SPRAVATO® Treatments at Ascent Mental Health

SPRAVATO® FAQs

Is it dangerous (addiction/overdose)?

            SPRAVATO® is a well-tested and well-researched medication that has been used in anesthesia for decades. It is popular in anesthesia because it is one of the few dissociative medications that does NOT cause respiratory depression. Additionally, SPRAVATO® tends to mildly increase blood pressure, unlike many similar medications that can cause an unsafe drop in blood pressure. These characteristics make it an incredibly safe medication for in-office use. In addition to the general safe nature of SPRAVATO®, all patients receiving SPRAVATO® treatment are monitored for safety by our medical staff throughout their treatment. SPRAVATO® is almost impossible to overdose on and has no known physiological mechanism for addiction or dependency.

Should I do anything to prepare mentally (set and setting/ dealing with distressing content)? 

            Medications like SPRAVATO® are very responsive to our mindset. Spending a short amount of time at the beginning of your appointment thinking about people and places that make you feel safe will significantly increase the likelihood of a pleasant experience. While the vast majority of patients report SPRAVATO® treatments as being a very relaxing and enjoyable experience, on rare occasions, patients do report having distressing experiences. This is likely related to how SPRAVATO® works. SPRAVATO® turns down our ego defense mechanisms, and this is a good thing, it allows us to interact with our depression in a different way and is often the mechanism for healing. If confronted with a distressing experience, it is important not to fight it, but instead get curious about it (think of yourself as an observer and ask questions). Remind yourself you are in a safe place and that it is just a temporary experience. It is also important to remember that just because an experience is distressing, that does not mean it is not beneficial. Healing often means confronting difficult parts of our past, but please remember that the staff at Ascent Mental Health are here to support you through this process in any way we can. For patients with particularly distressing content, it is recommended that they participate in SPRAVATO® Assisted Therapy to help them process their experience.

How does SPRAVATO® help with mental illness (the theoretical scientific mechanism)?

An excellent resource for understanding how SPRAVATO® and other psychedelics are beneficial in treating mental illness is Michael Pollan’s book “How to Change Your Mind.” It is a deep dive into the history, research, and resurgence of psychedelics as a valid modality of psychiatric treatment. One of the most interesting portions of the book is in Chapter Five. Here Pollan explores what brain imaging is teaching us about the effect of psychedelics on the brain. One of the most notable findings is that psychedelics turn down a series of neurological pathways in the brain known as the Default Mode Network (DMN). The DMN serves a multitude of functions in navigating our daily lives. It is the network of neurological pathways that take over when nothing is consuming our immediate attention (Daydreaming). The DMN plays a major role in how we define the self (our definition of who we are). Lastly, the DMN is often referred to by psychologists as the great orchestrator of the brain. Here, we will spend a little time exploring the DMN functions that may be related to the positive effects found in the research on psychedelic experiences.

            Daydreaming: Where does the mind go when it is not occupied by an immediate task? Unfortunately, for many people with mental illness, this is an unpleasant place—individuals suffering from depression may default to ruminations or feelings of worthlessness. People suffering from substance abuse may default to thoughts of guilt or the urge to use. Those battling eating disorders may default to need to feel in control and relentless thoughts about body image. People suffering from anxiety may default to an unrelenting need to get things done and have everything perfect. This list goes on. For our patients who suffer from these experiences, by turning down the DMN, a psychedelic experience can give them a welcome reprieve from the unrelenting negative thoughts they may battle every day. It allows them a chance to cognitively and emotionally interact with their mental illness in a new way.

            The Self: The way each of us defines ourselves is wildly complex. In our brain is the wiring for thousands and thousands of rules and definitions that make up our unique experience of self (who we are). Embedded in our sense of self are the rules for how we deal with things like guilt, shame, grief, and trauma. These are our defense mechanisms. Many of our defense mechanisms were written in our minds when we were very young and entirely without our awareness. Defense mechanisms that may have protected us as children may now only serve to drive our negative self-image. Defense mechanisms laid down in our neurology during times of extreme stress or emotion are often written by our primitive brain (the amygdala), and therefore may seem irrational. This is the case with PTSD. In a psychedelic experience, as the DMN is turned down, the overpowering definitions of self are softened. This allows the patient to see and possibly define themselves in a new way. The ruts and trenches of how one thinks about one’s self are filled in and new definitions of who we are, are given a chance to flourish.

            The Great Orchestrator: Our brains receive and process enormous amounts of information. As a child, this information is not filtered, but over time our brains learn to create shortcuts and filter out extraneous information through a process called specialization. This process is seen in language acquisition, motor skill development, and an assortment of other skills essential to daily life. As a part of specialization, the DMN comes online and directs or orchestrates the cognitive shortcuts or filters that are essential to daily life. The downside to this is that the cognitive shortcuts and filters imposed by the DMN make it more difficult to see ourselves or the world in a new way. If we are perpetually seeing ourselves or the world in a negative way, then turning down the DMN through the use of psychedelics may facilitate new insights into life and a reframing of a negative self-image into a more honest and kind one.