The Medication That Helps Me Manage My Treatment-Resistant Depression

The first hint that depression might present itself in my future showed up when I was a young girl. As I watched TV one summer afternoon, a profound feeling of inexplicable grief overcame me. I had never experienced anything like it before, so I ran upstairs where my mother was cleaning. I can still remember the warm, lemony smell of the furniture polish.

“I just had a really scary feeling,” I told her.

She asked what scared me and I told her nothing—the feeling seemed to appear out of nowhere. She paused for a moment, and then told me that everyone has scary feelings sometimes. Being with her made me feel safe, so I asked if I could help her clean. She looked surprised, but happily agreed. As I dusted a bookshelf, the feeling faded.

Over the years, I had more of these “really scary feelings,” but they seemed to last longer each time. It wasn’t until I was a teenager that I truly experienced my first depressive episode, but even then, I never got help for it. I grew up in a small town and didn’t know that help might be available to me. All I knew was that I often experienced inexplicable sadness, lacked motivation to do anything, avoided social situations, and often felt hopeless about my future. It wasn’t until I was 20 years old that I was officially diagnosed with major depressive disorder (MDD) at my university’s clinic and started taking my first oral antidepressant.

Looking back, it’s hard to think about everything I’ve lost because of my depression. In college, I would get straight A’s, even in my toughest classes. Then, the following semester, my depression would hit harder, and everything would fall apart.

After college, I had more traditional, nine-to-five jobs, but I’d constantly be terrified that my depression would start to consume me, that I would disappoint everyone and eventually lose my job. I started freelancing as a writer, graphic designer, and teacher just so I could adjust my schedule around my depression.

It was also hard for the people in my life to understand that I had depression. They knew me as a friendly and fun person because I’d isolate myself as soon as I was feeling depressed. I lost friends because they thought I was avoiding them, but really, I was just too ashamed to tell them what was going on.

When the weight of my depression got bad enough, I would have thoughts about not wanting to be here anymore. But even though I dealt with these suicidal thoughts, I never acted on them. My children, husband and friends kept me motivated, and I knew I never wanted to transfer the pain I was feeling on to them.

Like many people, I’ve cycled through many oral antidepressants and medications over the years. They’ve always helped me somewhat at first, but even then, would only get me to 60 or 70 percent. Eventually they’d stop working for me completely and I’d be right back to where I started.

About a year ago, I was finally diagnosed with treatment-resistant depression (TRD) and I was so relieved. After trying so many medications, I already had a feeling, but receiving an official diagnosis meant that I could now receive better help for my depression. My psychiatrist suggested I try SPRAVATO^® (esketamine) CIII nasal spray in conjunction with my oral antidepressant. He walked me through all of the risks and benefits. But before my first treatment began, I was extremely nervous and dreaded the medication’s serious side effects, which I was told included 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. Once I was onboard, he enrolled me in the medication’s Risk Evaluation and Mitigation Strategy (REMS) program to keep track of any serious side effects I may experience. (Please see Important Safety Information, including BOXED WARNINGS and a list of side effects below. Click here)

But once I started SPRAVATO^®, my depression improved, and although this medication may not work for everyone, it worked to help reduce my depressive symptoms as part of my treatment plan.

When I prepared for my appointments, I actually got excited about my SPRAVATO^® treatments. The day of, I packed what I call my “SPRAVATO^® bag,” which included my headphones, an eye mask, and sometimes even a voice recorder so I could document my experience. My youngest son would drive me to and from the certified treatment center. Once I arrived, I did all the check-in paperwork, and Holly, the treatment facilitator, took me back to the treatment room. The room felt very zen, with plants and paintings of flowers.

Under Holly’s supervision, I actually administered the nasal spray myself. As I sat back, and let the process ensue, Holly monitored me for two hours to track any adverse events and to make sure that my blood pressure was okay before my son took me home.

Sometimes, I just looked around the room and took in my surroundings. Other times, I put on my eye mask and headphones, and I retreated into my own mind. The best way I can explain the treatment is it felt as if my mind was “unchaining” or “unlocking.”

I truly wish more people understood that depression isn’t something you can simply “tough out” or “snap out of.” It’s like the difference between having a headache and a major migraine. While headaches can be uncomfortable and aren’t fun to live with, migraines can be disabling and completely ruin your day or even days. It’s the same thing with depression. While I don’t want anyone to feel true depression, it’s hard to understand unless you’ve experienced it yourself.

Now, as a mother, I’ve been open with my children about my own struggles with depression, and I feel so fortunate that my family, including my partner, have always been so supportive. My sons are young adults now, but even when they were young, they could not have been more compassionate and understanding. And, although I wish I had never been depressed in the first place, I do believe the experience has made me and my family more empathetic to others’ pain.

Since my SPRAVATO^® treatments, I’ve been inspired to write about my personal experience and document what I felt like during treatment. While I sometimes still mourn the years I lost to my depression and wish I had found the right treatment sooner, I’m so grateful for my family, my life, and the beautiful world we live in.

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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