Six Powerful Ways to Maximize Your Spravato / Esketamine Treatment through Integration Therapy

By Brittany Albright MD, MPH

Spravato (esketamine) is a magical and mysterious medication, highly effective for treating stubborn depression. These patient administered nasal devices have not only saved countless of my patients’ lives from suicide, but Spravato has rescued so many of them from being trapped in their negative perspectives. That being said, this medication is a powerful force and requires careful and thoughtful compassion and intentionality poured into each individual who opens themselves up to the healing properties this medication can provide.

From the perspective of a certified psychedelic assisted psychotherapist and psychiatrist who administers and supports patients through esketamine therapy, integration is a critical component of the treatment process. Esketamine, a powerful pharmacological agent, FDA approved for treatment-resistant depression and closely monitored in office for a minimum of 2 hour treatment sessions via a REMS (Risk Evaluation and Mitigation Strategy) due to its dissociative and psychoactive properties, requires a comprehensive approach for optimal patient outcomes and comfort levels.

Here's a more detailed guide on facilitating integration from a psychiatric standpoint:

Pre-Treatment Preparation

1. Informed Consent and Education: Prior to initiating esketamine therapy, it's imperative that patients understand the potential effects, risks, and the importance of integration. An informed consent process that includes education about the psychological and emotional experiences that may arise during treatment sets the groundwork for successful integration.

2. Therapeutic Alliance: Building a strong therapeutic alliance is essential. This involves establishing trust and open lines of communication, allowing patients to feel safe and supported in discussing their experiences and emotions related to the treatment.

3. Setting Intentions: Together with the patient, identify specific therapeutic goals and intentions for the esketamine treatment. This helps in focusing the therapy and provides anchors for integration activities post-treatment.

During Treatment

1. Mindful Observation: Encourage patients to adopt a stance of curious observation during their esketamine experiences. This involves noting thoughts, feelings, and sensations without judgment, which can be pivotal for later reflection and integration.

2. Safety and Comfort: Ensure the treatment setting is comfortable, safe, and conducive to a positive therapeutic experience. The environment plays a significant role in the patient's ability to engage with and reflect on their experience.

Post-Treatment Integration

1. Debriefing Sessions: Schedule debriefing sessions soon after each esketamine treatment. These sessions are opportunities for patients to discuss their experiences, emotions, and any insights gained. It's a time for the psychiatrist to listen, validate, and help the patient make sense of their experience.

2. Structured Reflection: Encourage structured reflection through journaling or other means of expression. This can help patients process their experiences on a deeper level and articulate changes in their perceptions or feelings.

3. Cognitive and Behavioral Strategies: Incorporate cognitive-behavioral strategies to help patients apply insights gained during treatment to everyday life challenges. This may involve challenging negative thought patterns, enhancing problem-solving skills, or developing healthier coping mechanisms.

4. Holistic Support: Advise on holistic support measures, such as mindfulness practices, yoga, or meditation, which can aid in emotional regulation and stress reduction, reinforcing the therapeutic benefits of esketamine.

5. Ongoing Therapy: Esketamine treatment should be part of a broader therapeutic plan that includes ongoing psychotherapy. This continuous support is crucial for maintaining and building upon the gains achieved through esketamine therapy.

6. Monitoring and Adjustment: Regularly assess the patient's progress towards their therapeutic goals, adjusting the treatment plan as necessary. This includes deciding on the continuation or cessation of esketamine therapy based on therapeutic outcomes and patient well-being.

Ethical and Professional Considerations

• Confidentiality and Ethical Care: Maintain the highest standards of patient confidentiality and ethical care throughout the treatment process. This fosters trust and safety, which are essential for therapeutic success.

• Professional Development: Stay informed about the latest research and clinical guidelines related to esketamine therapy. Engaging in continuous education and possibly supervision or consultation with colleagues can enhance the quality of care provided to patients.

Integration is a dynamic and ongoing process. As a psychiatrist, the goal is to support patients in weaving their esketamine therapy experiences into their broader journey towards healing and growth, ensuring these experiences contribute to lasting change and improved quality of life.

To learn more about Spravato / esketamine, refer to: https://www.spravato.com/.

What is the most important information I should know about SPRAVATO®?

SPRAVATO® can cause serious side effects, including:

• Sedation and dissociation. SPRAVATO® may cause sleepiness (sedation), fainting, dizziness, spinning sensation, anxiety, or feeling disconnected from yourself, your thoughts, feelings, space and time (dissociation).

  • Tell your healthcare provider right away if you feel like you cannot stay awake or if you feel like you are going to pass out.

  • Your healthcare provider must monitor you for serious side effects for at least 2 hours after taking SPRAVATO®. Your healthcare provider will decide when you are ready to leave the healthcare setting.

• Respiratory depression was observed with the use of SPRAVATO®; additionally, there were rare reports of respiratory arrest.

  • Your healthcare provider must monitor you for serious side effects for at least 2 hours (including pulse oximetry) after taking SPRAVATO®. Your healthcare provider will decide when you are ready to leave the healthcare setting.

• Abuse and misuse. There is a risk for abuse and physical and psychological dependence with SPRAVATO® treatment. Your healthcare provider should check you for signs of abuse and dependence before and during treatment with SPRAVATO®.

  • Tell your healthcare provider if you have ever abused or been dependent on alcohol, prescription medicines, or street drugs.

  • Your healthcare provider can tell you more about the differences between physical and psychological dependence and drug addiction.

• SPRAVATO® Risk Evaluation and Mitigation Strategy (REMS). Because of the risks for sedation, dissociation, respiratory depression, and abuse and misuse, SPRAVATO® is only available through a restricted program called the SPRAVATO® Risk Evaluation and Mitigation Strategy (REMS) Program. SPRAVATO® can only be administered at healthcare settings certified in the SPRAVATO® REMS Program. Patients treated in outpatient healthcare settings (e.g., medical offices and clinics) must be enrolled in the program.

• Increased risk of suicidal thoughts and actions. Antidepressant medicines may increase suicidal thoughts and actions in some people 24 years of age and younger, especially within the first few months of treatment or when the dose is changed. SPRAVATO® is not for use in children.

  • Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a higher risk of having suicidal thoughts or actions. These include people who have (or have a family history of) depression or a history of suicidal thoughts or actions.

• How can I watch for and try to prevent suicidal thoughts and actions in myself or a family member?

  • Pay close attention to any changes, especially sudden changes, in mood, behavior, thoughts, or feelings, or if you develop suicidal thoughts or actions.

  • Tell your healthcare provider right away if you have any new or sudden changes in mood, behavior, thoughts, or feelings.

  • Keep all follow-up visits with your healthcare provider as scheduled. Call your healthcare provider between visits as needed, especially if you have concerns about symptoms.

• Tell your healthcare provider right away if you or your family member have any of the following symptoms, especially if they are new, worse, or worry you:

• suicide attempts

  1. thoughts about suicide or dying

• worsening depression

  1. other unusual changes in behavior or mood

Do not take SPRAVATO® if you:

• have blood vessel (aneurysmal vascular) disease (including in the brain, chest, abdominal aorta, arms and legs)

• have an abnormal connection between your veins and arteries (arteriovenous malformation)

• have a history of bleeding in the brain

• are allergic to esketamine, ketamine, or any of the other ingredients in SPRAVATO®.

Sweetgrass Psychiatry, with locations in Mount Pleasant, SC and Isle of Palms, SC is proud to have been the first Spravato Treatment Center in the state of South Carolina. We have over 5 years of experience prescribing and monitoring thousands of patient treatments. We welcome you to start your journey to mental wellness today and call us at (843) 800-1303 to schedule your appointment today.