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5 Ways Spravato® is Different Than SSRIs

5 Ways Spravato® is Different Than Most Depression Medications

5 Ways Spravato® is Different Than SSRIs

Spravato® is a version of ketamine administered as a nasal spray. It is used to treat a type of depression called treatment-resistant depression. Treatment-resistant depression is a type of depression that is not improved by other medications. Spravato® is different from SSRIs, which are commonly prescribed for depression, in a few ways:


1. How it works:

Spravato® affects a different part of the brain called the glutamate system, and blocks certain receptors to help improve depression symptoms. Whereas SSRIs work by inhibiting the reuptake of serotonin changing the levels of this chemical in the brain.


The glutamate system and the SSRI system are different in terms of their role in the brain and how they affect depression. In simpler terms the glutamate system and the SSRI system are like two different teams in the brain that work in separate ways to help with depression. 


Glutamate plays a role in regulating mood. Glutamate is the most abundant neurotransmitter in the brain and is involved in various brain functions, including mood regulation, cognition, and learning. It acts as an excitatory neurotransmitter, meaning it helps facilitate the communication between nerve cells.On the other hand, the SSRI system focuses on a different brain chemical called serotonin. Serotonin is a neurotransmitter that also plays a role in regulating mood. SSRIs, which stands for selective serotonin reuptake inhibitors, work by increasing the levels of serotonin in the brain. By preventing the reuptake of serotonin, SSRIs help to keep more of it available in the brain, which can improve mood and relieve depression symptoms.


Both systems have different ways of addressing depression, and medications like Spravato and SSRIs target these systems to help people with depression feel better.


2. How you take it:

Spravato® comes as a nasal spray that you use in your nose making the absorption very quick. SSRIs usually come as pills that you swallow.


The nasal spray does of Spravato® are administered after you’re seen by clinic or center staff, and a psychiatrist. From there the effect of the medication will start to set in, and the psychiatrist and medical staff will monitory and support the patient during the appointment which typically lasts 2 hours. Those taking Spravato® should have a ride home after their appointment, and have a restful sleep before driving.


3. When it’s used:

Spravato is used when other medicines, like SSRIs, haven’t worked for depression. SSRIs are often the first choice for treating depression.


Diagnosing treatment-resistant depression involves a full evaluation. Initially, depression is diagnosed based on symptoms and criteria, and some people find successful reduction of symptoms with medication, therapy, or both.  However for some, these first-line treatments don’t work. For those individuals, a psychiatrist will assess treatment history, including the types of medications, other interventions, and side effect. From there they may recommend a different type of treatment, like ketamine or Spravato®. 


4. How quickly it works:

Spravato® has rapid benefit with some patients experiencing improvement within hours or days. SSRIs usually require several weeks of continuous use for symptom relief.


The method of taking Spravato®, as a nasal spray, is one reason why patients’ feel effects rapidly. However, quicker symptom relief is also related to the way in which Spravato® connects with the brain. Researchers are also studying the ways in which Spravato® improves neuroplasticity, or the brain’s ability to change, which can accelerate the relief the symptoms of depression especially when offered in combination with therapy. 


5. Where it’s taken:

Spravato® is given in a clinic or center with mental health care experts on hand for you. In contrast, SSRIs can be taken at home  as a daily pill. 


Many patients find the presence of their mental health professionals very comforting. Since Spravato® is a version of ketamine some people may be hesitant to participate in treatment out concern about the psychedelic-like effects of the medication. However, the dosage and care of each patient is closely monitored by psychiatrists, nurses, and medical assistants who are familiar with Spravato® treatment enhancing both safety and efficacy. 


It’s important to know that Spravato has risks and side effects, so it should only be used with a doctor’s guidance. If you have questions about depression treatments, it’s best to talk to a doctor who can give you personalized advice based on your situation.

Connect with care, today!


Welcome Dr. Aneel Ursani, MD

Heading Welcomes Dr. Aneel Ursani, MD

Heading Welcomes Dr. Aneel Ursani, MD

Dr. Aneel Ursani has joined Heading as Chief Medical Officer. With his years of leadership and entrepreneurial experience Dr. Ursani brings drive for innovative medicine and a belief that nimble, mission-driven businesses will lead the way for better patient outcomes and a healthier mental outlook. 



In connecting with Dr. Ursani about this new position he shared his insights and excitement about the new role and what he hopes to accomplish both for Heading and how his plans for Heading align with his vision for improved psychiatric medicine.


Why did you choose Psychiatry?

I chose Psychiatry for many reasons, but I was drawn to it in medical school because of how different it was from the rest. Rarely in other specialties do you have the privilege of personally getting to know your patients at such a deep level. Patients share things they wouldn’t share with anyone else. You often see them in their hardest moments and can play a pivotal role in their recovery.


How does Psychiatric Medicine continue to inspire you?

The approach to treatment is comprehensive and every case is personalized. Solutions are not solely pharmacological but often involve troubleshooting deep rooted issues which have strong psychological and social components. That’s certainly challenging, but it’s rewarding when it leads to long lasting positive change in a person’s overall health and wellbeing.

What’s your vision for the future of mental health care?


We have a lot to address to improve mental health care in our country. We have gaps in access to care, long wait times, a provider shortage, concerns about affordability, as well as accountability. At Heading we are directly working to address all of these.  


How is a team approach, with psychiatrists and therapists working together, particularly beneficial?

Patients who have been struggling for a long time often need a combination approach, and they need providers who take their insurance. 

Offering more than one service line, with in-network providers, makes the care process easier for patients. Our goal at Heading is to treat patients with the same care and compassion we’d offer our family – with the right treatment combinations to ultimately achieve full remission. As a company who believes in value based care, having a combination of providers in one practice is a win for everyone involved – providers, payers, and most importantly, patients.


Ketamine therapy is growing in interest, as is interest in other psychedelic treatments. How do you think psychedelic treatments will be part of the mainstream psychiatric landscape in the future?

Ketamine therapy has a special place in the psychiatry treatment algorithm. 


There is a large subset of patients who are treatment resistant to traditional oral medications and talk therapy. Ketamine certainly has a huge impact on these patients and the fact that we are able to offer this and other interventional treatments to our patients is exciting. Having access to these treatments, and potentially the treatments that may be available in the future, makes me excited about how the field of psychiatry can continue to address gaps.


Interventional treatments like Spravato® and ketamine, and other psychedelic therapies which may become more available soon, are still considered fringe by many. How can Heading continue to pave the way for broader acceptance and access for those who need these services?


The opportunity lies particularly in the subjects of accountability and outcomes. 


We must be a data driven healthcare system anchored in measurement based care – we have to demonstrate that we can help patients heal. 

Our patients deserve the highest quality care, and that means access to the treatment that is right for them. Ketamine may not be the answer for everyone. SSRIs may not be the answer for everyone. Staying close to the science, and offering highly tailored care means better outcomes.  


At Heading we strive to provide them the right treatment through our variety of treatment offerings. This includes evaluating the appropriateness for traditional as well as cutting edge interventional treatments. 


Heading is a mental health practice offering virtual medication management, virtual therapy, and virtual nutritional therapy statewide in Texas, and in-person IM Ketamine and Spravato® therapies at their centers in Austin and Dallas-Fort Worth.  Heading treats adults dealing with a wide variety of mental health disorders and has a particular speciality supporting patients with long-standing and hard to treat disorders like treatment-resistant depression, major anxiety disorders, and PTSD. As he comes on board Dr. Ursani will lead the way in continuing to advance a team-approach for more holistic in-network care that keeps patients at the center of every treatment plan. 

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Who Is Not a Good Candidate for Ketamine Therapy?

Who is and is not a Good Candidate for Ketamine Treatment?

Ketamine treatment is a breakthrough for people who have not experienced relief from traditional modes of treatment or medications, or the effectiveness of these methods of care has diminished. Unlike traditionally prescribed medications which can take several weeks to show effectiveness, patients receiving ketamine often report a reduction in symptoms within the first few sessions.

Research shows that Ketamine  may be suitable for people with various mental health conditions such as depression, anxiety, PTSD, OCD, and chronic pain, who have not responded to traditional treatments such as therapy and antidepressant medications. Specifically, Ketamine treatment has shown promising results in treating treatment-resistant depression, suicidal thoughts, and chronic pain. FDA approved drug Spravato® is approved for the treatment of treatment-resistant depression, and has changes the lives of many who have received this line of care.

There are many reasons why a traditional medication may stop working, or is otherwise not suitable for someone with treatment-resistant depression, or chronic, long-standing stress disorders like anxiety, or PTSD. For example some patients cannot tolerate the side effects of traditional medications. However, it is important to note that each individual’s circumstances are unique, and it is recommended to consult with a qualified medical professional to determine if Ketamine treatment is a suitable option for their specific condition and medical history.

Ketamine and Spravato® are breakthroughs for many, but are not right for everyone.  In this article we look at some factors that may play into Ketamine candidacy and important safety considerations.  

Factors to Consider for Ketamine Candidates

It is important to consult with a qualified medical professional to determine if Ketamine treatment is appropriate for an individual’s treatment of depression, anxiety, or PTSD. At Heading we conduct an intervention treatment Q&A with a care coordinator as well as a 60 minute psychiatric consultation session to establish a personalized care plan and also to determine candidacy prior to a patient receiving treatment.


It’s important to note that candidacy works hand in hand with outcomes and patient goals. Both of these should be monitored continually through the process, and the process is not ‘one-and-done’. Prior to every in-center ketamine or Spravato® appointment several factors are monitored before treatment. Keeping optimal outcomes, and safety in mind patients have access to their care-team during treatment sessions, immediately after treatment sessions, and throughout the course of a treatment protocol. 


Ketamine is becoming more well known as an interventional treatment for depression and anxiety that have not responded well to other treatments. Ketamine offers rapid relief for many people, especially when other medications have not worked.


That said, the results for any depression treatment method are not the same across the board, because every patient’s individual needs are different. That’s why it is important that a mental health care-team always consider the best course of treatment for an individual.


As a patient considers ketamine treatment there are factors to keep in mind.


Ketamine may not be the right choice for someone if:

  1. They have uncontrolled high blood pressure or heart disease. Ketamine can cause an increase in blood pressure and heart rate, which is why it is important for prescribers and care teams to be aware of a patient’s cardiovascular health history prior to receiving treatment.

  2. A patient has a history of schizophrenia or schizoaffective disorders. Ketamine may have adverse side effects and worsen symptoms of these conditions.

  3. A patient has a history of substance abuse or addiction. Ketamine has the potential for abuse and care teams are careful to ensure that treatment will not trigger relapse. 

  4. They are pregnant or breastfeeding. There is limited research on the safety of ketamine use during pregnancy and breastfeeding, and it is not recommended.

  5. They have certain medical conditions, such as liver or kidney disease.

  6. They are unable to participate in the requirements for the protocol such as payments or co-pays, the time-investment is not suitable for that moment in life, or making arrangements for care such as getting a ride to a center if they are receiving treatment at a medical office or making time for the length of treatment is not feasible with their schedule. 

It’s also important to note that this is not an exhaustive list, and a thorough consultation under the direct care of a psychiatric medical professional is crucial.  Since the goal of ketamine therapy is to experience relief from long-standing and hard-to-treat mental health disorders, if the protocol isn’t working for a patient – that’s ok! There are always changes that can be made, and other treatments.  Personalized approaches including combination therapies, and a team of mental health care providers working together can make all the difference – as mental health care is not one-side-fits-all. 

Ketamine In Center Care and Safety

The two most important goals of determining candidacy are:

1) patient safety, and 

2) the best possible outcome for feeling better and healing.



Methods of receiving ketamine vary, and patient preference, insurance coverage, and access plays a large part into whether or not they seek treatment in a center, or through another means.  However, in-center treatments, under a doctor and medical team’s supervision, have added benefits to meet high standards for safety and outcomes.



“Patients receiving ketamine in a clinic or medical center receive an entire team of people who are supporting the best possible outcomes. Safety is, of course, paramount. Patients also take comfort in knowing that they have a medical team who can immediately make them more comfortable and answer any questions or concerns they may have in real-time. These are also the same medical professionals you will see time and time again. Developing therapeutic relationships requires trust, and building trust over time with your care team enhances the experience,” shared Dr. Arif Noorbaksh M.D. a leading psychiatrist at Heading who practices out of Dallas, Texas and offers virtual psychiatric services and medication management to patients statewide.


In addition to having medical professionals immediately available to monitor physical metrics before a treatment such as blood pressure and weight, some patients receiving Ketamine also feel more comfortable receiving treatment knowing that they are in a safe medical center with nurses and doctor’s just a few steps away as the medication takes effect.  Ketamine can induce a dissociative state, sometimes this is referred to as a ‘trip’, and the patient may feel out of body, like they are flying, or experiencing a range of sensations outside of their normal state of being.  In-center treatment options provide a patient with immediate options for assistance, and a team of medical professionals determining when a patient is ready and able to leave treatment. At Heading a ride to and from an appointment is required as it is not advised to drive or operate machinery until a patient has had a good night sleep after treatment. 


Thoughts When Considering Ketamine

  • Ketamine is an effective medication offering rapid relief for depression, but not everyone is a good candidate for treatment.
  • Safety is a top priority. Work with providers who offer thorough screenings and care throughout the process
  • Effectiveness is key. There’s no point in starting or continuing a treatment protocol if it is not proving to be effective. Select a psychiatry provider who will offer a holistic assessment of your needs, including honest feedback about whether or not Ketamine is a good choice for you, as well as what additional treatment protocols they might recommend such as additional medication options, lifestyle changes, or the addition of psychotherapy which can be important in both behavior change as well as integration of the Ketamine experience.
  • Consider your own personal preferences for set and setting. How would you feel in a center with medical professionals steps away versus another method?
  • Ask a lot of questions in your intake and consultations. No question is dumb or unnecessary. You deserve care coordinators and psychiatric professionals who take time to answer all your questions, and ensure your needs are being met throughout the process.
  • Become aware of insurance, payment, and coverage options. There may be expenses related to your care. Ask questions up front, and consider how investing in your mental health impacts your wellbeing and life overall.