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Esketamine (Spravato): clinical information for healthcare professionals.

Intranasal, non-competitive NMDA receptor antagonist indicated for adults with treatment-resistant depression. TGA-registered March 2021. PBS-listed May 2025.

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Esketamine Indications

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Approved Indication

Spravato is indicated for adults with treatment-resistant depression (TRD) – Major Depressive Disorder where two or more antidepressants of adequate dose and duration have failed within the current depressive episode.

  • The patient must be able to attend in-clinic sessions for treatment monitoring.

Dosing and administration schedule

All doses are self-administered by the patient under supervision at GoodMind clinic

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Induction phase: Weeks 1–4

Twice weekly dosing

Starting dose (most adults): 56 mg for doses 1 & 2, then typically 84 mg

Elderly (65+): start at 28 mg, titrate on tolerability

Maintenance phase: Week 5+

Weeks 5–8: once weekly

Week 9+: once weekly or fortnightly

Frequency individualised to clinical response

Inclusion & exclusion checklist

Eligibility critera

  • Adult with confirmed MDD diagnosis
  • Two or more adequate antidepressant trials failed
  • Physically able to attend in-person clinic sessions (2+ hours per visit)
  • No active or recent substance use disorder
  • BP within acceptable range pre-session (<140/90 mmHg general guide)

Contraindications

  • Aneurysmal vascular disease (intracranial, thoracic, abdominal aorta, peripheral arterial)
  • Arteriovenous malformation
  • History of intracerebral haemorrhage
  • Hypersensitivity to esketamine, ketamine, or any excipient
  • Active psychotic disorder (relative — individual risk-benefit)
  • Active substance use disorder within the last 12 months
  • Uncontrolled hypertension >140/90 mmHg pre-dose
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Comorbidities — Guidance for referring clinicians

Important Information to Include in Referral

  • Anxiety disorders (GAD, panic, social anxiety, OCD) — not a contraindication. Include current treatment.
  • PTSD — not a contraindication. Highly relevant.
  • ADHD — note current stimulant use (BP monitoring implications). Not a contraindication.
  • Substance use history — active disorder within 12 months is a relative contraindication. Document historical use clearly.
  • Bipolar disorder — not a standard indication. Discuss with GoodMind clinical team before referring.

Medical comorbidities — please document

  • Hypertension — if controlled, proceed. If uncontrolled (>140/90), optimise before referring. Include antihypertensives.
  • Cardiovascular disease — individual risk-benefit assessment required. Document clearly.
  • Hepatic impairment — moderate-to-severe impairment — flag for the GoodMind psychiatrist. May affect dose titration.

How Esketamine differs from IV or subcutaneous ketamine

Spravato is the only TGA-registered, PBS-subsidised ketamine-class medicine for TRD in Australia.

Esketamine (Spravato) Racemic ketamine (IV/IM)
TGA approval Registered for TRD Not registered for TRD (off-label)
PBS subsidy Yes — from May 2025 No
Route Intranasal IV infusion or IM injection
Setting Dedicated GoodMind clinic Variable — anaesthetist-led or off-label psychiatry
Dosing schedule Standardised induction + maintenance No standardised protocol
Evidence base Phase 3 RCTs — TRANSFORM & SUSTAIN Smaller academic studies

Discuss a referral with our clinical team.

For questions about the clinical evidence or suitability of a specific
patient, call our clinical team Monday to Friday 9am–5pm AEST.

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Urgent query? Call 0468 054 264 

info@goodmindteam.com.au 

How to refer a patient to GoodMind for Esketamine therapy.

Referrals are accepted from GPs, psychiatrists, and other medical specialists. Most patients are contacted within 48 hours and commence treatment within two weeks.

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Esketamine is a Psychiatrist Only Prescription Medication

You can referer your patient to a GoodMind psychiatrist for end to end management.

If you are a psychiatrist and wish to prescribe for your patient, we can arrange their treatment and monitoring within our clinic under your care. Please email us for more information on that process.

The Journey To Treatment

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1

Confirm the patient meets eligibility criteria

Adults with treatment-resistant depression. Review major contraindications

2

Complete the online referral form

Approximately five minutes. The form collects the clinical information our psychiatrists need to triage promptly.

3

Clinical triage within 24–48 hours

Patient will be contact by Support Specialist and re-screened for contraindications. Full treatment process, costs and considerations outlined

4

Initial Psychiatric Assessment

Patient booked in for psychiatry review by a GoodMind psychiatrist to review eligibility for esketamine. Occurs within one to two weeks.

5

Treatment

Patient commences treatment at their nearest clinic, with regular reviews by the treating clinician

6

Ongoing Care

We actively referrer all our patients to psychotherapy to improve their outcomes. The neuroplastic effects of Esketamine are strongest within the first 24-48hrs after treatment

What to include in your referral

To avoid delays in patient contact, please include the following in the form or accompanying letter.

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Clinical Information
  • Confirmed diagnosis of Major Depressive Disorder (current episode)
  • History of prior antidepressant trials — minimum two different classes, with dose, duration, and reason for cessation
  • Current medications — particularly benzodiazepines, opioids, stimulants, MAOIs, and zntihypertensives
  • Relevant medical comorbidities — cardiovascular, cerebrovascular, hepatic, respiratory
  • Any known contraindications
Admistrative Information
  • Patient contact details — mobile and email
  • Medicare number
  • Preferred clinic location — Sydney CBD, Chatswood, Melbourne, Brisbane, Gold Coast, or Darwin

Ready to refer a patient?

Referrals reviewed within 24–48 hours. Patients typically commence treatment within two weeks.

Submit a Referral
View Referral Process

Urgent query? Call 0468 054 264 

info@goodmindteam.com.au 

Veterans & First Responders

Access fully funded care for eligible patients. Emerging evidence on Esketamine efficacy for comorbid TRD and PTSD.

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DVA patients & veterans

GoodMind has specialist experience supporting DVA patients and first responders with treatment-resistant depression, including those with complex trauma presentations.

  • DVA-covered patients — please flag DVA status on the referral form
  • GoodMind liaises directly with DVA on eligibility and coverage
  • GoodMind has a network of DVA psychologists and health providers to support holistic care
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First responders

For many first responders, accessing mental health care can be challenging due to long wait periods, limited availability of providers, or the demands of their work schedules. GoodMind Therapeutics provides mental health related services for police officers, paramedics, and firefighters across Australia.

  • GoodMind has a network of trauma-informed psychologists and health providers to support holistic care for first-responders
  • First responders (WorkCover-covered) — flag on referral form for appropriate pathway guidance
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Ready to refer a patient?

Referrals reviewed within 24–48 hours. Patients typically commence treatment within two weeks.

Submit a Referral
View Referral Process

Urgent query? Call 0468 054 264 

info@goodmindteam.com.au 

The largest randomised evidence base of any rapid-acting antidepressant.

Summary of the pivotal TRANSFORM and SUSTAIN trial programs, real-world evidence, and MADRS outcome data for clinical reference.

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Summary of Clinical Evidence

Spravato is the only TGA-registered, PBS-subsidised ketamine-class medicine for TRD in Australia and carries the most robust Phase 3 RCT evidence base for any rapid-acting antidepressant currently available. The PBS listing from May 2025 reflects the TGA’s assessment of safety and efficacy across the TRANSFORM and SUSTAIN program.

Evidence context

Long-term safety and efficacy data are drawn from the SUSTAIN-2 and SUSTAIN-3 open-label extension studies. These studies support a broadly consistent safety profile with extended use. Referring clinicians should note that data beyond 12 months of continuous use remains limited.
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Ready to refer a patient?

Referrals reviewed within 24–48 hours. Patients typically commence treatment within two weeks.

Submit a Referral
View Referral Process

Urgent query? Call 0468 054 264 

info@goodmindteam.com.au .

Work with Us

Summary of the pivotal TRANSFORM and SUSTAIN trial programs, real-world evidence, and MADRS outcome data for clinical reference.

Refer a patient:

Submit Referral
Check Patient Eligibility

Why join GoodMind?

Meaningful clinical work

Specialised TRD treatment — a growing, underserved field with strong evidence-based protocols and rapid clinical impact.

Veteran & first responder focus

Specialist clinical environment with experienced leadership in trauma and defence-related mental health.

National & growing

Expanding network across Australia with new clinic sites opening. Flexible sessional and full-time arrangements.Specialised TRD treatment — a growing, underserved field with strong evidence-based protocols and rapid clinical impact.

Current Openings

Psychiatric Nurse — Esketamine Administration

Multiple locations · Full-time & part-time · Darwin · Brisbane · Gold Coast · Sydney · Melbourne

Registered Nurse
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Sessional Psychiatrist

Multiple locations · Sessional / VMO · AHPRA registration + Spravato training required

Sessional Psychiatrist
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Clinical Coordinator

Multiple locations · Full-time · Patient liaison, scheduling, referral triage support

Clinical Coordinator
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Nurse Practitioner

Sydney CBD & Melbourne · Full-time · NP registration required

Nurse Practitioner
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Ready to refer a patient?

Referrals reviewed within 24–48 hours. Patients typically commence treatment within two weeks.

Submit a Referral
Check Eligibility First

Urgent query? Call 0468 054 264 

info@goodmindteam.com.au 

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As per the guidelines set by the Therapeutic Goods Administration (TGA), we cannot advertise prescription medications to the public. However, we are committed to providing the best possible care to our clients and offer a range of next-step therapies that can be discussed during a consultation with our team.