How I Found the Right Treatment Plan for My Challenging to Treat Depression

Growing up, I always felt a little off and sort of sad, but it wasn’t until I reached junior high that I realized I needed to talk to my doctor. With medication, good friends, snowboarding and lacrosse, I was able to have a pretty normal high school experience. 

College, however, was a different story. What I had expected to be the best years of my life were plagued with ever-worsening depression.

I had watched my two sisters thrive in their four years attending universities, making lifelong friends, and traveling to far-off countries, all while maintaining good grades. I couldn’t understand why I was so miserable when I had done everything the exact same way. 

There was one pillar of the perfect college experience that I did excel at: partying. I found myself going out more and more, and self-medicating – doing anything I could to escape the reality I had created for myself. Although my grades didn’t suffer, my state of mind, outlook, and friendships did. Eventually, it was all too much; I was drowning. I withdrew from all my classes and moved back home. I tried to keep going as best I could and enrolled in courses at a college in my hometown, but my depression made me feel like I could barely keep my head above water. 

Most people may not realize that depression can rob you of the different pieces of your life, big and small. Depression takes things little by little, so slowly that you don’t even notice at first. Then suddenly everything is gone: hobbies, passions, a sense of belonging, even family.  What used to bring you happiness, the things you loved most, have all been stripped away. 

Eventually, you reach the point where you can’t do the most basic things. You can’t get out of bed or take care of yourself. It becomes more than you can handle. Everything is a colossal challenge. Every day is so exhausting, and it takes everything in you just to survive. 

That’s how I felt, day in and day out, for the better part of a decade. Then two years ago, amid the worst depression I’ve ever experienced, I made a promise to myself that I would do everything in my power, try every medication, every type of therapy and every treatment I could find to save myself: for me, this included 16 different antidepressants, acupuncture, reiki, transcranial magnetic stimulation on the left and right sides of my skull, and 12 courses of electroconvulsive therapy.  

After electroconvulsive therapy failed, I gave up. I was out of options. With nothing left in my arsenal, I started to accept that there had to be something wrong with me. It was the only conclusion that made sense. Maybe I was just meant to be unhappy, and overwhelming depression was going to be my life forever. 

Grace was diagnosed with treatment-resistant depression or TRD — a form of depression that is more challenging to treat. Patients with TRD have not responded to two or more antidepressants (of adequate dose and duration), which is why she continued to experience depressive symptoms even after previous treatments.

Then I came across an article about SPRAVATO^® (esketamine) CIII nasal spray. It immediately piqued my interest. The most well-known and most commonly prescribed treatments for depression focus on the same neurotransmitters in the brain and have for decades. This medication is believed to take a different approach, and while the way it works is not completely understood, it is thought to act on a different neurotransmitter, called glutamate.

After hours of research and speaking with my doctor, I decided to make an appointment with a certified provider to learn more. They warned me that SPRAVATO^® has risks and benefits and outlined the most serious side effects, including sleepiness (sedation), fainting, dizziness, spinning sensation, anxiety, feeling disconnected from yourself, your thoughts, feelings, space and time (dissociation), breathing problems (respiratory depression and respiratory arrest), the risk of abuse and misuse, and increased risk of suicidal thoughts or actions. This is why it is essential to have medical supervision during treatment. (Please see Important Safety Information including BOXED WARNINGS and a list of side effects below. Click here). 

And while this medication may not work for everyone, combined with my oral antidepressant, it was the right choice for me and has become an essential part of my treatment plan, which also includes talking with my therapist and loved ones, getting outside on a hike or finding a creative outlet in art.

Treating treatment-resistant depression is difficult because it’s hard to see any effect in the short term. It takes months for traditional antidepressants to build up in your system, and if a dosage increase is necessary, it can be months until you feel true progress. When I am struggling with depression, days feel like months, and months feel like years. There were so many times when I felt like I was taking one step forward and two steps back.

At first, I didn’t see a difference in myself, but I think a good gauge of how your treatment is going is by talking to those around you. While I didn’t notice a difference right away, my family and my boyfriend did. I remember watching a movie with my mom, and I looked over at her and she said, “You’re laughing! You’re actually laughing again!”  

Within a month and a half, I felt my depressive symptoms had improved. I noticed a difference in wanting to be a part of things, engaging in conversation, going to family events and even to the store. Then, I eventually started painting, writing and taking care of myself again. Just doing more than surviving was huge, and I felt like a weight was beginning to lift off my shoulders. 

For so long, my only concern was getting through to the next day, so when I started to make plans and my future wasn’t so blank, I began feeling optimistic about the future again. It was slow at first, like planning a hike for the upcoming weekend, but now I’m finally able to imagine where I want to be in five years and have hope and faith in myself that I will be able to accomplish my goals. 

And yes, I still have bad days. But I’ve learned new strategies to deal with them. One thing that helps me is to list five things I am grateful for and five things I like about myself. It sounds simple but sometimes all you need is a reminder that you are worth it.

The days, weeks and months can be long and hard, but keep trying. Finding the right treatment plan is hard. During the process, it’s easy to blame yourself and feel like you must be the problem. But now looking back, I know that simply isn’t true. 

I’m in a place that I never thought I would be in. I want to do more with my life, and I now know that I can.

To learn more about Grace and her experience with treatment-resistant depression and SPRAVATO^®, watch her full video here.

INDICATIONS

What is SPRAVATO^® (esketamine) CIII nasal spray?

SPRAVATO^® is a prescription medicine, used along with an antidepressant taken by mouth to treat:

• Adults with treatment-resistant depression (TRD)
• Depressive symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or actions

SPRAVATO^® is not for use as a medicine to prevent or relieve pain (anesthetic). It is not known if SPRAVATO^® is safe or effective as an anesthetic medicine.

It is not known if SPRAVATO^® is safe and effective for use in preventing suicide or in reducing suicidal thoughts or actions. SPRAVATO^® is not for use in place of hospitalization if your healthcare provider determines that hospitalization is needed, even if improvement is experienced after the first dose of SPRAVATO^®.

It is not known if SPRAVATO^® is safe and effective in children.

IMPORTANT SAFETY INFORMATION

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 thoughts about suicide or dying

worsening depression 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^®.

If you are not sure if you have any of the above conditions, talk to your healthcare provider before taking SPRAVATO^®.   

Before you take SPRAVATO^®, tell your healthcare provider about all of your medical  conditions, including if you: 

• have heart or brain problems, including:
  • high blood pressure (hypertension)
  • slow or fast heartbeats that cause shortness of breath, chest pain, lightheadedness,  or fainting
  • history of heart attack
  • history of stroke
  • heart valve disease or heart failure
  • history of brain injury or any condition where there is increased pressure in the brain
• have liver problems
• have ever had a condition called “psychosis” (see, feel, or hear things that are not there, or believe in things that are not true).
• are pregnant or plan to become pregnant. SPRAVATO^® may harm your baby. You should not take SPRAVATO^® if you are pregnant.
  • Tell your healthcare provider right away if you become pregnant during treatment with SPRAVATO^®.
  • If you are able to become pregnant, talk to your healthcare provider about methods to prevent pregnancy during treatment with SPRAVATO^®.
  • There is a pregnancy registry for women who are exposed to SPRAVATO^® during pregnancy. The purpose of the registry is to collect information about the health of women exposed to SPRAVATO^® and their baby. If you become pregnant during treatment with SPRAVATO^®, talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or online at  https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/.
• are breastfeeding or plan to breastfeed. You should not breastfeed during treatment with SPRAVATO^®.

Tell your healthcare provider about all the medicines that you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. Taking SPRAVATO^® with certain medicine may cause side effects. 

Especially tell your healthcare provider if you take central nervous system (CNS) depressants,  psychostimulants, or monoamine oxidase inhibitors (MAOIs) medicine. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine. 

How will I take SPRAVATO^®? 

• You will take SPRAVATO^® nasal spray yourself, under the supervision of a healthcare provider in a healthcare setting. Your healthcare provider will show you how to use the  SPRAVATO^® nasal spray device.
• Your healthcare provider will tell you how much SPRAVATO^® you will take and when you will take it.
• Follow your SPRAVATO^® treatment schedule exactly as your healthcare provider tells you to.
• During and after each use of the SPRAVATO^® nasal spray device, you will be checked by a  healthcare provider who will decide when you are ready to leave the healthcare setting.
• You will need to plan for a caregiver or family member to drive you home after taking  SPRAVATO^®.
• If you miss a SPRAVATO^® treatment, your healthcare provider may change your dose and treatment schedule.
• Some people taking SPRAVATO^® get nausea and vomiting. You should not eat for at least 2  hours before taking SPRAVATO^® and not drink liquids
  at least 30 minutes before taking  SPRAVATO^®.
• If you take a nasal corticosteroid or nasal decongestant medicine take these medicines at least 1 hour before taking SPRAVATO^®.

What should I avoid while taking SPRAVATO^®? 

Do not drive, operate machinery, or do anything where you need to be completely alert after  taking SPRAVATO^®. Do not take part in these activities until the next day following a restful  sleep. See “What is the most important information I should know about SPRAVATO^®?” 

What are the possible side effects of SPRAVATO^®? 

SPRAVATO^® may cause serious side effects including: 

See “What is the most important information I should know about SPRAVATO^®?” 

Increased blood pressure.  SPRAVATO^® can cause a temporary increase in your blood pressure that may last for about 4 hours after taking a dose. Your healthcare provider will check your blood pressure before taking SPRAVATO^® and for at least 2 hours after you take SPRAVATO^®. Tell your healthcare provider right away if you get chest pain, shortness of breath, sudden severe headache, change in vision, or seizures after taking SPRAVATO^®.

Problems with thinking clearly. Tell your healthcare provider if you have problems thinking or remembering. 

Bladder problems. Tell your healthcare provider if you develop trouble urinating, such as a  frequent or urgent need to urinate, pain when urinating, or urinating frequently at night.  

The most common side effects of SPRAVATO^® when used along with an antidepressant taken by mouth include: 

feeling disconnected from yourself, your thoughts, feelings and things around you  dizziness nausea feeling sleepy spinning sensation

decreased feeling of sensitivity (numbness) feeling anxious lack of energy increased blood pressure vomiting feeling drunk feeling very happy or excited

If these common side effects occur, they usually happen right after taking SPRAVATO^® and go away the same day. 

These are not all the possible side effects of SPRAVATO^®.  

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. 

Please see full Prescribing Information, including Boxed WARNINGS, and Medication Guide for SPRAVATO^® and discuss any questions you may have with your healthcare provider. 

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For more information about SPRAVATO^®, please visit www.spravato.com.

This information is intended for the use of patients and caregivers in the United States and its territories only. Laws, regulatory requirements and medical practices for pharmaceutical products vary from country to country. The Prescribing Information included here may not be appropriate for use outside the United States and its territories.

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