Esketamine has finally been approved by my insurance

On By WendyIn Chronic Illness, Mental Health
https://www.spravato.com/

I found out last week the ketamine (really esketamine, um SPRAVATO) has finally been approved by my insurance, and it has taken this long for me to wrap it around my brain so I could write about it.

My doctor keeps saying I’m getting ketamine, but really I’m getting SPRAVATO, which is esketamine. Ketamine is not FDA approved for treatment resistant depression (TRD), it has been used for it off label for quite some time now with very good results but it is very unlikely they will ever approve it for anything other than an anesthetic because it cannot be monetized. That’s where esketamine comes in. “Esketamine is a molecule taken from ketamine’s racemic mixture (basically two mirror image molecules which spin in different directions).   As it is an altered form of ketamine, esketamine could be newly patented.  As a result, corporate dollars were invested in clinical trials that led to the current FDA indicated use of nasal esketamine for TRD.” (Nasal Esketamine vs IV Ketamine) IV Ketamine has been used to treat TRD since 2010 and has a 70-80% success rate, esketamine is also showing to be very effective which makes sense since it is a molecular part of ketamine, but it has only been in use in clincal settings for a year so I don’t feel like we really know long term results yet.

I start my first treatment on Tuesday, March 10th at 2pm. I have to be enrolled in a restricted program called SPRAVATO Risk Evaluation and Mitigation Strategy (REMS) Program. It can only be administered in a healthcare setting certified in the SPRAVATO REMS Program to patients enrolled in the program. I go in and under supervision I give myself the nasal spray. Then I stay there in a quiet room, with Stuart, (there is no way he would let me do this without him being there) and I’ll be observed for 2-3 hours. You shouldn’t drive or operate machinery until the next day. For the first month I have to go in twice a week for a treatment, the second month is once a week, then it goes to every other week….eventually it goes to once a month and that’s the maintenance dose. That’s all depending on how well I do on it. I could go through the dosing faster, or I could not do well on it at all, but that is the normal regimen. I can tell you that I have been struggling with this schedule. The fact that Stuart has to leave work so much so that I can go in just to get this medication, ugh, this is awful. I’m trying really hard not to feel guilty, but it sure it hard. His boss hasn’t made this easier.

Most of the side effects of SPRAVATO are short lived but they can be pretty intense.

  • Dissociation (was reported 2 ways in clinical studies through adverse event reports, 41% of patients, and by using standardized scale, 61% – 75% of patients.)
  • Dizziness (29%)
  • Nausea (28%)
  • Sedation (was reported 2 ways in clinical studies through adverse event reports, 23% of patients, and by using standardized scale, 49% – 61% of patients.)
  • Spinning sensation (23%)
  • Reduced sense of touch and sensation (18%)
  • Anxiety (13%)
  • Lack of energy (11%)
  • Increased blood pressure (10%)
  • Vomiting (9%)
  • Feeling drunk (5%)

It can also cause abuse and misuse. (I don’t really know how since you can only get it in a clinical setting. How can you misuse a drug that you can’t take home?) It can cause an increased risk of suicidal thoughts and behaviors. (Why does it say this on every anti-depressant? Isn’t this what they are supposed to stop? hmmm. Or is this different?…scratching my head on this one) Temporary increased blood pressure that may last about 4 hours after a dose (could this be because people have been spinning and dissociating, and having increased anxiety?? I’m pretty sure my blood pressure is going to be a bit high before we even start.) Problems thinking clearly (not sure I’ll notice a difference on this one) or it could cause bladder problems, such as a frequent or urgent need to urinate, pain when urinating, or urinating frequently at night. (well that could be inconvenient). **all of the information about SPRAVATO came from literature provided by SPRAVATO.

Now you can probably see why it has taken me a while to wrap my head around this. The fear of having a vertigo attack has been real, and the thoughts of dissociation is a little scary, but I’ve been meditating and trying hard to simply stay in the moment and not get too ahead of myself, if I keep on thinking I’m going to get vertigo that’s a sure way to make that come true. I’m going to try hard to go in there with no expectations, simply aware of what may happen and having good thoughts about how this may help.

This is not only for my resistant depression, it is also going to hopefully help my migraines. It has been shown to help, reduce migraines, so I really am going in this optimistically.

36 thoughts on “Esketamine has finally been approved by my insurance”

    1. Thank you my friend.
      If this didn’t also show benefits of also helping with migraines I might not do it. That’s sad I know, but this hasnt had a lot of studies on the bipolar population so who knows what might happen. It could throw me into a manic swing.
      But we aren’t going there, one moment at a time.
      Thanks for the positivity, I can use all I can get! 😆😘💕💕

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  5. This is fantastic news, Wendy!! It’s an interesting point about misuse, not sure how that’s possible if you can’t self-administer at home. Esketamine wasn’t given approval for NHS use in the UK but I’ve read lots of good things about it, with some positive research and user experiences, so positive thinking all the way. If it could help even a little with both migraines & depression (preferably without awful side effects) then that would be so, so good. Will be thinking of you – good luck with the first dose tomorrow!!
    Caz xxxx

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    1. I understand the reasons NICE didn’t approve it. It isn’t cost effective. Ketamine shows better results in studies with fewer doses, you don’t need to add on a supplemental antidepressant… here the FDA won’t approve it for this because it ISN’T profitable. I hope they allow ketamine treatments there. I kind of annoyed that I have to use something that hasnt been on the market but 1 year, hasn’t shown as much success as ketimine, and is expensive. (Luckily I have insurance) When I could have just gotten plain old tried and true, cheap ketamine, that I know would help with migraines too. Did I say kinda? 😉😆
      Thank you Caz!! 💕💕💕

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      1. I think some people feel the same with CBD vs cannabis. I get where you’re coming from, I’m not sure how I’d feel if I were in your position. I guess I’d still be keen to try it out of desperation and curiosity but I’d still be peed off at the uncertainty over it and wishing the root treatment (ie. regular ket) could be used instead. Time to put that wishful thinking & positive thinking to the test, Wendy!! xxxxx

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  7. How did it go Wendy? How are you feeling?

    Shame the drunken side effect isn’t higher (joke) 😉

    Strange they have to go this route when you could have taken the straight Ketamine. Well, not really if it is down to not being financially viable. Same thing for L-ascorbic (vitamin C) governments refuse to do the research but the benefits are HUGE. I take between 4 – 12 grams a day! Please look into ‘C’…………….. I read this book –

    The information is extensive (sometimes repetitive, but that helps with learning). Talks of C pioneers; what it does to the body etc etc.

    Love to you and Stuart xoxo

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    2. I meant to post about it today/yesterday, but I have been having vertigo for 2 days, not from that! Well, maybe partially. I’ve been having Benign paroxysmal positional vertigo, caused by the crystals coming loose in your ear that are normally there. To get the SPAVATO you tilt your head back to insert the nasal spray, and I had to do this 3 times. It’s delivered in 3 segments. I think that might be what caused it. But who knows, could be all the sneezing I did that night! 😳 Things a blooming all of a sudden here!
      However, the first treatment went well, it was very interesting. 😂 To say the least. You could say I had a nice trip. 😆🤣 I can see why people would get addicted to this stuff, if you wanted to have an outer body experience 👍. But it doesn’t last that long, and I’m grateful for that.
      I’ll try and write about it soon.
      I have my second treatment in the morning. Since I’m not feeling great I’m nervous all over again. 🙄.
      I take mega C too! I’ll try to find the publication you mentioned.
      Thank you my friend. 💕💕

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      1. Oh, am glad you take mega C too!

        Wendy, I hope the SPAVATO works long term for you. Strange about the naturally occurring ear crystals coming ‘loose’ – might you be allergic to it? (Hopefully not!) Good that the other side effect made you feel ‘happy’ 😀 xoxo

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        1. I’ve had this happen before, it’s not uncommon really. It’s the most common cause of vertigo. I think it was caused because I had to tilt my head back to take the nasal spray, 3 times, and I had an allergy attack that night, from the things blooming, and the sneezing may have caused it.
          But it’s okay now and i had a second treatment and all is good!! I plan to post about it all tomorrow. Fingers crossed. xoxo

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              1. Oh, it must smell heavenly. 🙂

                Wendy, do you know anything about migraines not just one side of the head but at the base of the skull (both places)? It’s in my eye sockets now and I’m nauseous. Most times the ibuprofen works to get the worst pain away but tonight is bad. They’re there all the time just turned down low.

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                1. I have migraines there too, right now actually. I don’t know why it changes. I get more in my neck now because of arthritis there, but I know where you are talking, it’s not the neck, it’s the base of the skull. I don’t recognize any unusual symptoms. Have you tried a little caffeine? Heat on your neck and ice on your head might help.
                  I wish I was there so I could try to help.
                  Holding you close tonight. xoxo

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                    2. Thanks Wendy, it’s now back to the usual ‘background migraine’.

                      I’m thinking there’s a correlation between high inflammation and migraine. What do you think?

                      Mine weren’t on this chronic scale before my injury…

                      xoxo

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  8. It’s really interesting to me that you are on esketamine. I was going to volunteer for a local study here in South Australia but was not prepared to stop my current medication. When I am feeling good it takes about 6 weeks to go down 150mg and I cannot be sure I wouldn’t feel extremely depressed once I got down to 2/3 my usual dose for longer than a few weeks. I managed to do it once but started going “off” after a few weeks and had to ramp it up again. It feels as though dropping from 450 mgs to zero before trying the esketamine would probably make me wipe myself out. My free time over the past 40 years has been largely “wasted” as I haven’t felt good enough to do things I enjoy, so I’m loth to interfere with my established regime. Although I rarely feel horribly depressed these days, being retired is not working out well because my partner constantly gets me to organise, contain and dispose of my hobby materials, instead of being able to enjoy making things from them now I am happier! I don’t have the strength to create anything despite wanting to. Keep me posted about the treatment!

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