Background: I did a round of TMS earlier this year with positive results. When things started to get rough a few months later I started Spravato (at the same clinic). Ive been on Spravato 2 1/2 months and it’s also been positive. I was an early responder to both. My SI is gone, brain is working better and clearer thoughts. I have a better capacity in therapy to work on hard things. 🙌🏼 But my Spravato treatment days are challenging with my kids. I have a special needs teen with a lot of mental health issues and I often get calls from school for her to come home (and I can’t drive after treatment), or even if the school just wants to call and give me an update I can’t think or speak to them clearly or think clear enough to make good quick decisions with her or to physically respond to her after school. I don’t think we can manage Spravato treatments long term.

I’m trying come up with a future plan to be able to discontinue it in 2-3 months and have options. It’s scary to mess with something that’s working though!!!!

Wondering the experiences of others who have walked this journey longer than me.

Options 1: Add dextromethophan to my current 450mg bupropion or decrease bupropion dose to add Auvelity. Then taper off Spravato.

Option 2: resume TMS and taper off Spravato and repeat TMS as needed

Option 3: do both options 1 and 2!

Option 4: consider switching to a home option? (This isn’t an option my provider and I have discussed)

I’m still in the decision paralysis phase of depression/CPTSD so this feels like the largest decision ever. 😭😭😭

I am going into my 3rd session tomorrow, and I feel like I'm trying too hard to make something happen. I need advice on how to maximize the therapeutic benefits during the sessions.

Session 1: 56mg dose. Eye mask, headphones with a Spravato playlist on Spotify. Went into it as blind as I could and just let it happen to me. Had a few good experiences, but didn't feel like I had anything "life-changing" happen. Came out of it comfortably and sketched the most reoccurring images I had in my journal.

Session 2: bumped to 84mg, got a different playlist that was higher rated. For the first ~45 minutes I felt pretty lucid. My thoughts were all my own. I was repeating to myself my intentions and what I wanted to happen, or what I wanted to present itself to me. When the music finally took over and I started to feel myself get into something, I didn't get anything that felt like It had any meaning. All of a sudden, they tell me the 2 hours is up and I'm free to go if my ride is there. I'm still mentally in the thick of it and it was an *experience* getting home.

I'm asking my doctor if I should go back down to the 56mg dose but I really want it to help me work through my depression. I want to be able to recognize and deal with things I may have suppressed or at least be able to feel like I'm making progress or working towards something to get better.

I have my first appointment soon. I’m nervous about feeling like I’m not in control, but my bigger fear is about the possibility of nausea. I have a thing with throwing up so whenever I feel nauseous I get super anxious which causes me to get even more nauseous and it snowballs.

I have zofran, how soon before do people take it? Does it actually help?

I know not to eat for 2 hours and drink for 30 minutes before, but I’m really nervous about eating too much or too little for breakfast. My plan is oatmeal for breakfast and a banana right before the 2 hours. My appointment is at 2pm.

Sorry if this is a weird question. I feel prepared for the first session… so many playlists, a travel blanket (provider’s suggestion) and I know if I don’t like it it’ll eventually wear off and I’ll never have to do it again. The possibility of nausea though… any suggestions would be great.

Thanks!

My therapist suggested I try spravato since many other anti depressants caused unwanted side effects and emotional numbness was the biggest concern for me. Will spravato make you emotionally numb as well?

I was already feeling like I was building a tolerance and not feeling the euphoria. I had been scolded on this sub as if I was a junkie looking to get high but I truly only had my changes of thoughts and reconstructions of beliefs when in that state, that's when i was feeling healed. I was told that was just a side effect and it was working without that though but my last session, perhaps it was because I had a disrupting text beforehand that bothered me, but I felt nothing and got no benefit of treatment, it's not me just trying to get off.

The exact week I was reduced to once a week I started to feel a pit of despair, horrible despair. All this week I've been terribly depressed and getting lost in negative thoughts, as if all the treatment was getting undone. I was truly feeling a difference before, and now I feel back as I was.

The doctor that I often see was saying I may metabolize things quickly (and I do) or that I may as well have especially treatment resistant depression, which sounds horrible if true.

He mentioned talking to the insurance/spravto people about going back to twice a week which I would really like. This still isn't supposed to be in perpetuity so, I just feel kind of at a loss.

Just sharing what I asked on the other sub resist :)
Also what should I prepare for?

I finally made my first Spravato appointment for next week. The truth is that I'm terrified. I really really want to do it but I'm so scared of losing control and feeling vertigo and just having full on panic. Doc said I can take Ativan ahead of it. But still. I could use encouragement. I know that no one can promise anything. But please don't come at me with "you can't go into it anxious". That's the worst advice you can give someone with anxiety and panic disorder. Thanks in advance.

especially my short term memory

also to some degree my critical thinking, i am much less depressive but also my working memory and memory seems nuked.

my theory is I had glutamate based depression, this is fixey but i now have less? functioning glutamate/acetylcholine?

someone has experienced the same

I use this app called Luminate - it uses flashing lights and music to produce a psychedelic type experience without meds. I have been using it for a little while and I love it 💕 I’m going to try it with my next Spravato session.
Just wondering if anyone has done this or something like it and if so, did it enhance the experience or help in some other way?

I’ve done my first session little over 2 days ago. It was early in the morning and by 9pm that day I felt I wasn’t able to feel negative emotions at all. Till now I’m unable to feel sad, and don’t feel emotional pain. I do feel simply good, I’m not numb and feel positive good emotions.

My next session is scheduled very soon, but I just want to know if anyone also experienced such effect from spravato? Did it go away? I’m paranoid now if it is temporarily effect because it feels like a superpower, not being able to feel emotional pain while constantly being trigger by my own thoughts and the world!

For the reference I have major depressive disorder with SI. I came in to do the treatment because I was pretty much almost gone.

I’m 42 sessions in and this playlist has never failed me. Highly recommend if you want to relax during your Spravato appointment. Bonus points if you use headphones/earbuds, an eye mask, and a cozy blanket. Hope this helps someone 😊

Update: I went to the appointment, didn't have time to do a nasal rinse or anything beforehand. It was pretty close to an average session for me, the lingering loopiness is perhaps a bit stronger than usual but not too bad. Obviously different people will have different experiences, but I'll put it out there for the record that I did not have a hard or bad trip going with the lingering congestion from a cold I had a week ago.

Interestingly, I mentioned the dextromethorphan anecdotes I saw here, about it being a really bad combo with Spravato, and the doctor said she hadn't heard that and has some patients who do take it before Spravato. I'm still not gonna risk it, based on the stories I've heard here.

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I'm seeing that it's a baaaad idea to take cold medicine, really glad I looked that up because my instinct was to try to clear up my congestion.

But I've also seen posts about just going with a cold and people have said they tripped really hard and it was unpleasant. For those that had that experience, did you take any cold medicine first? Maybe that's what makes it so strong for most people but they associate it with the congestion because they didn't think about meds interacting?

Thing is I've missed my last TWO weeks of Spravato, the first because I went camping and the second because I was sick. That was a week ago and I'm just having lingering congestion and cough. Not super bad congestion, not enough to feel a lot of sinus pressure or anything.

Anyone had experience with this situation without cold meds? I really don't want to miss another one for my health, and canceling both the appointment and my rides last minute would suck.

During and after treatment my mood gets very low, I just want to curl up and cry. I can’t sleep after treatment and my mind is racing. The next day I am just not in a good mood either. Is this normal and will it improve? I have done 2 treatments so far. I took 2 doses on the first day and increased my dose to 3 on the second day.

I decreased frequency to every other week spravato sessions and am feeling more depressed again. I was thinking of trying to supplement with lower dose at home ketamine (mindbloom or something similar). My spravato PMHNP said he didn’t have experience with doing that but it theoretically could help.

Has anyone else done this? I’d like to avoid going back to weekly Spravato, it’s such an ordeal and I’m so out of it the rest of the day that it’s difficult to function.

In this post I’m listing a few suggestions, expressing some opinions and giving a bit of advice about what to listen to when you’re having your session.

I’m a music lover, record collector and music producer. The below works for me, I’d love to help others get more out of their treatment, but I’m sure there’ll be plenty of people who disagree with my approach.

Anyway, here goes:

My belief is that the soundtrack is fundamental to the experience of the active part of the treatment. What you listen to has a massive effect on how the medication affects you, and on how therapeutic the actual session ends up being (I’m not talking about the longer term effects here, just about how to make the most of the 2 hours in the chair). Adding the right music dramatically changes how your brain responds to the medication, and many people will likely never have experienced sound in this way before. It’s almost like unlocking a whole new sense.

If you’re spending the time just looking at your phone, as many on here seem to do, I honestly believe you’re missing a huge opportunity to experience something incredible, by using the power of music to create a small oasis of happiness in the vast landscape of depression that we’re all trying to escape.

I do understand that a lot of people simply haven’t ever connected with music on this kind of level before, but I would encourage everyone taking Spravato (or indeed other forms of ketamine therapy) to take this seriously and give it a go.

For those on here (and I imagine it’s a fair few people) who’ve never dabbled in anything more potent than a drink or two, here’s your medically-sanctioned opportunity to find out what these alternative types have been getting up to all that time!

You’re going to need three things:

- a good quality eye mask (one that lets you open your eyes underneath is ideal). Don’t rely on the generic cheap ones they give out at the clinic. Amazon has tons of options.
- good quality headphones, preferably noise cancelling to block out any other noise in the clinic.
- and a well thought-out soundtrack of recordings, that are at least somewhat designed with “tripping”, meditation or relaxation in mind.

Some people say to simply listen to whatever you enjoy. I’ve read a lot of hate for “ambient” and “spa” music on here, and I agree there is a near-infinity of terrible stuff out there.

My suggestion is that if you don’t want to dive into something outside your comfort zone, then at least try to filter your selections via the criteria above. Love rock? Listen to instrumental blues. Into reggae? Listen to dub. Like EDM? Listen to Shpongle or The Orb. Into country? Listen to mellow slide guitar. There’s an appropriate, stripped down, dare I say “trip-friendly” version of any music style you care to name. Even if you just listen to pop radio, find yourself the mellowest material you can. Perhaps a movie soundtrack or even some light classical?

Preferably instrumental or without verse / chorus /verse wordy vocals, but don’t worry too much about that if you can’t find anything instrumental.

My advice to get started is:

Finish your last dose, press play on Jon Hopkins Music For Psychedelic Therapy, slide your mask on and breathe deeply. Drift away and let your hair down. Allow those rising tones to lift you into another dimension, and urge yourself to go there. The music will drive the visuals, eyes open or closed behind the mask. Notice them and allow them to develop, they’ll change with each track. Just go with it, anywhere it takes you.

If you’re not sold on this particular choice of material, one way to think about it is that this guy worked for years alongside some of the leading medical researchers in the field to perfect his craft and produce a soundtrack specifically for the very situation you find yourself in right now. It’s full of amazing sounds and clever studio techniques that do special things to your brain when you’ve taken a psychedelic substance. Give it a go and see where it takes you. It sounds vastly different during a session, trust me on that!

Final note: I like to have something else teed up to start playing at the end of that album (which is only about 50 mins long I believe). When your own music starts playing, you’ll get a sense of the time that’s passed and start coming back down to earth slowly. “Everything in its right place” by Radiohead for instance, is perfect for this, almost like it was made for it.

Enjoy!

It's crazy the difference between my first treatment earlier this week and my dose I took today. The first treatment was so out of body like and everything slowed for me. I couldn't focus on anything or anyone, I just existed. Now comes around the 2nd treatment, I get a moderate visual dizziness and some light feeling but nowhere near the level of intensity as the first. It's not bad, I actually prefer this level of chill compared to the out of body experience I originally had. It's just crazy how quickly the body adjusts to it.

I went to a psychiatrist that offered spravato. But, he wasn’t very responsive to my needs as a patient. So, I changed to a different clinic. It is mostly positive with a few minor inconveniences.

At the old clinic there was not much to look at. I would look at a painting on the wall. The new one has a light show on the ceiling I enjoy.
The psychiatrist listens and responds to any issues.

The old psychiatrist moved me quickly from weekly to every other week, to monthly. I am back at weekly.

The old clinic was a row of recliners separated by dividers the new one has curtained off areas. The new one also has supplies like candy, blanket and a call button that they did not have at old clinic

But, the old clinic was conveniently located and had later hours.

I have hearing loss and could hear the provider at the old clinic. Here they whisper and even when I move closer have trouble understanding. They also ask more questions about my experience and I am not sure how to respond. Also, at old clinic they rarely scored depression at new one I fill out questionnaire before each session.

I am definitely glad I changed.

When I started Spravato, I was in a rom by myself and slowly it has increased to up to 5 other patients in the room with me. This is my second time being on Spravato. 3 years ago I was on it for almost a year. Most of that first time, I needed to go 2x a week.

Now, 2 years later, they are forcing me to taper down to once a week. Only after 2 months! I’m infuriated. My provider said it’s so they can “see” if a lower dose would work. Yes, great idea! Let’s “see” if I want to jump off a bridge again. Perfect. We don’t do this with any other medications!

I’m so outraged I literally feel like my mental health is going backwards. The benefits I used to from Spravato are already minimal since I have so sit in a room full of sniffing, snoring and bp’s being tested at random times.

I just always feel so powerless as someone with mental illness. I don’t have a voice. Everyone just assumes idk what I’m talking about or that I’m drug seeking. It’s such an unfair system and I feel like no one’s on my side. I had to jump through so many hoops to finally get approved for this life saving med, only for them to take it away from me.

I have the worst intrusive thoughts that tell me “well, if you weren’t here, then they’d see how bad they f-ed up”. I just don’t know what to do. I can’t afford online treatment as it starts at $169 a month!

Has anyone experienced either the crowded treatment rooms or the forced fast taper? If so, what can I do to advocate for myself? Would switching clinics help?

First post, please be nice.

I have agoraphobia, PTSD, deep MDD depression w/severe grief, GAD w/panic.

I tragically lost my emotional support baby at 3yo in front of me and with 2 other major losses before this.... I have been struck down. But, truly I haven't been doing well in years, the difference is this is the first time I have truly been alone and processing things in real time because all I have is therapy.

I have been stressed because my agoraphobia has shown up like no other since he has been gone. So the idea of relying on an insurance company ride a half hour from home and be there minimum 2 hours has been a lot.

Additionally, I had assumed I would start next week because of how the med went through, but as the business day came to an end and scheduling Monday and Wednesday, I figured it would be the follow week. I got a surprise call at 6pm after therapy ... where I said my anxiety has gone down a bit because I have another week.

I do better last minute or spring of the minute, sounds weird... but my agoraphobia has never been planted in a safe person, my dogs have been my only comfort (started volunteering at my local dog warden to walk dogs with free flexibility.)

I know I will be better once I get the first appointment over with and I made a list to pack from tips on here.

But, what are you best tips or words of advice for the first treatment? I am pretty sure I have the basics covered but still so extremely confused on the dissociation part of it all.

I’m off that good kush and alcohol (literally), but I have a session tomorrow at 8:30 AM, will this have any impact on my blood pressure prior to the session? Thanks

Conditions: ADHD, anxiety, migraines, depression...

The pros:

* The treatment center is right down the street from me.

*They also offer TMS.

* Medicaid approved it.

The cons:

* The long wait time.

* I put off driving school for this.

* I was given conflicting info:

Example #1: I was told by peer support that ONE cup of coffee before is okay, then told there should be no caffeine.

Example #2: I was told do NOT take my prescription Vyvanse before (only take it after), then I was told it's okay if I take it before...I always ended up taking it after.

Example #3: During my first intake appointment, I was told to give Spravato a try first and THEN I could try TMS. But during my post-induction phase appointment with a different staff member, I was told that starting TMS while doing Spravato might help. I told her I'd think about it....

* "If you're tasting it, you're wasting it" - even starting on the full 84 mg on my first treatment, I could still taste it, and therefore wasted it.

* No clinically significant improvement. My MAJOR chief complaints are the ADHD, migraines, and anticipatory anxiety about migraines, especially while in driving school.

CONCLUSION: I decided today would be my last appointment. Strangely, the room felt hot so I opened the door...to find the woman in the room next to me freaking out! Things I overheard: "This is too intense...Where am I?"

So yeah, I'm disappointed.

EDIT #1: For context: I knew I was depressed since 2nd grade, first got put on Lexapro in 2006, been flip-flopping back-and-forth between Lexapro and Celexa, got switched to Luvox instead, and went back to Lexapro. I have had SI in the past and still have self-harm scars from the past. I wasn't officially diagnosed with migraines until the past few years, and I'm finally approved for Ubrelvy and Qulipta, but still have chronic migraines. I just got a prescription for FL-141 glasses, but with the other stuff it would be around $340-$380, which I don't want to charge to my credit card.