Self-harm and self-injury: How esketamine, TMS and medication may support recovery

Self-harm is one of the most visible signs of seemingly invisible distress. For many, it’s a deeply private way to cope with emotional pain caused by trauma, depression and/or other underlying issues. While recovery can feel inaccessible when other approaches offer limited relief, modern interventions have reshaped the ways clinicians treat many patients who struggle with self-harm. 

Psychiatry Treatment Centers specializes in advanced treatments like Spravato® (esketamine) and transcranial magnetic stimulation (TMS) therapy. In this article, we’ll discuss the signs of self-harm and how esketamine, TMS and medication may help.

Understanding self-harm and self-injury

Self-harm describes when someone hurts themselves on purpose. While this behavior can lead to suicide, that’s not always the goal. Self-inflicted harm without suicidal intent is referred to as nonsuicidal self-injury. People injure themselves for many reasons. For some, it provides a sense of relief when they’re having a hard time coping with stress or negative feelings like loneliness or anger. Other people do it to take out their frustration on themselves or let others know they need help. Also, several mental health conditions may be associated with self-injury, such as:

• Anxiety
• Depression
• Bipolar disorder
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Certain personality disorders

Signs of self-harm

The risk for nonsuicidal self-injury may depend on several factors. Generally, it’s higher for people with a history of trauma or abuse. Possible warning signs of self-harm include:

• Feeling worthlessness or helplessness
• Impulsive or intense emotions and behaviors
• Scabs, scars, fresh cuts, bruises, bite marks or burns, especially in patterns
• Impulse-control issues, like they can’t stop rubbing or scratching the same area of skin
• Frequent accidental injuries
• Keeping sharp objects on hand

Depending on the location of their injuries, a person may try to cover up the noticeable marks with their clothing, even in warm weather. Self-harm behaviors can occur anywhere on the body, but they’re often done on the following areas: 

• Abdomen
• Arms
• Chest
• Thighs
• Wrists

Dial 911 if you feel that you or a loved one with a self-inflicted injury needs emergency care. You can also call or text 988, the 988 Suicide & Crisis Lifeline, for immediate support.

Spravato®

Spravato® is an FDA-approved medication that contains esketamine. Unlike other prescriptions, the patient administers this nasal spray under the supervision of a provider in a certified Spravato® treatment center. Spravato® works by targeting the NMDA receptor in the brain, which can help restore vital neuronal connections. 

First, you’ll receive a psychiatric evaluation to determine if Spravato® is right for you. A provider will also coordinate with your insurance for prior authorization. Once that’s complete, you can begin treatment, which usually spans two to three months. Each session includes two essential parts:

• Spravato® administration — In a private treatment room with a provider, you will self-administer the nasal spray.

• Two-hour observation period — Next, you’ll be placed in a quiet room, while the staff monitors your vital signs and any possible side effects.

During the observation period, you can listen to calming music, journal or read. At PTC, we also supply eyemasks and/or earplugs for added comfort.

Transcranial magnetic stimulation (TMS)

TMS therapy is an FDA-approved, noninvasive outpatient treatment for treatment-resistant depression, anxious depression and obsessive-compulsive disorder. This method uses electromagnetic pulses to stimulate underactive parts of the brain that are known to be associated with your  symptoms. The goal is to improve cognitive functioning and emotional regulation.

As with Spravato®, you’ll need a psychiatric evaluation to determine if you need this treatment and your provider will work with your insurance to get the necessary prior authorization. A patient undergoing TMS therapy typically attends 36 sessions that span six to eight weeks. After the initial appointment where your provider pinpoints the optimal parts of your brain to target, each session takes approximately 10-20 minutes.

TMS therapy doesn’t require downtime, so you may return to your usual routine after each session.

Integrating treatments to support recovery

Spravato® and TMS therapy are innovative treatments that may be prescribed when other mental health treatments have proven insufficient or resulted in intolerable side effects. But that doesn’t mean that traditional approaches won’t be part of your treatment plan. Many providers recommend that their patients continue taking the prescriptions they typically use to support their mental health and go to psychotherapy. 

You and your provider can explore different options available together. Each person’s treatment plan is personalized to meet their needs, and it can depend on their symptoms, health, lifestyle and other factors. 

Take the next step toward healing with Psychiatry Treatment Centers 

Recovery from self-harm and the underlying reasons behind it can be a journey, but it’s one you can take with a caring, experienced provider by your side. At Psychiatry Treatment Centers, we can help you manage the underlying condition that could be behind your self-harm tendencies. Our services include medication management, esketamine, TMS therapy and psychotherapy, and we specialize in treating patients with several mental health concerns, including: 

• Generalized anxiety disorder (GAD)
• Major depressive disorder with suicidal ideation or behavior (MDSI)
• Attention-deficit/hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder (OCD)

Reach out to our team by phone for more information about self-harm treatments or to schedule an initial appointment. You can also book your first appointment online today.