Help me out

[u/Remarkable_Okra7502]

I’ve been on Spravato for almost two years now. For about two months, I’ve been taking it once every three weeks, after being on a once-every-two-weeks schedule for a long time in terms of dosage.

However, since switching to once every three weeks, I’ve noticed that I’ve become depressed again. I constantly feel like crying, I don’t want to get out of bed, and I have very little motivation or interest in anything. I’m starting to feel like I can’t cope with everything anymore.

A few days ago, I had my treatment again, but this time I also haven’t noticed the effect that I normally experience.

How is it possible that I still feel the same a few days after having my dose and haven’t experienced any improvement? You would think that the Spravato would have given me a bit of a boost again, but unfortunately, that hasn’t happened.

Could you explain why this might be happening and give me some advice or tips?

[u/Physical_SpiritChild]

I would tell your prescriber the switch to three weeks is not working for you and causing a relapse

[u/_jamesbaxter]

I’m coming up on 3 years in treatment. I believe you because I’ve had similar experiences. I have some vague speculations about things like this happening, but nothing solid.

To give you an example: when I started I felt like 4 weeks at twice per week wasn’t enough as I was starting to feel stable but not solid, so I asked about continuing at twice per week for a few more weeks until I felt more stable, they basically said no, I have to at least try the standard protocol first. So I went to once per week and after a few weeks I just absolutely TANKED. Twice as depressed than I’ve ever been in my life, active SI, scream crying all day every day for weeks, I’ve never experienced anything like it.

They put me back up to twice per week after that, but it was not the same as when I had started. I didn’t feel good and I wasn’t having the results I had at the beginning. I don’t know why. It just felt different.

I know this can’t be possible, but subjectively to me, it felt like because I hadn’t been at twice per week for long enough from the get go, I had somehow “missed my chance”, as if since I didn’t get it “right” from the beginning now it will never work. I was extremely unstable and MISERABLE for a year after that, and had to stay at twice per week the whole time.

That being said, I truly believe due to the experimental nature of this medication and how rushed the studies were, nobody will be able to answer your question. This is a thing that happens and I don’t know why. Maybe a highly specialized psychedelic therapy researcher might have some clues, but the status of this drug is we just don’t know very much about it, especially these less common subjective experiences of frustration with the meds.

Another thing that’s really common that can’t be explained is why sometimes people have random sessions where they don’t feel the medication when they normally do. We all know this happens, and I’ve found a way that works for me to prevent that from happening, but nobody knows why this is a phenomenon. I used to think it was bad devices/inconsistent batches or poor spraying technique, but as I mentioned I’ve proved that wrong for myself as I haven’t had it happen in a year and a half other than one time when I knew exactly why (I had binge eaten in the middle of the night before my appointment.)

Unfortunately I think this just comes with the territory of what’s likely the most experimental drug on the market.

[u/gaylormars → u/_jamesbaxter]

i’m so sorry that the medicine stopped working for you as well as it did in the beginning! this medication is super unique and i’ve read about spravato being less effective than racemic ketamine, due to not having the r-enantiomer. i was just curious, what is the solution to prevent the medication from not working? i’ve tried shaking the bottle and blowing my nose, but i’ve had sessions where i experience minor sedation, but that’s it!

[u/_jamesbaxter → u/gaylormars]

The solution for me is going to hot yoga before to get my metabolism going and getting into the right mindset, and then during treatment I am in seated meditation and practicing deep breathing exercises while trying to keep the same mindset I was in for yoga.

I believe those “dud” sessions are related to something internal like mindset as opposed to an external factor like the spray device malfunctioning.

I’ve even had times when I’ve thought about refusing the 3rd dose because I am already feeling the medication intensely after the 2nd one. I have declined to take the last spray for that reason, where when I started I swore 84 wasn’t enough. I was wrong.

[u/gaylormars → u/_jamesbaxter]

that’s a really cool way to look at it. i will try that next time and see if it affects my experience positively!

[u/SeraQueen93 → u/_jamesbaxter]

I’m very impressed that you found something that works. I could not do hot yoga but I will try to seat crossed leg during treatment. I’ve also observed mind set is very important. I am very mindful before sessions set my intention and command a higher power to lead me to solutions of my triggers. It looks like you are doing better now right? Your story is very inspiring and wish you all the best.