Brrrrrr is the sound that comes out of my mouth when I look at the low for tonight.

(and I do that weird arm motion thing too, where they're crossed and my fingers are magically making me feel warm with a reverse version of jazz hands)

Still chilly here!

In certain parts of the US right now, even my usually warm, sweaty Florida, we’re feeling a whole lot of winter.

We’ve been seeing weather warnings for days about freezing temps which is not really a typical thing around here.

But it is now. And I don’t like it.

It feels dark, heavy, even a little bit hopeless. I just want to stay inside under a blanket and do nothing.

Which is totally fine for a day or 2 while it dips into the upper 30’s.

But what about for people who live like that all the time?

Treatment resistant depression can feel like a never-ending winter of hopelessness. And even with medications, there can be little relief.

But there are options!

And Reader, you can be the hope-gift-er for someone when you tell them about this new-ish medication!

Today I’m talking about Spravato, an esketamine nasal spray indicated for treatment resistant depression and acute SI.

If you don’t have the time for this quick 6 min video, here’s the bare minimum you can walk away with and still really help someone!

5 Things to know About Spravato (esketamine):

1. It’s not just another SSRI: Spravato works on the brain’s glutamate system instead of the usual serotonin pathway. This unique mechanism helps it act faster; sometimes within a few hours instead of weeks for traditional antidepressants
2. Best for the toughest cases: It’s designed for treatment-resistant depression (TRD) and major depressive disorder with acute SI and in people who haven’t responded to at least two other antidepressants.
3. It’s a nasal spray, not a pill! This isn’t your typical daily medication. It’s given under medical supervision in a certified clinic, with a two-hour observation period afterward.
4. Dissociation isn’t always a bad thing: Spravato may make us think first of dissociation, but if it happens it's not usually terrible. It's often described by patients as reflective or calming; a unique side effect that some find helpful.
5. A giant leap towards hope! For therapists, it’s an innovative option to discuss with clients stuck in depression. For patients, it can offer a new path forward when other treatments haven’t worked.
6. This isn't a tip: But it is the FDA's medication guide for Spravato in case you want to know more!

I haven't had any personal patients who've tried it, but I've had plenty of discussions about it! And being able to share another possible option for feeling better makes all of us feel warm fuzzies!

Winter doesn’t last forever, and neither should depression. If you have a client where typical SSRIs aren't cutting it, maybe Spravato is just the thing for them!

We already know all meds don't work for everyone, but here's just one more tool to bring a little hope and light back into someone's life.

Cheers to healthy brains,

Dr. B

Jessica Beachkofsky, MD

Your friendly, online psychiatrist!

P.S. Here's the video link again!​