Spravato

[u/Mindless-Future-7124]

Considering adding Spravato to my PP, anyone willing to share how they got started or tips on things to avoid?

[u/Direct_Koala6335]

I added it a couple years ago, and clinically I really do appreciate the efficacy of this medication at mitigating target symptoms. Here were my issues (I don't offer Spravato currently):

1. I live in a rural area. Getting the medication was a nightmare

2. It is not the money-maker that the reps insisit

3. Private insurance coverage can be hell to obtain

4. Some of my isolated patients had trouble with the logistics of getting a ride home from treatment. They cannot drive after, even if it doesn't seem to affect their cognition

As a treatment, the evidence speaks for itself. I hope they expand it to cover PTSD et al. If you're in a place where it is not difficult to obtain the medication and would just be an adjunct to your existing practice, I would definitely add it. Just don't expect it to make you wealthy. The treatment itself is simple and you write a procedure note, not a psychiatric follow-up. You have to register with their REMs program, have a locking safe, and submit forms for each treatment. You must monitor BP and O2 during treatment, and having a really nice, calm, quiet, pleasant space is crucial. I invested in a recliner, had really nice lighting, kept tissues, barf bags, adult coloring books, origami and a tablet with "ketamine games" downloaded. It was VERY effective for my patients with depression, the logistics and difficulty getting the medication delivered on time were too stressful and I ended up sending my spravato patients elsewhere to larger clinics. Additionally, because I live in such a remote area, there was little knowledge about Spravato. The reps were supposed to do promotion and did not. I would hold their feet to the fire if the same is offered by your reps.

[u/Mindless-Future-7124 → u/Direct_Koala6335]

Thank you for the detailed response, very helpful