitled, “A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders.”
Treatment is given in the clinic in a medically monitored environment. There are no at-home options for treatment at the moment given the risk of abuse and medical complications.
Ketamine is infused over 40 minutes. Spravato is given over 10 minutes via 3 nasal puffers. Patients are monitored for 2 hours in total.
Induction treatment with Spravato is given twice weekly for one month. The schedule for maintenance therapy depends on the patient’s initial response.
49 Cuttermill Rd. Great Neck, NY 11021
(646) 830-0131
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