Learning Self-Love After Struggling with Treatment-Resistant Depression

I lost my dad to heart disease at a young age. When he died, I watched my mom really struggle to cope with that loss and she was no longer able to take care of herself, my older siblings, and me. I eventually realized she was fighting to overcome more than the loss of my father—she was also in the middle of her own battle with mental illness. During this time, I felt alone and unsupported, and more than anything, I just wanted a big hug and love from my mom. 

During my teenage years and into early adulthood, I felt more alone and the depressive symptoms I was experiencing became more frequent and severe. When the COVID-19 pandemic hit in 2020, my depressive symptoms skyrocketed. Each day I would wake up in my New York City studio apartment and immediately begin working as an IT consultant. I would join all my work calls from bed with my camera off and found it difficult to participate or speak up during those calls. I had no motivation to do anything else—I was in survival mode. And, some days I couldn’t even get myself to sleep and small tasks like showering, eating and attending internal meetings with my IT team felt overwhelming and close to impossible. 

As time progressed, I no longer cared about my hobbies, my job, or even my life—but I didn’t really understand why I was feeling this way. If it wasn’t for my cat, Colonel Puss Puss, I would have been completely alone, sitting in the darkness of my small apartment. 

After feeling like every living day was a nightmare for so long, I started going to a new psychiatrist, who was recommended to me by my therapist, in July of 2020. It didn’t take long for my psychiatrist to recommend I start taking antidepressants. However, I wasn’t very optimistic that medication would work. 

Growing up, I saw my mom suffer from severe depression and never find real relief from any of her antidepressants, so naturally, I was reluctant to take medication. After a lot of contemplating, I decided to give it a try. I cycled through a couple medications, but my intuition was right—none of my depressive symptoms were relieved. Impatient and frustrated by the 12-week trial period I had to go through for each new medication, just to see if it would work this time, I wanted to throw in the towel. 

Then to add insult to injury, after trying and not responding to more than two oral antidepressants, my psychiatrist diagnosed me with treatment-resistant depression or TRD, which meant that the type of depression I have doesn’t respond adequately to traditional antidepressants. By the time he gave me the diagnosis I was exhausted and defeated.

One day I received a last-minute meeting invite from my boss—my immediate reaction was thinking I was going to get fired and I went into a downward spiral of panic. Curled in a ball and sobbing on my apartment floor, my chest pain was so severe that I thought I was having a heart attack. I could see the hospital through my window, but in that moment, I had no motivation or desire to walk across the street and ask for help.  

Soon after this depressive episode, my closest friend and family started to become very concerned, and I moved across the country to live with my older sister in Portland, Oregon. My sister saw first-hand the severity of the depression I was experiencing, from sleeping underneath my bed to ensure I didn’t see any sunlight to barely playing video games with my nephew or even being able to focus on a full episode of a TV show. 

Watching how much I was struggling during this time, she helped me receive short-term disability, so that I could focus on finding a treatment plan that worked for me. With the help of my sister, therapist and psychiatrist, I started to learn about a different treatment option available to people diagnosed with TRD, called SPRAVATO^® (esketamine) CIII nasal spray. 

My psychiatrist walked me through the risks and benefits and administration and dosing requirements, which include going into a certified SPRAVATO^® treatment center twice a week for the first four weeks of treatment. We also discussed some of the most serious side effects of SPRAVATO^®, 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. As with all SPRAVATO^® patients, I was enrolled in the Risk Evaluation and Mitigation Strategy (REMS) program to keep track of any of those serious side effects I may experience (listed above). (Please see Important Safety Information, including BOXED WARNINGS and a list of side effects below. Click Here.)

I carefully weighed the pros and cons of adding SPRAVATO^® to my treatment plan and ultimately decided that after years of experiencing darkness and cycling through a handful of antidepressants with no relief, I had to see if this medication could help me better treat my depressive symptoms.

Once enrolled in the REMS program, I was able to start my twice-weekly SPRAVATO^® treatments in conjunction with an oral antidepressant. Then something unbelievable happened—within a few weeks, I started to feel a little bit better as my depressive symptoms decreased. My outlook slightly shifted and I started caring for myself again.

I’ll admit, at first, these improvements felt temporary or fake because I hadn’t felt optimistic in so long. I truly started to feel clearer and lighter as my depressive symptoms improved after my SPRAVATO^® treatments, which gave me a new perspective and helped me apply the tools I had learned in therapy. I felt like I didn’t need to hide myself from anyone anymore and I could finally see the steps I needed to take to move forward. And, although this treatment may not work for everyone, SPRAVATO^® became a key piece of my treatment plan to help me manage my TRD during one of the most difficult times in my life.

Through therapy and treatment, I know that being isolated during the pandemic heightened my depression. It reminded me of how alone I felt when I was a young boy, and knowing what I know now, I wish I could go back in time and give my younger self a big hug and the self-love that I so badly needed. 

Finally, I started to return to the things I once loved without overthinking or hesitation, like running, hanging out with friends, writing short stories, and playing video games with my nephew. Through treatment and lots of work, my days are no longer completely consumed with self-hate and darkness but rather more self-love and light.  

I know how isolating depression can feel, which is why I wanted to share my story with others—so they know that there are other people who understand, and they don’t have to go through their darkest times alone. 

Once I started openly communicating with my loved ones and healthcare team to find the right treatment plan for me, I felt like I could take the necessary steps forward in treating my TRD and I started to feel optimistic and excited for the future. I consider myself to be lucky—from the open communication I had with my healthcare team and my support system’s help advocating for me when I couldn’t advocate for myself—it only took me a few tries with different medications before I was able to work SPRAVATO^® into my treatment plan. Through conversations with my doctor, I learned that it can be common for many adults experiencing TRD to cycle through various medications before finally learning about and trying SPRAVATO^®.

With each step forward, I like to reflect on my growth and give gratitude to the people who supported and inspired me to get better. The more people I can connect with, by sharing my experience and supporting them through their treatment-resistant depression, makes my journey all worth it.

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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