Esketamine (Spravato®) for PTSD | Tampa & Wesley Chapel | Florida TMS Clinic

Off-Label PTSD Augmentation • REMS-Certified Care

Esketamine (Spravato®) for PTSD

For adults with PTSD—especially when treatment-resistant depression (TRD) coexists—esketamine offers a rapid-acting, glutamatergic option under careful supervision in Tampa & Wesley Chapel.

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Off-label notice: Spravato® (esketamine) is FDA-approved for TRD and for depressive symptoms in MDD with acute suicidal ideation/behavior — not specifically for PTSD. We consider it when PTSD coexists with TRD and standard therapies are optimized.
Why consider esketamine? Evidence summary How treatment works Esketamine vs. TMS Who qualifies Tampa & Wesley Chapel FAQs

Why consider esketamine for PTSD?

Many PTSD patients also live with TRD. Esketamine (an NMDA receptor modulator) can rapidly lift mood and improve neuroplasticity, supporting fear extinction, emotion regulation, and reconsolidation of traumatic memories with less “alarm.” Pairing dosing visits with EMDR/CBT may help consolidate these gains.

  • Fast antidepressant effect: improvements often within 24–72 hours.
  • PTSD symptom gains: open-label cohorts show reductions in re-experiencing, hyperarousal, and sleep problems over weeks.
  • Therapy synergy: aligning EMDR/CBT with esketamine’s plasticity window can accelerate healing.

What the evidence shows (current, evolving)

n=35
VA San Diego Case Series
IN esketamine in Veterans with TRD + PTSD
  • PCL-5 ↓ ~15 points over induction; ~46% hit ≥30% PTSD improvement.
  • PHQ-9 ↓ ~5 points; some PTSD gains emerged even when depression response was modest.
n=11
Frontiers Psychiatry (Real-World)
6-month follow-up with maintenance
  • Improvements in MADRS/PHQ-9, functioning, and suicidality across months.
  • Supports a taper to q2–4 weeks for durability.
n=6
Medication-Enhanced Psychotherapy
Esketamine + EMDR/supportive/hypnosis
  • MADRS ↓ ~12.6 average; PCL-5 ↓ 10–46 points across patients.
  • Largest gains: re-experiencing, negative mood/cognition, hyperarousal; avoidance may lag (target with therapy).
n=5
Heliyon (Oral Esketamine)
1–2×/week + psychotherapy
  • 4/5 improved depression and resilience; 1 worsened after real-life trigger → emphasizes trauma-informed monitoring.

Evidence is preliminary (open-label/retrospective). We individualize decisions and track outcomes measurement-based.

How treatment works at Florida TMS Clinic

  • Eligibility & planning: Confirm PTSD/TRD history, prior trials, suicidality, medical suitability.
  • Program: Induction typically 2 visits/week for ~4 weeks, then weekly → q2–4 weeks per response (56–84 mg IN under REMS).
  • Visit length: About 2 hours including administration, recovery, monitoring (vitals, comfort).
  • Aftercare: No driving until the next day; arrange a safe ride.
  • Integrating therapy: We coordinate EMDR/CBT during the acute phase to leverage neuroplasticity.
Flashbacks: Some patients experience brief trauma recall during early sessions. With grounding/orientation, these episodes often diminish and can be therapeutically useful rather than adverse.

Esketamine vs. TMS — Which is right for PTSD + TRD?

  • Speed: Esketamine may act in days; TMS generally builds over 2–6+ weeks.
  • Mechanism: Esketamine = glutamatergic modulation; TMS = circuit-specific neuromodulation.
  • Session experience: Esketamine requires monitored observation; TMS has none.
  • Driving: Esketamine: no driving until next day; TMS: driving allowed.
  • Combination: For TRD + PTSD, a sequenced or combined strategy (Esketamine + TMS + EMDR/CBT) can optimize speed and durability.

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Who is a good candidate?

  • Adults with PTSD and treatment-resistant depression after best-practice trials (antidepressants + trauma-focused therapy).
  • Active engagement (or readiness) for EMDR/CBT.
  • Medically appropriate for supervised intranasal therapy and follow-up.
  • Preference to consider a rapid-acting option while continuing evidence-based psychotherapy.

Safety & monitoring

We’re a REMS-certified center. Common effects are transient (brief dissociation, dizziness, nausea, temporary BP increases) and resolve during on-site observation.

Esketamine for PTSD in Tampa & Wesley Chapel

Florida TMS Clinic — Tampa

Serving Tampa, South Tampa, Downtown, and Westshore. Same-week evaluations often available.

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Florida TMS Clinic — Wesley Chapel

Serving Wesley Chapel, New Tampa, Lutz, and Land O’ Lakes with convenient access and parking.

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Take the First Step

If best-practice PTSD care hasn’t been enough, our team can evaluate whether an esketamine trial makes sense—typically alongside EMDR/CBT and, when appropriate, TMS.

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Esketamine & PTSD — FAQs

Is Spravato® FDA-approved for PTSD?
No. It’s FDA-approved for TRD and for depressive symptoms in MDD with acute suicidal ideation/behavior. PTSD-specific use is off-label and considered case-by-case after standard therapies are optimized.
How fast might symptoms change?
Mood can improve in days; PTSD clusters (re-experiencing, hyperarousal, sleep) often improve over 4–8 weeks when sessions are paired with EMDR/CBT.
Do I still need EMDR/CBT?
Yes. We strongly recommend coordinating therapy to reinforce new learning during periods of increased neuroplasticity.
What are common side effects?
Transient dissociation, dizziness, nausea, and temporary BP increases. You’ll be monitored throughout the visit and should not drive until the next day.
Can esketamine be combined with TMS?
Yes. For TRD + PTSD, combined or sequenced approaches (Esketamine + TMS + EMDR/CBT) may optimize speed and durability. We individualize the plan.
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