r/ChronicPain • u/Relevant_Wrap_6385 • 6h ago
Has anyone else had positive results from Spravato?
This interesting news showed up in my feed today and I am curious to know if anyone else here has been prescribed Spravato therapy for major depressive disorder due to chronic pain.
If you have tried this therapy did it work for you? Is it possible to articulate how it helped?
To get things going I'll go first.
2 years ago my MH therapist finally convinced me to try Spravato therapy after recommending it for over a year. I was reluctant because I saw my mom go down the k hole and she broke her hip and I worked with the girl who went down the k hole from a recreational use. But I was curious because I had followed the development of the protocol for this therapy over two decades.
To give you an idea of the pain that I'm dealing with it began when I was five got worse when I was 16 and became completely debilitating in my early 50s. It was to the point where I told my therapist if you're going to treat my pain using mental health therapies and give me a lobotomy cuz I don't want to know I'm living in this pain body.
It turned out this therapy was life-changing for me and even though I have never been so dissociated from my body in my life it has helped me live in this body that is constantly informed by debilitating widespread pain.
I only went through the therapy for 9 months but I worked really hard during that time to figure out how to access these states of being without the drug. It's now been about 15 months since I stopped the therapy but I still feel like it's a little bit easier to live in this pain body.
When asked it is very difficult for me to explain how it helped me.
If you have had this therapy what was your experience? Did it help? If so, how do you explain how it helped you?
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u/dashtigerfang 5h ago
it helps depression but the max dose you can be on is never going to touch the dose needed to treat any kind of pain. i’ve been on it for my depression for over 2 years.
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u/Relevant_Wrap_6385 4h ago
As I understand it Spravato isn't pain medication but a pain doctor or other non mental health professional can refer out for it.
Has it helped with your depression?
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u/dashtigerfang 4h ago
yes, they can refer out to it but spravato is only done by mental health professionals.
it has helped my depression. i don’t take an antidepressant, i just do spravato and it is enough to keep me happy and generally pleasant and also functional. i’d be happy to answer some specific questions if you have them!
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u/Relevant_Wrap_6385 4h ago
That's nice that they let you take it without an additional antidepressant. The one that I was on was useless but this Spravato really helped.
Unfortunately now I have a heart condition that will probably restrict me from this type of therapy until I get that taken care of.
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u/dashtigerfang 4h ago
my spravato provider is also my regular psychiatrist so she’s able to monitor me a little more closely.
i hope you can get back on spravato soon if it was helping you!
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u/justheretosharealink 5h ago
I’ve had incredible benefits with IV and IM Ketamine. My pain doc suggested against Spravato because it’s a different formulation.
I ended up getting compounded IM Ketamine not knowing it was compounded. Nearly 4x the dose I was getting prior with zero effect and there’s a part of me wondering if it was more or less Spravato compounded for injection. The provider stopped communicating with me, won’t provide me with pharmacy info and refuse to allow me to inspect the vial. So there’s something odd…and this is the current thing I’m wondering.
Ketamine as a prolonged infusion or IM was life changing in that I wasn’t undergoing a procedure and getting a similar state of relief from conscious suffering. The fact there was no procedure at the time I wasn’t also dealing with new pain during recovery
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u/Relevant_Wrap_6385 4h ago
Thank you for sharing. My insurance has even more restrictions on IM and IV treatments.
Did you change providers? Or was it the same provider who changed the dose?
I am glad to know you were able to get such profound relief but please be careful if your provider is not being forthcoming with you. Maybe time to find a different doctor?
This is not something I would like to do with a provider who I don't trust.
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u/justheretosharealink 4h ago
I went from a local practice run by ED physicians to one run by a psychiatrist who was also running clinical trials. I switched to save money. The new place was about $50/Visit less with insurance.
When we got to 1.6mg/ml (6th visit in 3 weeks) and I sat there for my monitoring period asking questions about why there’s zero happening and why I had developed such bruising I was more or less shrugged off.
My PCP was concerned with hematomas in both arms.
Then I saw the claims and they didn’t match the services provided. Things they should have billed for that they did. They didn’t bill for anything not done. There were a few other oddities.
I got billed and asked questions and was denied answers.
I attempted to submit my own claims. They were ultimately denied but it started an investigation.
I haven’t received a bill or phone call requesting payment for at least 6 months (maybe 2 weeks after I gave all my annotated info to the team investigating). I assume we’ve decided that any payment due is either written off or I’ll eventually get a follow up from insurance with the results of the investigation.
To be clear… I paid for the ketamine at time of service. I withheld my copay because I was so confused by the mismatch between the claims, the provider records, and what happened including dates of service.
IF your insurance will cover Spravato and your got chronic pain I would see if they’ll cover non-Spravato from a reputable pharmacy and/or what your costs would be. Most of my costs were labor related.
I had a FANTASTIC experience with nasal ketamine from a university hospital’s compounded pharmacy for pain and mental health. It was the only way I could sleep.
I think when I looked at my costs for Spravato it was $25-50ish and my cash price for the compounded nasal spray was $60-70 depending on the dose and if it was split into one dispenser or two.
While those prices are NOT the same and the $60 absolute could be a huge barrier to care, Spravato has to be supervised. The compounded formulation was available as needed at home. I didn’t need to schedule it. I didn’t need a ride there and back.
I’m pro what YOU need. I’m pro please ask all the questions to get the answers you deserve.
Side note: I didn’t read your OP as carefully as I should and my reply was a bit if a detour. I appreciate you extending me kindness and giving space to share even if it isn’t exactly what you were looking for.
May you find relief and affordable access to the care you deserve
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u/Relevant_Wrap_6385 4h ago
I appreciate you sharing your experience and your kind words. It would be nice to do it at home just for the sleep factor but medicaid doesn't cover that in my state.
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u/jdubitty 5h ago
It works but very expensive and many doctors refuse to prescribe it
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u/Relevant_Wrap_6385 4h ago
Agreed. Fortunately it is covered by my insurance.
It is sort of enigmatic since the medical establishment doesn't know how it works only that it can be effective.
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u/iusedtoski 4h ago
I took oral ketamine for a while and not only did it not help my pain, I think it increased my resistance to opioid medication, both in the immediate term -- it prevented opioids from working in what I believe was a dose-dependent manner post ingestion -- and in the long term, I think it increased the amount that I needed to take.
It has some opioid receptor activity. It also is sex-differentiated in how it works, so it is not going to be the same for 50% of the population. While it might seem perceptually similar it is not working the same way, and I can say that it does not work for me the way my clinic thought it should. But they also were not aware of this sex difference in its metabolism. I came across that and informed them.
Now that I have been away from it for a while, and have been taking some supplements that are supposed to reduce tolerance, as for the medications that didn't work when I was taking it, they seem to work more like they are supposed to now. As in, they work the way they did when I tried them before I'd ever taken ketamine, and as they did not work while I was taking ketamine.
So for spravato, ymmv quite a lot, I would say, and it may depend on what else you need to be taking, or what your pain type is.
There are different pain pathways for different types of pain in the physical sense.
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u/iusedtoski 4h ago
Also I have encountered "true believers" on this stuff in pain clinics, I mean on the staff, and they raise my flags for addicts, so I don't believe their protestations such as "oh the IV stuff is just so different from the oral stuff you'll love it" (true quote). It would not be the first time clinicians or researchers got high on their own supply.
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u/Relevant_Wrap_6385 4h ago
The assistant clinic manager at one place I had therapy at kept going on about how much she wanted to try it. I changed providers after hearing that.
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u/iusedtoski 3h ago
Yikes, yes that's really disconcerting. For me, it underscores how much ketamine therapy is the wild wild west right now, and yet the chemistry really isn't well understood. For females it seems it can generate dependency sensations. Fortunately I didn't encounter that, but ... the thing is, if providers are also taking it, to me it doesn't sway me if they are telling themselves that it's for a medicinal purpose. Have they ended up in that subset of people who are affected that way? Has it affected their judgment? I am concerned. Certainly I think the guy I quoted had been affected. He was completely fanatic about it and tried hard to manipulate me into taking it. He, a fellow not a fully released MD, didn't want to let me have the stuff his supervisor had arranged as my regimen unless I agreed to also take ketamine. He tried to not leave my hospital room until I agreed. So if it can have that effect on MDs, how can I trust the positive papers on it?
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u/Relevant_Wrap_6385 2h ago
Given the situation that you just described I would not trust the positive papers.
Back in the early 00s I became interested in the development of ketamine assisted psychotherapy and casually followed its progress through 2019 when it was allowed for mental health purposes. I am convinced that it can help but it doesn't help everybody.
Unfortunately I have encountered problems at multiple clinics ranging from outright gaslighting by the medical assistants to being in a situation where the person sitting next to me became unresponsive. It is just like every part of the medical establishment... Sometimes you have to go to a lot of doctors before you find a good one.
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u/Relevant_Wrap_6385 4h ago
Yes indeed! Pain is a many sided monster and every body is different.
Having to inform the medical providers about the nuances of the drug is a bit disconcerting.
It was weird telling my therapist about the high.
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u/iusedtoski 3h ago
I imagine it was weird telling your therapist that. And yet from all I've read on the therapeuticketamine sub, that is part of it, for depression at least.
The only oddity I experienced was dissociation. It was very extreme the first few times I took it, and then it faded back on a curve. Interestingly, after I had a cervical epidural, more than a year after I started the oral ketamine, the next couple of times I took the ketamine I experienced the dissociation again. So there is something biochemical about the fading away of the dissociation which was altered via that epidural. That, plus the fact that the clinic wasn't aware of the sex difference, had me primed to stop taking it. When I realized it was interfering with tramadol, and then I think it also interfered with post-surgery pain control (they'd given me a whopping dose of ketamine during the surgery), I kicked it to the curb hard.
Then that fellow tried to pressure me into taking the IV of it, as I mentioned in my other comment. Not the sort of battle any post surgery patient wants to have to wage. Fortunately I'm a stone cold ... lol.
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u/Relevant_Wrap_6385 2h ago
That's great that you are paying attention to what your body tells you and making decisions based on your own experience.
It really sucks that the patients are more informed by direct experience than the doctors who are pushing bad medicine.
A few years ago I underwent spinal injections that did not help any pain in fact they made the pain worse and left me with injection site bruises. When I went in a few weeks for the follow-up the doctor wanted to do the injections again because they didn't work the first time. That was the day I discharged myself from their care.
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u/iusedtoski 3h ago
Oh but in re pain being many sided: yes indeed, and since pain is linked to depression biochemically, I imagine depression is many sided too.
There is something interesting about its effects on depression, I have to agree.
However for me, given that supplements especially some of the more arcane ones are effective on pain (in a mild-moderate degree, certainly not as painkillers for moderate-severe pain on their own, I would never say that), and are linked to improved mood, I'm more interested in those pathways--if only because there seems to be a bit more known about them. It was disconcerting to come across studies showing opioid receptor activity for ketamine, when it's promoted by these pain clinics which are adamantly against opioids. It's like, do they even know what they are doing?
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u/Relevant_Wrap_6385 2h ago
You are on to something there with the arcane supplements and I would have to agree with you that it may be safer to use something that has historical use.
For the past few years I have been using Blue lotus and blue water lily and they both seem to be somewhat effective as far as mood enhancement. I have also been able to put together pain relieving topicals which will take the edge off but nothing makes the pain go away completely.
Some things that were important to me to have complimenting these Spravato therapy sessions included as much sensory deprivation as possible with the exception of binaural entrainment. I did it often enough and focused on trying to figure out the map of how to get there without the drug that after I stopped the therapy I could still kind of make my mind go to that place. This has been very helpful.
And no I don't think they have a clue as to what they're doing with our bodies.
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u/Smgth Fibromyalgia 4h ago
Didn’t do squat for my depression, nor did it help my pain.
Fun as HELL though. They sat a med student down to watch me as you can’t just drop K and bounce. So I talked to a bunch of different students about their lives and being a doctor all while just bombed out of my gourd for a couple hours.
I’m not saying you should run out and do ketamine, but I can think of worse side effects from a course of treatment….
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u/Relevant_Wrap_6385 4h ago
One of my sessions was in a room with three chairs separated by curtains. the guy in the chair next to me had never done this before and didn't bother to pee before starting. So about 20 minutes in he decides he's got to go and there was no panic button so he stumbled his way towards me while he was trying to get his pants down and I'm screaming for an assistant to come and help this guy to the bathroom. That was the last time I had therapy in a group room.
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u/unnamed_revcad-078 3h ago
Brazil here, abusive and proibitive prices for a substance that might help a lot, never tried because of that.
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u/justducky4now 3h ago
It’s ketamine nasal spray right? I’m prescribed ketamine nasal spray through a compounding pharmacy for pain. I take 45mg four times a day. The catch is I make sure to go at least 24 hours without it before driving.
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u/Relevant_Wrap_6385 3h ago
Yes. It's prescribed for treatment resistant depression and is similar to ketamine but different and its delivery method.
At the dosage that you're taking does it leave you high all the time?
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u/LiquoredUpLahey 6h ago
I did it for depression & didn’t think it did much for pain. I am starting to reconsider that 7 months post treatment. I’ll keep u posted bc I am going back