themighty logo

Facing up to Life while Living with Treatment-Resistant Depression

I was years behind all the other freshman when I started college. That’s what it felt like, anyway. They already figured out how to fit in and be happy. There was excitement in the air they breathed that felt suffocating to me. How could it be so easy for everyone else, I thought? While at the time I didn’t know it, the reason I was struggling to take it all in was because depression was holding me back.    

But this was the 1970s. We didn’t have as much information available about depression as we do now. The stigma surrounding mental illness was louder back then to the point where I felt fear of being labeled as “one of those people.” In fact, when I finally started seeing a psychiatrist, I was paying for it on my own because I was worried if I used my insurance everyone would find out about my diagnosis. I was so afraid of that happening. I didn’t realize what I felt had a name until I was 32. I was sitting in my backyard talking with a friend about how I felt, and she said, “It sounds like you’re depressed.” I called another friend and told her what I was feeling and she told me the same thing: depression. Then I went to see my general practitioner and was formally diagnosed with major depressive disorder (MDD).

Finally, I found a diagnosis that made sense to me. I felt like I was worn down by a storm every single day while the weather was sunny and warm for everyone else. That’s what depression does to you. It feels heavy, overwhelming, and exhausting, all at the same time. It makes you want to crumble over, lie down, and do nothing at all. I used to walk along the beach and just listen to the waves hit the rocks. That’s the only thing I could bring myself to do. I felt emotionally paralyzed and dwelled on the fact that I could no longer find joy in the simple things I used to love like gardening, reading books and decorating. I became so numb I didn’t even know what I was missing any more. 

Over the next 20 years, I went to various psychiatrists and tried different medications. Each time I would feel hopeful, but the medications didn’t always meet my expectations. Some would work and then stop working, or I would take something every day and it just wouldn’t work at all. I went back to my psychiatrist and asked to try something different, something that could help. That’s when I was diagnosed with treatment-resistant depression. Instead she told me there was nothing else she could give me.

With no other options at my disposal, I decided to pursue a different route. At the time, I heard about clinical trials for a drug called SPRAVATO® (esketamine) CIII nasal spray. Knowing that I had exhausted other conventional therapies, I asked my doctor if I might be a good candidate for the trial. He agreed I was and worked with me to make the medication part of my treatment plan with an oral anti-depressant. We discussed the risks and benefits of SPRAVATO® including some of the most serious side effects such as sedation, dissociation, the risk of abuse and misuse and increased risk of suicidal thoughts or actions. (Please see below for a list of  side effects of SPRAVATO®). I told him I would let him know right away if I had new or sudden changes in how I was thinking, feeling or behaving. My doctor also enrolled me in the SPRAVATO® Risk Evaluation and Mitigation Strategy (REMS) Program that keeps track of any serious side effects that SPRAVATO® patients may experience. 

From the time I began taking it, that sinking feeling of depression that used to consume me started to improve. I’m starting to notice the sky is blue. The clouds have parted, the sun is shining and I’m finally feeling good about myself and what’s ahead. While I know this medicine may not work for everyone, it’s greatly helped me manage my symptoms of TRD.

For Important Safety Information and BOXED WARNINGS, click here.

On treatment days I order myself a car, because I can’t drive, operate machinery or do anything where I need to be alert until the next day – after I’ve had a good night’s sleep. 

When I get to my doctor’s office, I tell my doctor how I’ve been doing and he takes my blood pressure before I take the medication. SPRAVATO® must be administered under the direct supervision of a healthcare practitioner. After treatment, I start to hear noises in the building. These noises are actually happening, but they just get accentuated and sound louder than normal. When I’m sitting there with my eyes closed, I see things swirling around. I see colors of white and yellow and red, but it doesn’t feel “psychedelic.” My doctor checks my blood pressure again before I go home. The relationship I have with my psychiatrist is the most amazing one I’ve had with any provider. The SPRAVATO® treatments, combined with my daily oral antidepressant, my therapist and my relationship with my doctor – I think it’s the whole package that makes my treatment plan work for me. 

Now, I’m able to see how much I missed out on while I was depressed. I know I’ll never be able to get back everything I missed out on, but I finally feel like I’m in a place where I can make decisions for myself – both big and small – and that’s empowering. I’ve been organizing and decluttering my home, which has made a difference in how I feel. And I’m getting out of the house more, helping me to maintain and build my friendships and social life. Turns out there’s many ways to find happiness that I was unable to see before. I’m even trying to break the bad habits I developed while I was in the depths of my depression.

The best way I can describe what it’s like to have TRD and then start feeling better is how I explained it to a friend as we were looking over the bay to the Golden Gate Bridge during a very windy, cold winter day. A storm was brewing and despite the first drops of rain, we remained there for a while taking it all in for what felt like forever. Then all of a sudden, the wind stopped blowing and things warmed up. I told my friend it was a lot like rising above depression. When you come out of it you think, “Oh, OK. This is what it’s supposed to feel like.” The wind is so uncomfortable, but you don’t realize that you’re even in it until it starts to decrease. 

It’s all part of the new moments and realizations that I’ve had since I’ve started feeling better after SPRAVATO®. It’s helped me move forward with my life in a way that I couldn’t before. I still have treatment-resistant depression, and I know I’ll always be working with doctors on my treatment plan, but I’m confident I can face what’s ahead of me.

Robin is a volunteer with the SHARE Network, a Janssen Pharmaceuticals, Inc., program, made up of people who are dedicated to inspiring others through their personal health journeys and stories of caring.

If a Janssen treatment has made a difference in your life or the life of a loved one, we hope you will consider joining the SHARE Network.

Every story is unique. If you are an adult living with treatment-resistant depression, talk to your doctor to figure out a treatment plan that’s right for you.

INDICATIONS

What is SPRAVATO® (esketamine) CIII nasal spray?  

SPRAVATO® is a prescription medicine, used along with an antidepressant taken by mouth to  treat: 

  • Adults with treatment-resistant depression (TRD) 
  • Depressive symptoms in adults with major depressive disorder (MDD) with suicidal  thoughts or actions 

SPRAVATO® is not for use as a medicine to prevent or relieve pain (anesthetic). It is not known  if SPRAVATO® is safe or effective as an anesthetic medicine.  

It is not known if SPRAVATO® is safe and effective for use in preventing suicide or in reducing  suicidal thoughts or actions. SPRAVATO® is not for use in place of hospitalization if your healthcare provider determines that hospitalization is needed, even if improvement is experienced after the first dose of SPRAVATO®. 

It is not known if SPRAVATO® is safe and effective in children. 

IMPORTANT SAFETY INFORMATION 

What is the most important information I should know about SPRAVATO®?
SPRAVATO® can cause serious side effects, including:
  • Sedation and dissociation. SPRAVATO® may cause sleepiness (sedation), fainting,  dizziness, spinning sensation, anxiety, or feeling disconnected from yourself, your  thoughts, feelings, space and time (dissociation).
    • Tell your healthcare provider right away if you feel like you cannot stay awake or if  you feel like you are going to pass out.
    • Your healthcare provider must monitor you for serious side effects for at least 2  hours after taking SPRAVATO®. Your healthcare provider will decide when you are  ready to leave the healthcare setting.
  • Abuse and misuse. There is a risk for abuse and physical and psychological dependence  with SPRAVATO® treatment. Your healthcare provider should check you for signs of  abuse and dependence before and during treatment with SPRAVATO®.
    • Tell your healthcare provider if you have ever abused or been dependent on alcohol,  prescription medicines, or street drugs.
    • Your healthcare provider can tell you more about the differences between physical and psychological dependence and drug addiction.
  • SPRAVATO® Risk Evaluation and Mitigation Strategy (REMS). Because of the risks for sedation, dissociation, and abuse and misuse, SPRAVATO® is only available through a  restricted program called the SPRAVATO® Risk Evaluation and Mitigation Strategy (REMS)  Program. SPRAVATO® can only be administered at healthcare settings certified in the  SPRAVATO® REMS Program. Patients treated in outpatient healthcare settings (e.g.,  medical offices and clinics) must be enrolled in the program.
  • Increased risk of suicidal thoughts and actions. Antidepressant medicines may increase  suicidal thoughts and actions in some people 24 years of age and younger, especially within the first few months of treatment or when the dose is changed. 
    SPRAVATO® is not for use in children. 
    • Depression and other serious mental illnesses are the most important causes of  suicidal thoughts and actions. Some people may have a higher risk of having  suicidal thoughts or actions. These include people who have (or have a family  history of) depression or a history of suicidal thoughts or actions.
  • How can I watch for and try to prevent suicidal thoughts and actions in myself or a  family member?
    • Pay close attention to any changes, especially sudden changes, in mood, behavior,  thoughts, or feelings, or if you develop suicidal thoughts or actions.
    • Tell your healthcare provider right away if you have any new or sudden changes  in mood, behavior, thoughts, or feelings.
    • Keep all follow-up visits with your healthcare provider as scheduled. Call your  healthcare provider between visits as needed, especially if you have concerns  about symptoms.
  • Tell your healthcare provider right away if you or your family member have any of the  following symptoms, especially if they are new, worse, or worry you:
    • suicide attempts
    • thoughts about suicide or dying
    • worsening depression
    • other unusual changes in behavior or mood

Do not take SPRAVATO® if you:

  • have blood vessel (aneurysmal vascular) disease (including in the brain, chest, abdominal  aorta, arms and legs) 
  • have an abnormal connection between your veins and arteries (arteriovenous  malformation)  
  • have a history of bleeding in the brain 
  • are allergic to esketamine, ketamine, or any of the other ingredients in SPRAVATO® 

If you are not sure if you have any of the above conditions, talk to your healthcare provider before taking SPRAVATO®.   

Before you take SPRAVATO®, tell your healthcare provider about all of your medical  conditions, including if you: 

  • have heart or brain problems, including: 
    • high blood pressure (hypertension)
    • slow or fast heartbeats that cause shortness of breath, chest pain, lightheadedness,  or fainting
    • history of heart attack
    • history of stroke
    • heart valve disease or heart failure
    • history of brain injury or any condition where there is increased pressure in the brain
  • have liver problems
  • have ever had a condition called “psychosis” (see, feel, or hear things that are not there, or  believe in things that are not true). 
  • are pregnant or plan to become pregnant. SPRAVATO® may harm your baby. You should not  take SPRAVATO® if you are pregnant.  
    • Tell your healthcare provider right away if you become pregnant during treatment  with SPRAVATO®.  
    • If you are able to become pregnant, talk to your healthcare provider about methods  to prevent pregnancy during treatment with SPRAVATO®. 
    • There is a pregnancy registry for women who are exposed to SPRAVATO® during  pregnancy. The purpose of the registry is to collect information about the health of  women exposed to SPRAVATO® and their baby. If you become pregnant during  treatment with SPRAVATO®, talk to your healthcare provider about registering with  the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or online at  https://womensmentalhealth.org/clinical-and-research/programs/pregnancyregistry/antidepressants/.   
  • are breastfeeding or plan to breastfeed. You should not breastfeed during treatment with SPRAVATO®.  

Tell your healthcare provider about all the medicines that you take, including prescription and  over-the-counter medicines, vitamins and herbal supplements. Taking SPRAVATO® with certain  medicine may cause side effects. 

Especially tell your healthcare provider if you take central nervous system (CNS) depressants,  psychostimulants, or monoamine oxidase inhibitors (MAOIs) medicines. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine. 

How will I take SPRAVATO®? 

  • You will take SPRAVATO® nasal spray yourself, under the supervision of a healthcare  provider in a healthcare setting. Your healthcare provider will show you how to use the  SPRAVATO® nasal spray device. 
  • Your healthcare provider will tell you how much SPRAVATO® you will take and when you  will take it. 
  • Follow your SPRAVATO® treatment schedule exactly as your healthcare provider tells you  to.   
  • During and after each use of the SPRAVATO® nasal spray device, you will be checked by a  healthcare provider who will decide when you are ready to leave the healthcare setting.  
  • You will need to plan for a caregiver or family member to drive you home after taking  SPRAVATO®. 
  • If you miss a SPRAVATO® treatment, your healthcare provider may change your dose and  treatment schedule.
  • Some people taking SPRAVATO® get nausea and vomiting. You should not eat for at least 2  hours before taking SPRAVATO® and not drink liquids at least 30 minutes before taking  SPRAVATO®. 
  • If you take a nasal corticosteroid or nasal decongestant medicine take these medicines at  least 1 hour before taking SPRAVATO®. 

What should I avoid while taking SPRAVATO®? 

Do not drive, operate machinery, or do anything where you need to be completely alert after  taking SPRAVATO®. Do not take part in these activities until the next day following a restful  sleep. See “What is the most important information I should know about SPRAVATO®?” 

What are the possible side effects of SPRAVATO®? 

SPRAVATO® may cause serious side effects including: 

  • See “What is the most important information I should know about SPRAVATO®?” 
  • Increased blood pressure.  SPRAVATO® can cause a temporary increase in your blood  pressure that may last for about 4 hours after taking a dose. Your healthcare provider will  check your blood pressure before taking SPRAVATO® and for at least 2 hours after you take SPRAVATO®. Tell your healthcare provider right away if you get chest pain, shortness of  breath, sudden severe headache, change in vision, or seizures after taking SPRAVATO®.
  • Problems with thinking clearly. Tell your healthcare provider if you have problems thinking  or remembering. 
  • Bladder problems. Tell your healthcare provider if you develop trouble urinating, such as a  frequent or urgent need to urinate, pain when urinating, or urinating frequently at night.  

The most common side effects of SPRAVATO® when used along with an antidepressant taken  by mouth include: 

  • feeling disconnected from yourself, your thoughts, feelings and things  around you 
  • dizziness
  • nausea
  • feeling sleepy
  • spinning sensation
  • decreased feeling of sensitivity (numbness)
  • feeling anxious
  • lack of energy
  • increase in blood pressure
  • vomiting
  • feeling drunk
  • feeling very happy or excited

If these common side effects occur, they usually happen right after taking SPRAVATO® and go  away the same day. 

These are not all the possible side effects of SPRAVATO®.  

Call your doctor for medical advice about side effects. You may report side effects to FDA at  1-800-FDA-1088. 

Please see full Prescribing Information, including Boxed WARNINGS, and Medication Guide for SPRAVATO® and discuss any questions you may have with your healthcare provider.

For more information about SPRAVATO®, please visit www.spravato.com.

cp-170363v1

*This information is intended for the use of patients and caregivers in the United States and its territories only. Laws, regulatory requirements and medical practices for pharmaceutical products vary from country to country. The Prescribing Information included here may not be appropriate for use outside the United States and its territories.

cp-189551v1