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Referral Process 

To make a patient referral for Spravato®, please complete the PROVIDER REFERRAL FORM, which can be sent to the HIPAA Compliant fax (603) 825-5620.  Please include a complete history of medications, including the length of the trial and the reason for discontinuation. This information is essential when we need to pursue the prior authorization.  Treatment is delayed without the proper documentation.   

SPRAVATO®

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Indications

  • Adults with treatment-resistant depression (MDD patients who have had an inadequate response to 2 or more oral ADs)

  • Depressive symptoms in adults with MDD with acute suicidal ideation or behavior (MDSI)

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Contraindications

  • Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial and peripheral arterial vessels) or arteriovenous malformation.

  • History of intracerebral hemorrhage.

  • Hypersensitivity to esketamine, ketamine, or any of the excipients.

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Most Common Side Effects

  • 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

Client Criteria 

Diagnosis for Spravato:

Major depressive disorder (MDD), recurrent or single episode, severe with failure of at least two or more adequate trials of antidepressants (treatment-resistant).

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Read more here: Referring Your Appropriate Patients with Treatment-Resistant Depression (TRD) to a REMS-Certified SPRAVATO® Treatment Center

 

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Please Note
Each patient will require prior authorization to approve Spravato. Referred patients will be scheduled for an initial consultation; then, we will initiate the insurance approval process for treatment. Typically, this process takes 1-3 weeks, depending on the patient’s specific insurance plan. Once authorization has been obtained, treatment will begin according to their availability and scheduling. 

The complete referral will aid in this process, and is appreciated. 

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Treatment Protocol

 
First 4 weeks – 2 treatments per week
Second 4 weeks – weekly treatments
After the first 8 weeks, we will discuss an individualized treatment plan to maintain progress made with the treatment.
 

Each treatment lasts 2 hours. After the treatment, the patient cannot drive and must be picked up by a friend, family member, or ride-share service.

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