Using SPRAVATO® Alongside Antidepressants in Tyler, TX

Most oral antidepressants can be used alongside SPRAVATO® — the combination is standard clinical practice. The antidepressants most commonly continued during SPRAVATO® treatment include SSRIs (sertraline, escitalopram, fluoxetine, paroxetine), SNRIs (duloxetine, venlafaxine, desvenlafaxine), bupropion (Wellbutrin), and mirtazapine.

Antidepressants with more complex drug interaction profiles or that affect systems that esketamine also affects warrant more careful review. TCAs (tricyclic antidepressants) and MAOIs have more significant interaction potential and may require more careful assessment.

If you are on an antidepressant that has not been effective and your provider believes switching to a different antidepressant alongside SPRAVATO® may improve your overall response, they may recommend initiating the switch at the time you start SPRAVATO® — this is consistent with the TRANSFORM-2 trial design, where a new antidepressant was started at the same time as esketamine.

The specific antidepressant decisions are individualized based on your history, tolerability, and the clinical assessment of your provider. Our evaluation takes a comprehensive look at your medication history before making any recommendations.

While most antidepressants can be used safely alongside SPRAVATO®, some specific medication combinations warrant explicit discussion during your evaluation.

CNS depressants: Benzodiazepines, sleep aids, and other CNS depressants can potentiate esketamine's sedative effects, increasing the risk of excessive sedation during the monitoring period. Your provider will assess whether any concurrent CNS depressant use warrants adjustment.

MAOIs: Monoamine oxidase inhibitors have complex interactions with many psychiatric medications. If you are currently on an MAOI or have recently discontinued one, this is an important part of your medication review.

Stimulants: Medications that increase blood pressure (including some stimulants and certain decongestants) can compound esketamine's cardiovascular effects. Concurrent stimulant use is reviewed during your evaluation.

The most important action is full disclosure: bring a complete list of everything you take — prescription, over-the-counter, and supplements — to your initial evaluation. Incomplete medication disclosure is the primary source of missed interactions.

Combination medication management requires systematic oversight — not just a single assessment at the start of treatment but ongoing monitoring across the full treatment course.

At your initial evaluation, we review your complete current medication list for interaction potential, therapeutic duplications, and whether adjustments to your oral antidepressant regimen before or during SPRAVATO® are warranted.

During induction, we monitor how you are tolerating the combination — both the acute effects during sessions and the overall effect on your depression between sessions. If the combination produces unexpected side effects or if your clinical picture suggests that a medication adjustment would support your response, we make that adjustment.

After induction, as you transition to maintenance SPRAVATO® and potentially a longer-term antidepressant regimen, we continue to evaluate whether your oral antidepressant continues to be appropriate and whether dose adjustments, switches, or discontinuation are warranted as your clinical status evolves.

We accept Aetna, Ambetter, Blue Cross Blue Shield, Cigna/Evernorth, Medicare, Optum, UnitedHealthcare, and UMR.

What happens to your antidepressant regimen in the long term — after SPRAVATO® induction and potentially after discontinuing SPRAVATO® maintenance — is a question worth thinking about from the beginning of treatment.

Patients who achieve durable remission on SPRAVATO® maintenance and eventually taper off esketamine will need to assess whether their oral antidepressant alone is sufficient to maintain that remission, whether it needs to be adjusted, or whether a longer-term antidepressant strategy is warranted.

Patients who achieve remission and continue SPRAVATO® maintenance long-term will need their oral antidepressant periodically reassessed — as their clinical status evolves, the medication that was appropriate at the start of treatment may not be the optimal choice long-term.

These are not decisions made at the start of treatment — but they are part of the ongoing care relationship that East Texas Psychiatry provides. We do not treat SPRAVATO® as a standalone procedure; we treat it as one component of a comprehensive, evolving psychiatric care plan.

If you are currently on an antidepressant and are considering SPRAVATO®, the first step is an evaluation that reviews your current regimen in the context of your full treatment history and clinical picture.

Call (430) 288-5800 or use the Schedule button to request a same-week consultation. Our evaluation is comprehensive — 60 to 90 minutes with a board-certified PMHNP — and produces a clear treatment plan that addresses your current medications, SPRAVATO® candidacy, and what combination treatment would look like for your specific situation.

This page is educational and is not a substitute for personalized medical advice. If you or someone you know may be in danger, call 911. To reach crisis counselors any time, call or text 988.