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Intranasal esketamine is a safe and effective treatment for Treatment-Resistant Depression (TRD).  Spravato is approved by the US-FDA for the treatment of patients with Major Depressive Disorder who have not responded or are intolerant of two antidepressant treatments.  Health professionals provide intranasal esketamine treatment at the UNC Outpatient Clinic at Vilcom Center, located on Weaver-Dairy Road in Chapel Hill, NC.  Patients referred by their primary prescriber will undergo psychiatric and medical evaluation in person or virtually, and insurance benefits or method of payment verified.  Patient’s level of depression is assessed before and after every treatment.  Patients are trained to self-administer esketamine with using the intranasal inhaler.  Patients place the esketamine inhaler in their right and left nostril, compress the bottom of the inhaler, and inhale the medication.  Doses are self-administered at five-minute intervals.  Depending on the necessary dose, patients will use either two or three inhalers during a session.  In addition to rapid reduction in depressive symptoms and suicidal thoughts, patients experience altered consciousness, primarily dissociation and sedation.  Patients are carefully monitored for medical side effects including increased blood pressure, heart rate and nausea.  The effects of esketamine emerge 5-10 minutes after administration of the first inhaler, reach a peak 15-45 minutes and then decrease during 45-minutes to 2 hours.  Patients will remain in clinic for 2 hours and may not drive for 24-hours after treatment due to cognitive side effects.  Intranasal esketamine is administered under the SPRAVATO REMS program as required by the FDA and the manufacturer Janssen Pharmaceuticals.  The sessions are repeated twice weekly for 4 weeks, then once weekly for the next 4 weeks, and as needed thereafter.  This schedule may change depending on a patient’s response.  Patients are screened before treatments to ensure safety from COVID-19.  Patients receive surgical masks. Patients can pull the mask down over their nose during self-administration but otherwise will need to wear the mask in order to cover their nose and mouth.

 

Esketamine-New-Patient-information

Esketamine Internal referral

Esketamine External referral

Janssen Patient Assistance: https://www.janssenprescriptionassistance.com/spravato-cost-assistance

Janssen Application: https://www.janssencarepath.com/sites/www.janssencarepath.com/files/spravato-savings-program-registration-form.pdf?v=5476

Referrals for esketamine therapy can be made by contacting: Sonya.bynum@unchealth.unc.edu or 984-974-3983 or Crystal Rogan at 919-445-0750″.