Spravato Treatments

April 22, 2024 5:17 PM

Have you had Spravato treatment? How quickly did it work? What do you recommend that someone bring to treatment? How can/should one prepare?

I have a diagnosis of treatment-resistant depression. I was previously going to have ECT, but it was determined that it wouldn't be a good fit for me. I just heard from my insurance company today that I had been approved for Spravato treatment. I have my first session scheduled for May 3. I'm nervous, excited and I guess maybe hopeful. I feel like this might be the last hope, and I've heard such good things for others. If you've had it, will you share your experience? What do you recommend that I do to prepare for the session? What should I bring? What should I do?

posted by Mr. Hazlenut to Health & Fitness (1 answer total)

Have you had Spravato treatment?

Yes. I didn't complete the full course because I started an intensive course of therapy, which was a better fit. But I'm glad I tried it, and I do believe it helped.

How quickly did it work?

If you mean how quickly I felt effects of the medication; very, very quickly. Within five minutes of having the spray administered, walking got difficult. Within another two or three minutes, I wanted to be lying down and had trouble even coordinating my hands to grab headphones or the emergency button. I kept dropping things. I would then lie down and keep my eyes closed because of dizziness, but felt good as long as I was lying still. This lasted for around ninety minutes. After two hours, I was able to walk normally again, but still uncoordinated. I was not save to drive home. I wouldn't have been save alone on public transport, I think. I would always feel tired and sleep a lot on the days of treatment, and I usually felt completely normal the day after. According to staff, I took unusually long to be back to normal.

If you mean how quickly I saw improvement of my mental state: It was difficult to know for sure. I felt (and my husband confirmed) that I was always much calmer the day of treatment, starting on day one. I was also really happy during the first dose, sort of tipsy. The next day, I would still feel a bit calmer. But I did not have the experience of my depression just being gone with Spravato. For me, the insights I got during the "trance" were very valuable, and it was important to be comfortable, listen to music during, and go in with an intention. One thing that was pretty magical is that I could go in with a problem, and come out feeling okay about it. It wasn't gone, but all its sharp edges were.

What do you recommend that someone bring to treatment?

A trusted person. Fuzzy socks so you can take your shoes off, but stay warm. Tissues because you want to blow your nose before administering the spray, so that you don't need to blow it after (wasting that good stuff). A blanket or extra sweater. A strong smell or favourite lozenge/hard candy (see below). Earplugs or headphones. A drink and snack for afterwards, because you'll be asked not to eat before. (Don't eat or drink before. I ignored this guideline once, and I had to throw up...while being unable to call for help or walk. It was an awful experience). A sleep mask. A playlist of instrumental music. I liked the Johns Hopkins 2021 record "Music for Pschedelic Therapy" and especially East Forest's 2021 record "In: A Soundtrack For The Psychedelic Practitioner, Vol. II." (Both MetaFilter recommendations). I also enjoyed Pachelbel's Canon on repeat.

How can/should one prepare?

Prepare to feel quite vulnerable. It can be scary to be in a body that's not obeying you, and your mind will be compromised as well. I couldn't use my phone because my fingers would't do what I wanted. I was unable to comprehend speech. The nurse would ask me when I could come for my next appointment, and I knew what I wanted to say, but all I said was "Uh huh.", and I had forgotten the appointment they set five minutes later. They come in to check your blood pressure during your "trance", and it was startling because I didn't really understand what was going on. I felt like a child, and/or someone having just woken up. I had trouble with my sense of time and reality. I tried bringing a watch, but could not understand what it was saying (double vision + confusion). Once, my husband came in after I had already started with the treatment, and I was thinking of him as a friendly bear-like creature, or maybe someone like Totoro. It made perfect sense to me that this bear-friend was coming into the room. But with the acceptance of magical creatures, the real world seems much more chaotic. At the same time, these experiences can be very interesting and pleasurable. I saw patterns and colours I hadn't seen before. I had the sensation of all my thoughts being calm bubbles, as opposed to a barbed wire of anxiety. And even afterwards, I usually felt strangely serene and had more interesting thoughts.

What I found most off-putting was the physical aspect of the medicine. Prepare for a strong taste. The spray can run down your throat, and it does not taste good, sort of bitter (plus, I think if it runs down, it won't get absorbed?). I also found the physical sensation of the spray in my nose very unpleasant, even though I'm not normally bothered by nasal spray. It reminded me of that feeling you get as a kid when you're in the pool and you've inhaled water, it's stinging your eyes and nose and mouth... After talking to my doctor about it, I started bringing some candy (malt, in my case). I'd use the spray, and then suck on the candy. That helped immensely because I didn't have to worry about the taste anymore. They don't want you to eat before or during, but the candy appeared to be okay. I read online that some people do things like bring some fresh mint to smell.

"I feel like this might be the last hope."

It really isn't! That is your depression talking. I'm not a doctor, but you could try ketamine infusions, rTMS, more extensive or different therapy programs (music therapy worked wonders for me), psilocybin...but I do really hope you get some relief from Spravato, and that you find the experience meaningful. If you have more questions, let me know. I'm happy to chat about it some more. It was a very interesting experience.

Hang in there. I know it feels like nothing is good. Hugs.
posted by toucan at 4:36 PM on April 30, 2024 [2 favorites]