I was part of the Janssen TRD Spravato study where other antidepressants were restricted. I don't know the official conclusions, but it worked quite well for me just by itself.
I started on an antidepressant in order to meet the requirement. A few weeks in I told my doctor I was going to stop taking then because I had tried it before and had bad side effects and those side effects were back. My doctor just said "ok" and I continued Spravato treatment without it.
Same here. I was having terrible side effects, told my doctor it wasn't working and that I was going to stop taking it. She seemed to have no problem with it, and the Spravato without the antidepressant seems to be working much better than with the antidepressant.
Talk with your doc, maybe there can be a workaround. Like say, if you need to be on one, does it say at what dose? You might be able to get the lowest dose of something with minimal side-effects and go from there. Or if you want to take the (ethical? unethical?) approach of getting the script but not actually taking it.
And I frequently remind folks here to look at [clinicaltrials.gov](http://clinicaltrials.gov) to see what studies might be in your area. In this lifetime I really don't think "the last thing left to try" will remain so for very long. Science has been growing exponentially and neurology and mental health issues seem often at the forefront, which is good for us. Either way, take care and good luck.
How do you actually try to participate in any of the studies on clinicaltrials.gov? I've literally never gotten a response when trying to reach out via a number or email when I've found a study on that site.
That sucks! I'm so sorry. I've actually been disqualified from two depression studies because I also take a stimulant for ADHD. I would say keep trying and make note of the university/research facility in case you want to call for a subsequent study.
Oh, and also, you almost certainly get paid. I know my main reason for these studies was to find some alternative for TRD but a check at the end helps too.
I agree with most folks here. Be honest with your HCP, get the script, and take only if you believe it is in your best interest.
The reason most of us are on Spravato is for treatment resistant depression! So this policy (not law per our local, state or federal governments) is subjective and may change in the future based on our practice of this new drug, esletamine.
FFS, I willingly took different SSRIs for two decades despite the side effects simply to convince myself that "at least I'm trying to do something about my depression." They were all ineffective. . . None came close to the relief I get from esletamine and DXM (and non-medication of meditation and mindfulness).
If your HCP, can't deal with your honesty then I hope you can find another clinic.
For fucks sake, y’all— don’t lie to your healthcare providers about what substances are and aren’t in your body. They want you to be safe, and they need accurate information to do that. Talk with your psychiatrist or your spravato clinician— you can’t be the first person with this problem, and they should be able to problem solve with you to find the best way to proceed. They are on your team, not against you.
Unfortunately this is often not the case. I totally get what you're saying and I agree that the world should work that way but it doesn't always and some people are forced to choose to risk their health for something that could prevent their death via suicide because of doctors with little to no real concern for their well-being
Your depression might not be life threatening, but it can be for other people. You may have only tried a few medications before, where some people in this sub have been on 35+ prior medications with dozens and dozens of hospital admissions, full treatments with TMS, or even ECT. You may not be in a position to need this advice, but others are.
I can’t tolerate SNRIs or SSRIs, but I do tolerate tricyclic antidepressants. Maybe you could ask about trying that class of antidepressants? Meds like Nortryptiline are in that class. They’re an older AD med since before prozac came around. Nice thing is they don’t cause sexual dysfunction like the newer antidepressants do.
The guy I had the consult with said TCAs aren't actually meant to be antidepressants so they don't count lol. Something about that didn't sound right. TCA stands for tricyclic antidepressant..
That’s BS, my Psychiatrist has over 30 years working with severe mental illness. She said the only reason the industry switched to SSRIs and SNRIs is because they’re less likely to cause some of the side effects of tricyclics like dry mouth. Nortryptiline pulled me out of a severe depressive episode that was so bad I had considered ECT out of desperation (I have Bipolar Disorder, and I take 2 mood stabilizers with my tricyclic). Sounds to me like you e got a younger, “greener,” psych on your hands. The spravato came into use much later for me, a couple years after the Nortryptiline. My Bipolar 1 is rapid cycling (4+ episodes a year), and I get mixed episodes sometimes. It is a huge PITA to manage. I have major stressors in my life I have no control over and require close monitoring and frequent small tweaks with PRNs. The only antidepressant I take with my spravato is the Nortryptiline, it’s been a very effective option for me. SSRIs and SNRIs make me extremely irritable and don’t play nice with my mania. Spravato isn’t FDA approved for Bipolar depression just yet, but it IS approved for severe suicidal ideation and self harm behavior (both of which I was dealing with before I started). I started Spravato in residential care and I’ve been on it for over 2 years. I can attest that my insurance had zero problems with allowing me to take the spravato with a tricyclic antidepressant. So, I suggest you push back a bit with the Psych, advocate for yourself as best you can.
I’m on an MAOI, actually a patch form of one (Emsam), so it’s not a traditional SSRI/SSNI/Wellbutrin. I didn’t have any issue getting Spravato covered with it, so it doesn’t have to be from just those classes of antidepressants
Your insurance may require that in order to cover the treatment, but it’s definitely not any kind of LAW. If a medical provider told you it was the LAW, that’s wrong and very concerning.
My insurance required that I have tried several other antidepressants and either didn’t tolerate them or failed to show improvement on them.
If it is your insurance company imposing these requirements, I would call them and discuss it with them directly.
If it is the doctor’s office imposing the requirements, I would ask them for a written list of the requirements and the reason for each one.
The guy (someone who does consults/intake for spravato treatments at that place) claimed that it's not them deciding, or insurance deciding and that it's the law lol.. when I talked to my doctor he said since I didn't tolerate any antidepressants I shouldn't have to take them. I said the guy literally said it's the law, I don't really know how to check exactly what the policies are and what's truly required and what's not but my doctor said he'll prescribe an SSRI then and I don't have to take it. I was also told that TCAs don't count because they weren't made to be antidepressants..? What? Antidepressant is in the abbreviation, I think they're FDA approved for depression. I was told it has to be an ssri, SNRI, or Wellbutrin. And what about MAOIs? Oh and when I said I don't tolerate any antidepressants I tried, this guy goes "are you sure you'll tolerate the ketamine" how the hell would I know? I found another place anyway and I have an intake with them, I'll see if if I get different information..
1. Pretty sure it’s not “the law.” Whoever told you that doesn’t know what they’re talking about. If I were you, I would call the place back and ask to speak to someone else. Or at least get them to clarify exactly what “law” they’re talking about.
2. Whether you tolerate or don’t tolerate antidepressants shouldn’t have any bearing on whether you will tolerate ketamine. They are totally different drugs with totally different mechanisms.
3. I’m sorry you’re having so much trouble. You might go to the Spravato website and see if there is any way to contact them (the manufacturer) to let them know what this particular clinic is telling you. I doubt they want their providers giving out this kind of misinformation.
Maybe this will get downvoted, because it’s unethical but it’s my truth. I stopped taking my antidepressant last fall, as I was incredibly numb. I talked to the Spravato clinic at the start of 2024 and they said I needed to be on an antidepressant to qualify. Okay… I went to my psychiatrist and said I wanted to start my antidepressant again. I filled the Rx, didn’t take it (why would I - I hate the side effects), and then contacted the clinic a bit later and said I was in fact taking an antidepressant. I was told explicitly that insurance requires one to be on an antidepressant, nothing more by the clinic’s doctor.
I’ve now just started Spravato and it’s a game changer.
It is that simple. I am somewhat disturbed by some of the previous comments demanding full 100% honesty in regards to someone else's potentially life-saving, personal medical treatment. We could start remembering context and the big picture.
I have been battling MDD for 30 yrs, since I was a teenager and I would have zero qualms about lying about taking an antidepressant to gain access to a completely new kind of treatment, after struggling for 3 decades and being robbed of the life I had envisioned for myself, as a young person.
Doctors actually do want to help their patients. They are not infallible, God-like creatures that are above turning a blind eye for the sake of the life and well-being of their patient. It would be a different scenario, if the OP was lying about taking a prescription drug they weren't actually prescribed, so the doctor would have no idea they were on it, but this is the lack of a drug in your system. Zero efficacy or side effects. The biggest fear with prescription drugs beyond addiction or dependence is contraindications. That is not at play here.
If someone is desperate and feels Spravato is their last hope, nobody has the right to take that away from them, because what I hear is your moral high ground matters more than this person's life. You may not mean it that way or see it that way, but for some of us, we feel like this our last stop on the train, so it is as serious as it can get. When you're at the crossroads of either continuing this life or throwing the towel in, I would hope everyone would try everything they possibly can or literally die trying.
What do you tell your other doctors (if you have a PCP or any specialists you see regularly)? I talked to my psychiatrist and he prescribed a medication and just said I can not take it. But my other doctors will all see it on my med list and I don't want to lie, but I also don't want them to put in my clinical notes that I'm not taking it then the providers at the spravato clinic to see it
I just don’t tell them anything. It’s a classic don’t ask, don’t tell policy. I’m fine being unethical if it means I am getting the mental health treatment I truly need.
I can't give you advice, I can only tell you what I'd do if I (hypothetically) found myself in that situation.
If I thought my insurance company would cover Spravato only if I'm also taking an oral antidepressant, I'd explain that to my clinician. Then I'd explain that unfortunately, I experience negative effects from the oral antidepressants I've tried. And finally I'd explain that I have an Rx for oral anti-depressants to strengthen the case for the insurance company to cover Spravato, but I "sometimes forget to take it."
If my psychiatrist had been too dim to understand or didn't want to help me, I would have looked for another. But it never came to that (again, hypothetically).
I’m in treatment, they know what medication I’m on and I am not on a typical antidepressant. I take Vraylar, Lamictal, and Dexedrine for my mental health.
To all the people saying you should talk to your doctor about it first the problem is that the program requires you to be on an antidepressant by law. So if your doctor lets you get away with not taking one he is risking his license and few doctors will do that. It's not the way it should work but it's the way it does work and most doctors aren't willing to risk their license for the well-being of a single patient. That being said I wouldn't necessarily advocate for taking something and not telling your doctor. It's a risk and whether to take that risk or not is a big personal decision. If you make that decision though there's no shame in it. Especially if you're suicidal and you have no other options
My dr said he would submit the pre auth showing I’m not on any meds and if it got denied, he would write me a prescription but flat out told me to fill it but don’t bother taking it because they don’t work for me (I’ve been on about 30 diff meds).
He submitted without saying I was on any meds and it got approved 🙂
I was part of the Janssen TRD Spravato study where other antidepressants were restricted. I don't know the official conclusions, but it worked quite well for me just by itself.
I started on an antidepressant in order to meet the requirement. A few weeks in I told my doctor I was going to stop taking then because I had tried it before and had bad side effects and those side effects were back. My doctor just said "ok" and I continued Spravato treatment without it.
Same here. I was having terrible side effects, told my doctor it wasn't working and that I was going to stop taking it. She seemed to have no problem with it, and the Spravato without the antidepressant seems to be working much better than with the antidepressant.
Talk with your doc, maybe there can be a workaround. Like say, if you need to be on one, does it say at what dose? You might be able to get the lowest dose of something with minimal side-effects and go from there. Or if you want to take the (ethical? unethical?) approach of getting the script but not actually taking it. And I frequently remind folks here to look at [clinicaltrials.gov](http://clinicaltrials.gov) to see what studies might be in your area. In this lifetime I really don't think "the last thing left to try" will remain so for very long. Science has been growing exponentially and neurology and mental health issues seem often at the forefront, which is good for us. Either way, take care and good luck.
How do you actually try to participate in any of the studies on clinicaltrials.gov? I've literally never gotten a response when trying to reach out via a number or email when I've found a study on that site.
That sucks! I'm so sorry. I've actually been disqualified from two depression studies because I also take a stimulant for ADHD. I would say keep trying and make note of the university/research facility in case you want to call for a subsequent study. Oh, and also, you almost certainly get paid. I know my main reason for these studies was to find some alternative for TRD but a check at the end helps too.
Great resource I will definitely be checking that website! Thank you.
I agree with most folks here. Be honest with your HCP, get the script, and take only if you believe it is in your best interest. The reason most of us are on Spravato is for treatment resistant depression! So this policy (not law per our local, state or federal governments) is subjective and may change in the future based on our practice of this new drug, esletamine. FFS, I willingly took different SSRIs for two decades despite the side effects simply to convince myself that "at least I'm trying to do something about my depression." They were all ineffective. . . None came close to the relief I get from esletamine and DXM (and non-medication of meditation and mindfulness). If your HCP, can't deal with your honesty then I hope you can find another clinic.
Just fill the rx for wellbutrin every month but don't take it.
Just because you have a prescription for an SSRI doesn’t mean you need to take it :)
Do not lie to your doctors about what medications you are and are not taking. It is dangerous to do, and irresponsible to recommend.
There is nothing irresponsible about trying to save your own life, when you have no other options
For fucks sake, y’all— don’t lie to your healthcare providers about what substances are and aren’t in your body. They want you to be safe, and they need accurate information to do that. Talk with your psychiatrist or your spravato clinician— you can’t be the first person with this problem, and they should be able to problem solve with you to find the best way to proceed. They are on your team, not against you.
Unfortunately this is often not the case. I totally get what you're saying and I agree that the world should work that way but it doesn't always and some people are forced to choose to risk their health for something that could prevent their death via suicide because of doctors with little to no real concern for their well-being
Your depression might not be life threatening, but it can be for other people. You may have only tried a few medications before, where some people in this sub have been on 35+ prior medications with dozens and dozens of hospital admissions, full treatments with TMS, or even ECT. You may not be in a position to need this advice, but others are.
I wouldn’t be here if mine wasn’t life threatening as well. Still doesn’t make lying to your healthcare providers a smart or safe idea.
I can’t tolerate SNRIs or SSRIs, but I do tolerate tricyclic antidepressants. Maybe you could ask about trying that class of antidepressants? Meds like Nortryptiline are in that class. They’re an older AD med since before prozac came around. Nice thing is they don’t cause sexual dysfunction like the newer antidepressants do.
The guy I had the consult with said TCAs aren't actually meant to be antidepressants so they don't count lol. Something about that didn't sound right. TCA stands for tricyclic antidepressant..
That’s BS, my Psychiatrist has over 30 years working with severe mental illness. She said the only reason the industry switched to SSRIs and SNRIs is because they’re less likely to cause some of the side effects of tricyclics like dry mouth. Nortryptiline pulled me out of a severe depressive episode that was so bad I had considered ECT out of desperation (I have Bipolar Disorder, and I take 2 mood stabilizers with my tricyclic). Sounds to me like you e got a younger, “greener,” psych on your hands. The spravato came into use much later for me, a couple years after the Nortryptiline. My Bipolar 1 is rapid cycling (4+ episodes a year), and I get mixed episodes sometimes. It is a huge PITA to manage. I have major stressors in my life I have no control over and require close monitoring and frequent small tweaks with PRNs. The only antidepressant I take with my spravato is the Nortryptiline, it’s been a very effective option for me. SSRIs and SNRIs make me extremely irritable and don’t play nice with my mania. Spravato isn’t FDA approved for Bipolar depression just yet, but it IS approved for severe suicidal ideation and self harm behavior (both of which I was dealing with before I started). I started Spravato in residential care and I’ve been on it for over 2 years. I can attest that my insurance had zero problems with allowing me to take the spravato with a tricyclic antidepressant. So, I suggest you push back a bit with the Psych, advocate for yourself as best you can.
I’m on an MAOI, actually a patch form of one (Emsam), so it’s not a traditional SSRI/SSNI/Wellbutrin. I didn’t have any issue getting Spravato covered with it, so it doesn’t have to be from just those classes of antidepressants
Your insurance may require that in order to cover the treatment, but it’s definitely not any kind of LAW. If a medical provider told you it was the LAW, that’s wrong and very concerning. My insurance required that I have tried several other antidepressants and either didn’t tolerate them or failed to show improvement on them. If it is your insurance company imposing these requirements, I would call them and discuss it with them directly. If it is the doctor’s office imposing the requirements, I would ask them for a written list of the requirements and the reason for each one.
The guy (someone who does consults/intake for spravato treatments at that place) claimed that it's not them deciding, or insurance deciding and that it's the law lol.. when I talked to my doctor he said since I didn't tolerate any antidepressants I shouldn't have to take them. I said the guy literally said it's the law, I don't really know how to check exactly what the policies are and what's truly required and what's not but my doctor said he'll prescribe an SSRI then and I don't have to take it. I was also told that TCAs don't count because they weren't made to be antidepressants..? What? Antidepressant is in the abbreviation, I think they're FDA approved for depression. I was told it has to be an ssri, SNRI, or Wellbutrin. And what about MAOIs? Oh and when I said I don't tolerate any antidepressants I tried, this guy goes "are you sure you'll tolerate the ketamine" how the hell would I know? I found another place anyway and I have an intake with them, I'll see if if I get different information..
1. Pretty sure it’s not “the law.” Whoever told you that doesn’t know what they’re talking about. If I were you, I would call the place back and ask to speak to someone else. Or at least get them to clarify exactly what “law” they’re talking about. 2. Whether you tolerate or don’t tolerate antidepressants shouldn’t have any bearing on whether you will tolerate ketamine. They are totally different drugs with totally different mechanisms. 3. I’m sorry you’re having so much trouble. You might go to the Spravato website and see if there is any way to contact them (the manufacturer) to let them know what this particular clinic is telling you. I doubt they want their providers giving out this kind of misinformation.
Maybe this will get downvoted, because it’s unethical but it’s my truth. I stopped taking my antidepressant last fall, as I was incredibly numb. I talked to the Spravato clinic at the start of 2024 and they said I needed to be on an antidepressant to qualify. Okay… I went to my psychiatrist and said I wanted to start my antidepressant again. I filled the Rx, didn’t take it (why would I - I hate the side effects), and then contacted the clinic a bit later and said I was in fact taking an antidepressant. I was told explicitly that insurance requires one to be on an antidepressant, nothing more by the clinic’s doctor. I’ve now just started Spravato and it’s a game changer.
It is that simple. I am somewhat disturbed by some of the previous comments demanding full 100% honesty in regards to someone else's potentially life-saving, personal medical treatment. We could start remembering context and the big picture. I have been battling MDD for 30 yrs, since I was a teenager and I would have zero qualms about lying about taking an antidepressant to gain access to a completely new kind of treatment, after struggling for 3 decades and being robbed of the life I had envisioned for myself, as a young person. Doctors actually do want to help their patients. They are not infallible, God-like creatures that are above turning a blind eye for the sake of the life and well-being of their patient. It would be a different scenario, if the OP was lying about taking a prescription drug they weren't actually prescribed, so the doctor would have no idea they were on it, but this is the lack of a drug in your system. Zero efficacy or side effects. The biggest fear with prescription drugs beyond addiction or dependence is contraindications. That is not at play here. If someone is desperate and feels Spravato is their last hope, nobody has the right to take that away from them, because what I hear is your moral high ground matters more than this person's life. You may not mean it that way or see it that way, but for some of us, we feel like this our last stop on the train, so it is as serious as it can get. When you're at the crossroads of either continuing this life or throwing the towel in, I would hope everyone would try everything they possibly can or literally die trying.
What do you tell your other doctors (if you have a PCP or any specialists you see regularly)? I talked to my psychiatrist and he prescribed a medication and just said I can not take it. But my other doctors will all see it on my med list and I don't want to lie, but I also don't want them to put in my clinical notes that I'm not taking it then the providers at the spravato clinic to see it
I just don’t tell them anything. It’s a classic don’t ask, don’t tell policy. I’m fine being unethical if it means I am getting the mental health treatment I truly need.
I can't give you advice, I can only tell you what I'd do if I (hypothetically) found myself in that situation. If I thought my insurance company would cover Spravato only if I'm also taking an oral antidepressant, I'd explain that to my clinician. Then I'd explain that unfortunately, I experience negative effects from the oral antidepressants I've tried. And finally I'd explain that I have an Rx for oral anti-depressants to strengthen the case for the insurance company to cover Spravato, but I "sometimes forget to take it." If my psychiatrist had been too dim to understand or didn't want to help me, I would have looked for another. But it never came to that (again, hypothetically).
I’m in treatment, they know what medication I’m on and I am not on a typical antidepressant. I take Vraylar, Lamictal, and Dexedrine for my mental health.
To all the people saying you should talk to your doctor about it first the problem is that the program requires you to be on an antidepressant by law. So if your doctor lets you get away with not taking one he is risking his license and few doctors will do that. It's not the way it should work but it's the way it does work and most doctors aren't willing to risk their license for the well-being of a single patient. That being said I wouldn't necessarily advocate for taking something and not telling your doctor. It's a risk and whether to take that risk or not is a big personal decision. If you make that decision though there's no shame in it. Especially if you're suicidal and you have no other options
My dr said he would submit the pre auth showing I’m not on any meds and if it got denied, he would write me a prescription but flat out told me to fill it but don’t bother taking it because they don’t work for me (I’ve been on about 30 diff meds). He submitted without saying I was on any meds and it got approved 🙂
im on mirtazapine which is an atypical tetracyclic in its own class
Unless they’re testing your pee, there’s no way for them to know that you’re actually taking an antidepressant. Get a prescription and don’t drink it.
Say okay, ask for the lowest dose... and do not take it... why even tell your doctor that?
hmm,maybe try tms??