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Living With Treatment-Resistant Depression

Listen to The Mighty Podcast episode, “Living With Treatment-Resistant Depression.” We’ve also provided a transcript below.

In this episode, Mighty Host Ashley Kristoff chats with psychiatrist Dr. Patricia Ares-Romero along with patient and mental health advocate Sally, who is living with treatment-resistant depression. The trio discusses challenging-to-treat forms of depression, treatment options, and available resources.

This episode of The Mighty Podcast is sponsored by Janssen.

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Medication Guide:

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Check out Dr. Ares-Romero’s article for more information:


Ashley Kristoff
Welcome to The Mighty Podcast, where we infuse the health space with positivity, humor, and vulnerability. The Mighty is a safe and supportive community, here to help you find the people and information you need to navigate your health journey. We’re so excited to spend some time together today.

This podcast episode is sponsored by the Janssen Pharmaceutical Companies of Johnson & Johnson and was approved under cp-337449v1. Our guests this week have been compensated by Janssen for their time to participate in this podcast. The views and stories they share today are their own.

During this episode, we will talk about treatment options for certain types of depression including SPRAVATO® (esketamine) CIII nasal spray. SPRAVATO® is a prescription medicine used along with an oral antidepressant to treat adults with treatment-resistant depression (TRD) as well as 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 and/or in reducing suicidal thoughts or actions. SPRAVATO® is not for use in place of hospitalization if your health care provider determines that hospitalization is needed, even if improvement is experienced after the first dose of SPRAVATO®. The exact way that SPRAVATO® works is unknown. Please stay tuned for important safety information during and after this episode.

Now let’s get into what the health we’re talking about today. Today, we are going to be talking about challenging-to-treat depression. So, we are joined by two incredible guests. We have Sally here who is a mental health advocate who lives with treatment-resistant depression and Dr. Patricia Ares-Romero, a psychiatrist with experience leading behavioral health initiatives. So welcome, thank you both for being here today.

Dr. Ares-Romero
Thank you. It’s my pleasure to be here to talk about this wonderful conversation. Thank you.

Sally R.
Thank you for having me.

Ashley Kristoff
Absolutely. Sally, why don’t you tell us a little bit more about yourself?

Sally R.
My name is Sally and I live in Virginia. And I am, I guess probably the best way to describe myself is a writer. I was a journalist at one point. Now I work in administration. I’m a creative person. I have been living with depression for many years and managing it just like any other disease. I think that it’s just like anything else. You just find ways to cope with it and manage it and so I’m really glad to be here right now [to] talk about it. Thank you.

Ashley Kristoff
Yep, I’m happy to hear a lot more about your experience and share a little bit more context for folks out there. Dr. Ares-Romero, why don’t you give a little bit more background about yourself.

Dr. Ares-Romero
Thank you. I am a psychiatrist by training. One of my specialties is treatment-resistant depression. Actually, that was my fourth year project: talking about treatment-resistant depression and how to best treat it back when I graduated in 2003. So, it’s always been something that’s really been close to my heart. I am in South Florida, I’m also faculty at the University of Miami. I really like to change the way we think about mental illness, and always know that there is treatment. And like Sally said, you know, we can live with it and deal with it and look for the best ways, right, for each person, everybody’s individual. So, that’s really what I kind of get passionate about is having everybody find their path on this journey.

Ashley Kristoff
Yeah, I think that’s an excellent message to send into this today, hopefully we will help a couple people out. Before we really get into the meat of the conversation, we always like to start things a little bit fun, a little bit bright. So, we have an opening, fun icebreaker question for you both. I can go first while you think about your answers. So, my question for you today is, “You wake up tomorrow, you are a superhero. What is your power that you get?” For me I’m going to go with, it’s a very tried and true classic, telekinesis. It just seems very useful. Sure, like superhero responsibilities that can move someone, move a danger, that’s great, but also every day that seems like, really ideal. Like I was talking to Sally a little bit ago about the fact that I sew, and it’d be really great to hold all the pieces together via telekinesis and be able to do the work with just my hands. Alright, Sally or Dr. Ares-Romero, what do you got?

Sally R.
I think for me, you know, my father was a pilot. And so, I have been in airplanes my entire life, literally. I think there is a picture of me as a child, like a month old in a little airplane, and I studied for my pilot’s license as well. So, I think flying is definitely my superhero. That would be something that I would like to be able to do without having to get an airplane. Yeah, definitely flying would be a thing that I would love to be able to do. But flying in an airplane is still great. I will say.

Ashley Kristoff
Yes, but it’s probably cheaper if it’s your superpower.

Sally R.
Exactly, exactly. Well, if I get on like a commercial airline, as soon as they turn on the engine, I just fall asleep immediately. I can’t even help it. Even if I have like something I want to read, I fall asleep immediately.

Dr. Ares-Romero
That’s great. Those are two great answers. I think what I would love to have as a superhero, and it’s going to sound a little cheesy, is to have a magic wand, right? And just kind of like, you know, just be able to spread magic wherever I went. And you know what is your wish? And I sometimes, you know, when I talk to my patients, I always say, I wish I had a magic wand, right? So, I can really, make this go away, or make this better for you. So, I wish I had a magic wand, that would be my superpower.

Ashley Kristoff
I love that. I love the diverse mix here. It is very fun. And it seems like we all just got good things going. So, let’s jump into the meat of our conversation now and give a little bit of background about major depressive disorder or MDD. So, Dr. Ares-Romero, can you tell us a little bit more about that condition?

Dr. Ares-Romero
Sure. So major depressive disorder, it’s a common and serious illness. And it negatively affects the way you feel, the way you think, and sometimes even the way you act. Fortunately, it is treatable and that’s always the message that I like to bring across. Because depression really can cause feelings of sadness, loss and interest, things that perhaps you used to enjoy, things that you used to do, activities. I’ll have patients tell me, “you know, I just don’t feel like doing that anymore. I don’t feel like reading a book anymore, or I don’t feel like gardening anymore.” It can also lead to many emotional and physical problems. And it can decrease your ability to function, both at home and at work. There’s different types [or] forms of depression, one of them, which is I think, the one that we really want to concentrate on today is treatment-resistant depression. And those can be more complex, these are a little bit more complicated to treat. Treatment-resistant depression, for instance, is typically defined as patients that do struggle with major depressive disorder, who have not been able to respond adequately to treatment. And it’s usually defined by a failure to respond to at least two antidepressants and they have to be taken at the correct dose and for the correct amount of time. So that’s really treatment-resistant depression. Then, we have major depressive disorder with suicidal thoughts or actions. And that’s when a person experiences suddenly worsening of their depressive symptoms and this can cause them to think, or have thoughts of self-harm, or maybe my life is not worth living anymore. Or maybe I’m a burden to my family and friends. And so, while people that live with suicidal ideation are sometimes diagnosed with major depressive disorder, it’s important to note that not all people living with major depressive disorder have suicidal thoughts or actions.

Ashley Kristoff
Definitely, I think as we’re talking about just the unique types of depression here, it makes total sense that some patients would experience it and others won’t. So, for the patients that do experience those suicidal thoughts as a result of their depression, what should they do?

Dr. Ares-Romero
So suicidal thoughts or actions can be common, and this is why it’s very important when you’re struggling with these types of thoughts, that you really are open. There’s a lot of stigma and fear around talking about those thoughts, and fear – what are people going to say or do? But it’s really important to kind of put that aside and really speak to your healthcare provider, your psychiatrist, psychologist, your doctor, [or] your support system. And there’s also this thinking that we hear about a lot, well, if we talk about suicide, and that’s going to make the person be suicidal, or act on it. And actually, that’s not so. It’s been shown that when we do talk about it, when we normalize the conversation, people are able to get help. But if you, if you do know, I do need to say this, if you do know someone, or you are someone that’s struggling with these thoughts or these ideas, please reach out first and foremost to your healthcare provider. But there’s also the National Suicide Prevention Lifeline. And that’s 1-800-273-TALK (8255) [or 988]. Or you can also go to the and get the help that you need.

Ashley Kristoff
Yeah, thank you for providing that resource and we’ll make sure that is available for everyone, as well. Sally, I want to talk a little bit about your personal experience. Let’s switch a little bit from the clinical diagnosis and really talk a little bit more about what it looks like. So, what’s your experience been with depression?

Sally R.
I think my experience with depression is probably not that different than a lot of people in a sense that, you know, I was treated for it for a number of years, and from time to time, I will feel like that my medication needs to be adjusted or perhaps I need to change my therapist. A few years ago, I was taking an antidepressant and I had a psychiatrist, the same psychiatrist I see now that I was seeing regularly, a therapist – you know, all the things that I normally have done over the years to manage my depression. I was struggling in a way that was kind of unexpected because I felt like I was doing all the things that I thought I should be doing. I was exercising, I was taking my medication, I was seeing a therapist and things like that, and over the years, I have learned that I need a toolbox of things. That sometimes one thing will be working for a while, and then I need to sort of switch it up. And that’s what happened to me a few years ago – the medication that I was taking, my psychiatrist was like, “Well, we can add another one.” And I was like, “I don’t know if that’s really what I want to do, maybe.” But, you know, I think I’ve found over the years that, really, it’s something that I have to, like I said, I have to sort of manage every day, but it’s not impossible to manage. And that I just make sure that I have a lot of different tools in my toolkit. So, I think that that’s sort of probably similar for a lot of people. I was in college, I think, when I was first diagnosed, which I think is also common for a lot of people.

Ashley Kristoff
Yeah, it can be a very stressful environment and really, really test your mind a little bit in more ways than one. So, that makes a lot of sense.

Sally R.

Ashley Kristoff
Yeah, you know you talked about a couple of treatments that you’ve tried over the years. So, I’d love to dive into some of the common treatment options for those who do live with challenging-to-treat depression. So, Dr. Ares-Romero, could you tell us a little bit about different types of treatment options that are out there?

Dr. Ares-Romero
Sure, and I love what Sally said you need like this toolbox, right? And be able to know what tools you need. So really getting to know yourself, your depression, and really being able to have you know, that communication with your psychiatrist is very important. So, when we’re treating depression, of course, we have different modalities, you know, we have psychotherapy, which is commonly talked about as talk therapy. And that’s focused really on exploring relationships between the patient’s thoughts, their feelings, their behaviors. You can identify some of the underlying issues that could be adding to the depressive feelings the patient is going through, it could also help with things like emotional trauma or interpersonal relationships that have kind of been dragging from the past. It’s very important. And actually, in my personal practice I do therapy because I enjoy doing, practicing therapy with some of my patients. But I also recommend therapy, right? So, there’s different therapy modalities and it just depends on the patient, and what their needs are. I don’t know, Sally, do you want to share anything on that, psychotherapy?

Sally R.
Yeah, so I have been involved, I’ve had therapy over the years at many different times. And I had a therapist at one point, that really, I think, was the person, she wasn’t the first therapist I had, I want to say that she was maybe like, the fifth or sixth, not to say that the ones prior weren’t helpful, and didn’t assist me at the time, this one, really, I think, was able to help me uncover a lot of the underlying issues that were causing my depression. And I still to this day have a therapist because although I have dealt with many of the issues from my past, and trauma, and things from my childhood. You know, there’s still things that come up from time to time. And one of the things that I have learned is, it’s not my partner, my husband, my friends’ responsibility to be my therapist, as much as I love them. And they are so supportive, [but] it’s not their job. And so, I have really tried to make sure that I have a therapist that I can talk to because that’s very important for me to have a balance of someone professional to speak to as well as the medication that I take, and the other things that I do, whether it’s exercise, trying to eat better, an artistic outlet, things like that. So, it’s really a combination of things and I think that over the years, I’ve learned different ways. And again, sometimes one thing will be working for a while and then it just doesn’t, and unfortunately, the way that depression works, at least for me, and this is just my experience, is that something that will have worked in the past just stops or the depression clouds my ability to get to that. I can’t make myself do the thing that I know will help me feel better because depression is like that. It really zaps you of your energy and your motivation. And even if your logical brain is like, “You would feel so much better if you did this.” You know depression is dark, it can be, and it’s just this sort of loud darkness, that’s like, “No!” and so I think that that’s one of the things that I’ve learned is that having a therapist to talk to when I get into that space, has really made a difference for me. And so there have been times over the years where trying to find the right therapist, it’s like trying to find the right hairdresser. Really, truly, because it’s not easy, you have to really put a lot of faith into that person and you have to know that you can be open and vulnerable with them. And that when you reveal whatever it is you need to, to them, that they’re going to support you. And when you leave that, you leave that meeting, you’re OK. You know, so I definitely think that finding the right therapist is difficult at times, but it’s worth it and I always tell anyone that is trying to find a therapist that don’t give up. If the first one didn’t work, just keep trying. I think the main thing that sort of I try to tell my friends or anyone, maybe one of the things that I just want to say today is that if you don’t feel like you can do it, then have a friend make the phone call for you or a family member. Because I do think that when you’re in sort of a depressive state, the hardest thing to do is maybe make that phone call. And if you’re frustrated with your therapist or your psychiatrist, and you don’t know what to do, don’t give up because there are other people out there. It’s just maybe you haven’t found the right one for you.

Ashley Kristoff
Yeah, I love all of that for many reasons. But one of them really stuck with me. My therapist said something about how like your mood hijacks your brain, which when you’re talking about how that little logical brain side of you is going like, “You would feel better if X, Y, and Z.” It’s like your mood gets in the way of that. And it’s really hard to override that when you’re in that mode. So that just very much resonated.

Dr. Ares-Romero
Yeah, that’s great. And I think also, the other takeaway point that’s so important is that there’s a right therapist for everyone and not every therapist is right for everyone, right? So, a lot of times patients will come to me, they’ll be like, no therapy doesn’t work I’ve tried, it doesn’t work. Well, it’s just you haven’t found the right therapist. And you have to kind of find that right fit. And I think it’s unfortunate, right? Because you wish you the first one, you know, it’s kind of like the first guy you date. You wish it was the perfect guy, right? Or the perfect gal. So yeah, so it doesn’t, and I like that analogy of it’s like a hairdresser. You really have to trust them. So that’s great. And it’s important, right? I think it’s important that we have the right therapist, and if you’re not happy with them, you’re allowed to switch. You’re the consumer, you can go ahead and switch as many times as you like because it’s your health. And I’m huge on advocating for my patients. You have the right to ask all the questions. You have the right to say no if you don’t agree with a treatment plan because it’s your health. So continuing on the different treatment modalities, because I can talk about psychotherapy forever, oral antidepressants is another way of treating depression. And the way this works, it increases some of the chemicals in our brain that help us relieve the depression and sadness and actually make us feel better. These are serotonin, norepinephrine, or dopamine. Or, they can also block the absorption of some of the neurotransmitters and this really has been known to regulate the mood and relieve depression for ourselves when we do take it and it’s usually oral, it means it’s in a pill form for the most part. Then we have ECT. ECT is actually considered a procedure and you do have to go to the hospital. It’s where a patient is placed under general anesthesia. They have small electrodes placed throughout their brain and in a controlled way, the idea is to trigger a brief seizure, which affects the neurons in the brain and kind of resets them and so this is the theory behind the relief of depression when you treat it with ECT. Usually, you have to have quite a few series of treatments, usually about 10 to 15. And then we have TMS. TMS is transcranial magnetic stimulation. This is a non-invasive procedure, where there’s a large electromagnetic cord. It’s placed against the person’s scalp in the prefrontal cortex and then during the session the magnetic field is created in order to be able to stimulate the neurons throughout the brain and it’s short pulses. Again, this is believed to stimulate those neurons to control the mood and improve the depressive symptoms. And again, several sessions are usually needed to complete this treatment, usually about six weeks and about 35 to 36 treatments – [it] depends on the treatment regimen. And then we have SPRAVATO®, which is esketamine. It’s a class III nasal spray. This is a treatment that I use in my personal private practice. For my patients who have treatment-resistant depression or challenging-to-treat depression, it was approved by the FDA in 2019 for the use of TRD in adult patients, and in 2020, they also received the approval for treatment of patients with adult patients with MDD with suicidal thoughts or actions. In both cases, it is administered with a combination of an oral antidepressant under the supervision of a health care provider in a certified clinic setting. And again, it is believed to take a different approach, which is different than the ones we talked about. And SPRAVATO® works on glutamate, which regulates the communication between nerve cells in the brain. So, it’s a different treatment modality than we have seen up to this point. It’s important to note that as with any medication, there [are] risks versus benefits to every treatment. I always tell my patients that. Let’s outweigh the risks versus the benefits always when we prescribe or we treat patients. And it does have a BOX WARNING for sedation cause fainting, dizziness, kind of spinning sensation, sometimes patients report like they feel a little disconnected from themselves or their thoughts – it’s considered dissociation is the name for it. SPRAVATO® is a controlled substance. There is a risk for abuse or dependence, but this is something that you should always speak to your healthcare provider [about] and they’ll be sure to check for those signs. Again, this is something that might not be right for everyone. So, I encourage you to speak to your doctor, and always, always, always to find the right treatment for you. You know, in my practice, my patients have responded very well. Again, this is the conversation, I do consultations, I have patients referred to me and I have my own patients in my own practice. So, it’s always having that really good conversation, where we talk about past treatment, what has worked, what hasn’t worked, and for a lot of patients, what excites them is the fact that it’s a different type of treatment, right? A lot of times when patients come to me they’ve been struggling for depression for years, right? And it’s been “increase a medication, change a medication, add a medication, subtract a medication” and not really having good resolution of their depressive symptoms. So, when I talk to them about all the treatment options, and I talk to them about SPRAVATO® and the fact that it’s through a different mechanism that what we’ve known up to this point, I think that’s the conversation that patients are excited about. They’re saying, “Hey, you know, I’ve tried all this, this is what has been done up to this point, I would like to try something else.” And of course, again, it has to be for the right patient. So that’s why it’s always important for you to talk to your doctor.

Ashley Kristoff
Yes. Sally, do you want to share a little bit about your own treatment experience with SPRAVATO®?

Sally R.
Sure. So, my experience is very similar to what the doctor said in regard to sort of, as I mentioned, I was taking an antidepressant, I was speaking to my psychiatrist. I had heard about SPRAVATO® on a podcast actually, and or I think, maybe not SPRAVATO® itself, but just different treatments that were coming sort of to market, I guess. And so, I had spoken to my psychiatrist about it again, he was like, “Well, let’s put you on another antidepressant.” And I was like, “I don’t really want to do that. I feel like maybe there are other things that might be available.” TMS was one and then SPRAVATO®. And so, I said, “Well, I just like to try it. You know, let’s just try it.” And for me, it was or it has been, it has really made a big difference for me as far as being able to manage my symptoms, I suppose you could say. So, I know that for me, that’s been the big difference. I still have an antidepressant I take. I still do the other things that I talked about as far as you know, exercise, a therapist, things like that. But I think the main difference that I have been able to tell with SPRAVATO® is that when I have treatment, I’m able to think about some things in a different way. Kind of get sort of away from my own self in a way that I can’t otherwise. Stop a chatter that’s going on in my mind. And I think that that’s made a big difference. So, for me it’s helped. I know that everyone has different experiences and has had different results. But I know for me, it’s made a big difference and that with other antidepressants I had to just like the doctor said, you have to look at the risks, and the side effects and things like that. And for me, this one, the benefits and the side effects, it makes sense for me. So, I’m glad that it’s available and I’m glad that I spoke up because I think that I was in such a place that I felt like I needed to, I was like, “Well, I don’t want to just take another antidepressant, I’ve already done that. There’s got to be some other things out there. And I’ve heard about them, can we look into that?” And, you know, my psychiatrist helped me get connected with the clinic and then the clinic evaluated me and said, “You know, you’re a good candidate, let’s give it a try.” I went down the path to make sure that I was the right candidate and it’s worked for me.

Ashley Kristoff
Yeah, I’m really glad that you went through that, was there any way that you look to find a little bit more information about SPRAVATO®? Or how did you learn a little bit more about the medication?

Sally R.
So, I did go online, I went to I went down the rabbit hole. I’ve read reviews. I really had no idea what to expect. And so, I talked to the psychiatrist that’s on staff there at the clinic and we talked about my concerns. He’s still there and he’s really quite good about assuaging my fears anytime I’m not really sure if I come in, and I’m not feeling well, he’ll sort of say, “Well, where are you today?” And I think that it kind of just goes back to you really have to be open and honest with your therapist, your doctor, whoever your healthcare provider is about where you are to make sure that the treatment that you’re getting is working for you. And if it’s not working, then you need to speak up and try and find something that will. Just because it’s not working right now, there might be something else out there that will.

Ashley Kristoff
Absolutely, and I think that’s such a key point that you really do have to, you have to speak up in whatever way you can. So, Dr. Ares-Romero, what are some of the best ways that you can talk to your doctor about these different treatment options and trying to find that right fit for you?

Dr. Ares-Romero
Yeah, I love that she said that and you kind of reiterated it. I think it’s very important for our patients and ourselves, right to just speak up. I always tell people, and you know, if I’m on a podcast or anywhere, I always say, “Well, if your doctor is not listening to you, it’s time to change.” Some doctors really must not like me very much. But I truly believe that. If your doctor is not willing to have that conversation with you, is just willing to sit there, look at you and say, “No, you need to take this,” then it’s time to say, “This is our last visit.” So, I think again, all treatments have risks, they have benefits, and it’s important to, to speak to your doctor and ask him or her, you know, “What, what do you think is a good treatment option for me? We’ve tried A, we’ve tried B, we’ve tried C, I still don’t see, I don’t see myself getting well. So what can we do?” So it’s important to have that open communication with your doctor, your healthcare provider and being able to have those really tough conversations. “I don’t feel this is working,” and it’s important for the person who’s going through the treatment to understand they haven’t done anything wrong. Sometimes it’s us as the professionals who are failing our patients, right? Because it’s very easy for us to say, “OK, let’s do it again,” or sometimes patients are afraid to kind of tell us that they’re not feeling well, they’re like, “OK, yeah, I’m good, I’m good.” And they really aren’t. So it’s, you know, having that safe space, where you feel confident to have the conversation with your doctor to ask the questions. You know, “Why do you think I’m not getting better? Am I on the right dose? Am I taking the right medication? Should we look at my diagnosis? Maybe I have the wrong diagnosis?” So I think it’s always important to have that conversation to speak up or to take a friend. I think Sally said this earlier, have a friend call or have a friend go with you, right? If you sometimes feel maybe a little intimidated or a lot of times patients want to please their doctors and I get that, but I never, never, never want my patients to feel like having depressive symptoms and not getting well is OK and it’s a status quo. Because we know that depression, although, a lot of times people struggle with it for many, many years, it is treatable. So, I think that’s the most important thing.

Ashley Kristoff
Absolutely. Sally, when you discussed these treatment options with your doctor, how did you originally bring up that topic of conversation?

Sally R.
Well, I think I brought it up like, “I heard about this on a podcast, is this something that I could try?” My mom was [a] type 1 diabetic and my dad had heart disease. And as a child, or growing up, you know, I saw them manage those diseases every day, right? My mom took insulin every day. She managed what she ate every day. And I think in a sense, I was lucky because in this regard, because I saw two people who managed diseases every day and lived full lives, I’ve always looked at depression the same way. When I was having issues, externally, when I went to my doctor and brought up SPRAVATO®, externally everything in my life was great. My job was great, my relationship was great, everything externally seemed fine. But I was just struggling, really, I was just struggling. And I didn’t know why I couldn’t understand why. I knew enough, having dealt with depression for long enough, that I was like this is a chemical imbalance. I know my medication isn’t right. I said to my psychiatrist, “Can we look at some of these other options that are out there? Can we see if I’m a candidate for this? Because we need to find another way to manage this. Because whatever I’m using right now isn’t working.” And that’s what we did. And I’m actually on the same antidepressant that I was on then, I’ve just added SPRAVATO®. That’s the difference. But you know, everybody’s different in that regard. I think you just have to know that it can be managed and you have to say something. And I know when I said something to my psychiatrist, he was sort of like, “OK, well, what podcast did you hear this on?” And I was like, “Well, that doesn’t matter.” I was like, “And I also did some research. You know, I used to be a journalist, I did some research, you know, let’s just look into it together.” He was like, “OK.” You have to advocate for yourself. And again, if you can’t, and if it’s not something you’re comfortable doing, then find whoever your loud friend is or your aunt or your cousin or whoever is able to do that for you. Sometimes it’s just hard to do. Sometimes it’s hard for me to do. I just think that it’s a matter of finding the right person to talk to. And if you can’t do it, find someone that will help you do it for you. It can be difficult. I know. But you can, you can do it.

Ashley Kristoff
Absolutely. I believe there is, there is a path for everyone like Dr. Ares-Romero said a little bit earlier. You got to find your path, whatever that looks like for you. It’s going to be a little different than, you know, the friend you know, who also lives with depression. It’s going to look a little different for everyone and that is that’s A-OK. That’s why we have so many different options and treatments and resources. So, I do want to make sure that we are highlighting some of those services and resources. So, Dr. Ares-Romero do you have a handful or a couple that you would like to share out?

Dr. Ares-Romero
I definitely do. So, I already mentioned the National Suicide Prevention Lifeline which provides 24/7 help. Free, confidential for people in distress and anyone that’s struggling through a crisis and that’s 1-800-273-TALK. That’s 273-8255 [or 988]. Then there’s the SAMHSA hotline, which 1-800-626-HELP. That’s 626-4357. And again, this is also free, it’s confidential 24/7 and it’s more treatment referral information service. They also have the website., which I’m [a] huge, huge advocate of NAMI. I sit on the board here in Miami-Dade County. It’s 1-800-950-NAMI, on 950-6264. And it’s really about support groups. They do free support for family, for the patient, provide practical next steps. And you can also text HOME to 741741 for free. It’s 24/7 crisis support in the US. There’s also Psychology Today, which has a nice directory, where you can go in there. It’s an interactive resource where you can look for and locate mental health practitioners across the country. Again, you know, I always say if you know it’s not working for you find somebody else. You know, your provider should number one listen to you and number two, work with you for your own personal treatment plan, because it’s not one-thing-fits-all. It’s everybody has a different treatment plan option. So that’s, that’s what I have.

Ashley Kristoff
And if somebody is looking for more information just specifically on depression, they want to learn a little bit more about that. Where can they look on those?

Dr. Ares-Romero
So, I think especially on, on the SAMHSA website, you can really look into depression. But you can also look at the National Institute of Mental Health, Mental Health America as well. And NAMI, the National Alliance on Mental Illness.

Ashley Kristoff
Fantastic. Thank you. Sally, do you have any you would like to share as well?

Sally R.
I was going to say that all of the resources the doctor mentioned are ones that I have used in the past and I definitely would recommend those. I think that one of the things that I’ve noticed about myself is that I can tell when I’m starting to struggle if I start to put books in my Amazon cart about mental illness or depression. I’m like, why am I doing that? If it’s more of those books than fiction, that’s a sign to me. But I figured that out at some point. But I would say that all of those resources are great ones and use them. They’re out there, they’re available, and just get the help you need if you need it.

Ashley Kristoff
Absolutely. And we’ll make sure that these resources are available for everyone to easily access as well. That’s the meat of our conversation. So, I really wanted to get into some of the kind of final wrap up questions we love to ask here. So, we’re going to jump into our Self-Care Corner. Again, I can start on this. So, if you want to think about it for a minute. What is some self-care that you’ve been doing recently, that’s been really helpful? For me, this past weekend, I went camping. I turned my phone off, except for I turned it on to take some pictures, but I turned it off otherwise. There was no cell phone service, there was no Wi-Fi, no ways to really connect. And so, it was really just a wonderful time to completely disconnect and just kind of live in that present moment. And I didn’t realize until I was in it how much I needed that. So that was, that was my little self-care this weekend. It was just a little bit of disconnection. Who is next?

Dr. Ares-Romero
I can go next if you like. So self-care for me, and I always share this with my patients, I think it’s something that we should be doing every day, right? And we forget about ourselves a lot of times. Especially women, I hate to kind of not talk about men, but us, we always kind of are the nurturers and we forget about ourselves, right? We have to make sure everybody else is fine – our parents, our kids, or our sisters or brothers, or best friends. And we sometimes forget about ourselves. And it’s important for us to know that we have to take care of ourselves first in order for us to be there, right, for everyone else. So, one of the things I enjoy doing, and I kind of have to do, is I wake up before anybody else in the house to have my coffee and peace and quiet. So, I need that real timeout. You know, I like to put myself in timeout, sometimes. It’s not about putting my kids in timeout it’s about putting myself in timeout. So, taking those minutes in the morning, where it’s just no phone, no emails, no text, just quiet time to just kind of think, right? And then you know, a little bit of meditation. But it’s really more about just thinking in quiet and silence. The other thing that I really enjoy doing for myself is if I’m having a little bit of a down day, because we all have those days, right? We have good days, we have bad days, you know, we have days, even if you’re somebody that struggles with depression. And, I have this conversation with my patients all the time. You might be well, doing well with your treatment, but you might have a bad day and that’s OK because we all have them. And if somebody tells you they don’t, they’re lying, because we all have bad days. And so those days are the days that I love to get in my car, jam some music, and just I probably look like a wild woman. And just like sing, sing. I don’t do it in my house because the walls probably fall around because I can’t keep a tune if my life depended on it. But I do that and that just makes me happy, or I dance in my living room and my kids just cringe like “Oh my god, Mom please stop doing that.” But those are the things that make me happy, and I often also tell my friends and my patients, “Laugh.” So, watch your favorite comedian, watch your favorite sitcom. Listen to whatever makes you laugh and just laugh. Research has shown it actually makes you feel better. So, laugh your little heart out. That’s what I do for my self-care.

Sally R.
That’s definitely good advice. I will keep that in mind, I do that. I like to cook. Cooking is relaxing for me. It’s a mess. I mean I make a mess as far as that goes. But I enjoy it. I enjoy the whole process of it. I enjoy looking for recipes, finding the ingredients. I like going to the farmers market and then seeing what’s available there. Like heirloom tomatoes are in right now, which I love. That’s part of my self-care is cooking. Because I’ve done something [and] there’s a product at the end. I enjoy that. And I would also say that definitely listening to music. You know, I have different playlists that I listen to. It’s funny because when I go to have my SPRAVATO® treatment, I have different playlists. I’ve kept a record of what I listened to because I feel like at some point that’s going to be interesting to look back at. There’s probably a Taylor Swift song to help me get through any emotion that I have. I’m pretty sure, probably. I would say that cooking and listening to music are how I take care of myself. And when I’m left to my own devices and if I’m by myself, that’s probably what I’ll be doing.

Ashley Kristoff
I love that. I love that music.

Dr. Ares-Romero
It’s fun.

Ashley Kristoff
Yeah, I love that music was involved in both of your answers. So, our next and kind of final question here. We’re The Mighty, we like to talk about what makes us feel kind of self-empowered or what made me feel Mighty this week. So, I’m going to go first again, but I’m going to the reverse order. So, Sally can go right after me. So, what made me feel Mighty this week is, you know, I’m continuing this music trend. I just finished an exercise program that was completely dance-based. It was just a month program around dancing. And so, I finished that. I already felt good about that. I had grown up as a dancer, and it’s something I really fell out of in the past 10ish years. The first exercise, I recorded myself. And I record myself along the way. At the end, I was able to see just how much I improved. And that was just a really good feeling on top of the actual mental health benefits that I got from just doing that exercise and that movement. So that made me feel really good this week. So, I’m going to head to you Sally.

Sally R.
That’s fantastic. Well, I think the main thing for me is, I got a guitar at the beginning of the pandemic, and then I got engaged and got married – and that took up a lot of time. I sort of put off my guitar lessons for a while, but I started those back up in the last week or last two weeks. One of the things that I’ve done in the last week is I have practiced guitar every day, and that makes me happy. It’s kind of like flying or riding a horse. You can only really be doing that in that moment. You can’t really be thinking about other things. You know, you can only be just doing that thing. So, it’s a reminder to myself that this is good. I feel good when I’m doing this. So that makes me proud of myself when I do that.

Dr. Ares-Romero
That’s great. I actually took guitar in high school. I should maybe pick it up again. There is not enough hours in the day. I’ve had this book circling in my brain for a few years and it’s so tough to sit down and put pen to paper or hand to tablet. So, this week, I finally committed to start. So, stay tuned. Let’s see. It’s scary, right, to start something like that and take that on. Now I guess I’ve said it out loud, so now I’m stuck doing it. So, it made me feel kind of empowered to kind of just make that decision. So, I’m excited.

Ashley Kristoff
That’s great and we’ll definitely be looking out for that in the future. Thank you both so much for sharing these things. Dr. Ares-Romero, Sally, do you have anything you want to say? Final thoughts here? Dr. Ares-Romero we will go to you first.

Dr. Ares-Romero
You know, I think I’ve said it a few times. It’s important for you to advocate for yourself, for the right treatment. It’s not one-size-fits-all. And you have the right to ask, you know, “Is this the right treatment option for me?” And do your research. You know, there’s a lot of resources. We’ve given you some here today, where you can actually look and see because if you’re not feeling better, then it’s time to make a change.

Sally R.
I would say thank you so much for having me and I think that the message that I would want to leave with is – I have depression. It is a disease that I manage every day but it doesn’t define me. It’s not who I am. You know, I don’t walk into a room and it’s Sally with depression. It’s just Sally. So, I think that that’s important and some days are better than others. But it’s not all of who I am. It’s just some part of me just like I’m a beginner guitar player – just some part of who I am. So, I think that’s important to remember with mental health, it’s just some part of who you are.

Ashley Kristoff
Absolutely. I can’t think of a better way to, to wrap that up because you just [shared] the perfect ending thoughts there, Sally. So, thank you, Sally. Thank you, Dr. Ares-Romero for being here today and sharing all of these amazing resources and your personal experience. I know it’s going to help a lot of people think about what they want to do in their own kind of treatment plan. If you want to continue this conversation, head over to or download The Mighty app to become part of our community. We’d love for you to give us a rating and review on Apple podcasts, follow us on Spotify, or if you’re listening on The Mighty, give this page a heart. Join us on our next episode and Stay Mighty. And thank you for listening to this episode of The Mighty Podcast and thank you Janssen for sponsoring this episode. Please stay tuned for important safety information about SPRAVATO®.

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.


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.
  • 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, 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.

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
  • 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) medicines. 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
  • vomiting
  • feeling drunk
  • feeling very
    happy or

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. 


For more information about SPRAVATO®, please visit

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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