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Clinic using esketamine to treat depression

The FDA-approved esketamine is a nasal spray that WellPower is using to treat depression in a little more than a dozen patients.

DENVER — Content Warning: This story mentions the topic of suicide.

When Eric arrives to his appointment at WellPower in Denver (formerly the Mental Health Center of Denver), he makes sure he has his essentials: a blanket, a sleep mask and his headphones. 

It's not exactly an expected checklist for a trip to a clinic. But it helps Eric with what's considered a unique treatment. 

"So when I started this, I was suicidal. I had lost somebody that I really cared for," Eric said. "I also lost my dad in the same year. I lost my dog, and I lost the relationship with my partner as well."

His depression had put him out of work, and after trying out different antidepressants, he qualified for another treatment: taking a form of ketamine at a clinic. 

"They turn out the lights and I put on my face mask and my trusty headphones and just ... sit back," he said. 

The treatment is part of a newer clinic at WellPower using esketamine, a form of ketamine, to treat depression. 

Credit: Luis de Leon
Spravato (esketamine) is a nasal spray that was FDA-approved to treat depression in 2019.

How the program works

The program offering the treatment first came to fruition as a pilot program in 2020. 

The year before in 2019, the FDA had approved Spravato (esketamine) to treat depression in adults who had tried other antidepressant medicines.

"I believe that we're the first community mental health center in all of Colorado to do this," said Denise Hosier, a longtime nurse practitioner and the Director of Adult Integrated Care and Nursing Services at WellPower. "And so I think it's really important for the people we serve to have access to this."

To be considered, they must have tried and failed at least two antidepressants, though Hosier notes that most of their patients have likely tried many. They also must be on an antidepressant regularly during the treatment. They also cannot be pregnant, have uncontrolled blood pressure or have uncontrolled psychosis.

If able to qualify, there's an extensive instructional and conversational meeting with them, including a meeting with a pharmacist to talk about the drug and side effects, among other meetings to make sure patients are prepared going into it. 

"Some people are a little nervous, but by the time they get to our clinic, they've tried just about everything," she said. "And so we haven't had anybody experience any adverse reactions. Most people just like to take the medication and relax and listen to music on their AirPods and just kind of relax. And some people take a bit of a nap, but we haven't we haven't had any problems with it at all."

All patients are in a room on the same floor as the nurses, who check on patients regularly, Hosier said. 

Most of the people they serve start on twice-a-week treatments for around four to six weeks.

"And then at that time, we adjust the dose if we need to and go up or down. And then from there, our hope is that they can go from that to once a week for a while, and then from there, maybe every other week and then maybe once a month as they improve," she said.

A big piece of the program is access, Hosier said, since they accept Medicare and Medicaid to help reduce costs for the patient.

"We knew that we had people in need that could get it," Hosier said. "It's been really rewarding to be able to give this to people who just desperately need it and see really good outcomes in the end for it, for people and their improvement and finding their way out of depression." 

They started with three patients in the pilot, and are now at 15 consistent patients, with another 15 on the waitlist.

Credit: Luis de Leon
The Spravato (esketamine) nasal spray is used at WellPower in Denver to treat depression.

'It showed me that I wasn't my depression'

For Eric, the feeling under the effects of the treatment allows him to discover more about himself and his depression, he said. But there's more to it.

"So talking about it or writing it down right afterwards helps you sort of solidify what you learned about yourself," he said. 

Eric explained that what he feels during the ketamine administration is similar to that of a dream. 

"In other cases, they are truly a psychedelic experience," he said. 

While everyone's experience may be different, Eric said for him, it was a scary feeling at first because the effects of the drug weren't something he was used to. 

"So I really have two choices," he said. "I can sit in this chair and be scared, or I can sit in this chair and be curious. And I started exploring the black hole I was in. And what I found was it was like a source of spiritual energy."

Over time, that feeling of being in a black hole can change, but he said it takes work.

"It showed me that I wasn't my depression, that I was much more than this body, than my thoughts. It was really a spiritual experience, and that was like the foundation for my recovery that I stopped thinking of myself as being depressed," he said. "I thought of myself as a person who was experiencing depression, but it wasn't who I was."

He said the effects help lift a weight off his shoulders. 

"I feel like things are possible, whereas before, the depression would tell me, don't bother, it's not going to work out," he said.

As the program works to expand, Eric hopes to also help break the stigma around mental health. 

"I would say for most of my life, I thought mental health meant you were really completely broken and worthless. And I think that might have kept me from looking closely in the mirror and saying, ‘Hey, are you okay?’ Because I felt that stigma," he said. 

RELATED: Mental health help and addiction resources for Colorado residents

Credit: Luis de Leon
Eric talks with a nurse at the esketamine clinic after getting his blood pressure taken.

RELATED: Denver radio host highlighting mental health with 'Therapy Thursdays'

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