When antidepressants aren’t enough, there is hope.
Middletown Counseling Services is a certified SPRAVATO® (esketamine nasal spray) treatment center, offering an FDA-approved option for eligible adults with treatment-resistant depression.
What is treatment-resistant depression?
Treatment-resistant depression (TRD) generally means major depressive disorder that has not responded adequately to at least two antidepressants taken at appropriate doses and for long enough. Sadness, loss of interest, fatigue and trouble concentrating can persist despite ongoing treatment. It is frustrating and discouraging, and it is more common than most people realize.
What is SPRAVATO®?
SPRAVATO® (esketamine) is an FDA-approved prescription nasal spray for adults with treatment-resistant depression. Unlike traditional antidepressants, it works primarily through the brain’s glutamate system, offering a different approach to treating depression. You take it yourself in our office, under direct medical supervision.
What to expect
From your first conversation to ongoing care, you will know what each step looks like.
Consultation
We review your treatment history, symptoms and medical conditions to see whether SPRAVATO® may be appropriate for you.
Your plan
We build an individualized treatment plan and enroll you in the SPRAVATO® REMS safety program, which is required for every patient.
Treatment day
You take the nasal spray yourself with a provider present, then rest comfortably in our SPRAVATO® Suite while we monitor you for at least two hours.
Ongoing care
Treatments are typically twice a week for the first four weeks, weekly for the next four, then weekly or every other week, with close follow-up throughout.
Preparing for a treatment day
- Arrange a ride home. You cannot drive or operate machinery until the next day, after a restful night’s sleep.
- Avoid food for two hours and liquids for 30 minutes before treatment, since some people feel nauseated.
- Plan to be with us for a little over two hours. Bring headphones, a book or whatever helps you relax.
- Tell us about every medicine you take, including nasal sprays, before each visit.
A quiet, private SPRAVATO® Suite
Treatment takes place in a dedicated room in our 100-year-old Middletown home, designed to feel calm and comfortable rather than clinical.
Martin Schwarting, PMHNP-BC
Effective mental health treatment takes more than prescribing medication. Martin’s approach emphasizes a thorough psychiatric evaluation, an individualized treatment plan, close follow-up and collaboration with our licensed therapists.
With psychiatric medication management, psychotherapy and SPRAVATO® treatment under one roof, your care stays coordinated and tailored to you.
Is SPRAVATO® right for you?
It may be worth a conversation if you:
- Are an adult living with major depressive disorder
- Have tried two or more antidepressants without adequate relief
- Can come to our office for treatment and arrange a ride home
Not everyone is a candidate. Our psychiatric provider will carefully review your history and needs to determine whether this treatment is appropriate.
Schedule a consultationCommon questions
You’re never alone. We’re here for you.
Call to schedule a consultation and learn whether SPRAVATO® may be right for you.
Important Safety Information for SPRAVATO®
What is SPRAVATO®? SPRAVATO® (esketamine) CIII nasal spray is a prescription medicine used to treat adults with treatment-resistant depression (TRD), and, along with an antidepressant taken by mouth, depressive symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or actions. It is not for use as an anesthetic, and it is not known whether it is safe and effective in children.
SPRAVATO® can cause serious side effects, including:
- Sedation and dissociation (feeling sleepy, or disconnected from yourself, your thoughts, space and time)
- Breathing problems (respiratory depression)
- Abuse and misuse, and physical or psychological dependence
- Increased risk of suicidal thoughts and actions in some people aged 24 and younger taking antidepressant medicines
Because of these risks, SPRAVATO® is available only through the SPRAVATO® REMS program at certified treatment centers, and a healthcare provider must monitor you for at least two hours after each dose.
Do not take SPRAVATO® if you have blood vessel disease (aneurysmal vascular disease), an abnormal connection between veins and arteries (arteriovenous malformation), a history of bleeding in the brain, or an allergy to esketamine or ketamine.
Other possible effects include increased blood pressure, problems thinking clearly and bladder problems. Do not drive or operate machinery until the next day after a restful sleep. Tell your provider if you are pregnant, planning to become pregnant or breastfeeding.
The most common side effects include dissociation, dizziness, nausea, sedation, a spinning sensation, numbness, anxiety, lack of energy, increased blood pressure, vomiting and feeling drunk.
This is a summary and does not include all safety information. Please see the full Prescribing Information, including Boxed WARNINGS, and Medication Guide at spravato.com, and talk with your provider. You may report side effects to the FDA at 1-800-FDA-1088.