North Carolina Eating Disorder Program Adds On-Site Depression Care

Treating co-occurring disorders in one place rather than two is the practical problem behind a change announced by The Emily Program in North Carolina in late July. The organization now offers Spravato, the brand name for esketamine nasal spray, at its adult inpatient and residential treatment center in Durham. Eligible adults receive treatment for an eating disorder who also have treatment-resistant depression or major depressive disorder with acute suicidal thoughts or behaviors.

To be sure, North Carolina already offered a wide range of programs for those impacted by mental health disorders. Indeed, before the change, residents who qualified for Spravato had to leave the facility, which interrupted the continuity of their eating disorder care. The company is among a limited number of eating disorder programs nationwide administering the therapy on site.

For families comparing residential treatment centers, the underlying issue here extends beyond one medication. It’s whether a program can treat two conditions at once, such as eating disorders and substance misuse, or has to hand one of them off.

Co-Occurring Conditions Complicate Treatment

Co-occurring disorders, also called dual diagnosis, describe a mental health condition and another condition present at the same time in the same person. Depression, anxiety, and trauma-related conditions frequently appear alongside eating and alongside substance use disorders.

Treating them separately usually works poorly. Each condition worsens the other, and progress on one stalls when the other goes unaddressed. Dr. Joe Crozier, regional medical director for The Emily Program, relayed that addressing both conditions at once remains essential to recovery for people with eating disorders and who also experience depression.

That principle is why integrated treatment has become the standard recommendation for co-occurring conditions across behavioral health, not only in eating disorder care.

Changes at the Durham Facility

The change is logistical rather than clinical, and that’s the point. Becca Eckstein, executive director of The Emily Program’s Douglas location, reported that integrating the treatment into the inpatient and residential programs reduces interruptions to care and lets the clinical team support eligible patients with both their eating disorder, any drug use, and co-occurring depression.

The Durham center provides 24-hour care for adults and combines medical monitoring, psychiatric care, nutrition therapy, and individual and group psychotherapy. It takes patients from across the country.

Esketamine Treatment

Esketamine is a nasal spray approved for adults with treatment-resistant depression and for adults with major depressive disorder who have acute suicidal thoughts or behaviors. Treatment-resistant depression generally means depression that hasn’t responded to an adequate trial of at least two antidepressants.

Due to its risk, clinicians administer esketamine under a restricted program. Patients take it in a certified healthcare setting and are monitored for a period afterward rather than taking it at home. That supervision requirement explains why on-site availability is crucial. A residential patient cannot simply pick up a prescription.

Crozier noted that unlike traditional antidepressants, which can take weeks to work, Spravato may provide meaningful relief from depressive symptoms within 24 to 48 hours for some patients. That’s the company’s characterization, and speed of response varies between individuals.

Ask Questions When Comparing Programs

If you’re researching mental health treatment facilities for someone with more than one diagnosis, a few questions separate integrated programs from those that treat conditions in sequence.

• Does one clinical team manage both conditions, or do two teams coordinate? 
• Is psychiatric medication management available on site?
• What happens if a patient needs a treatment the program doesn’t provide, and does the patient have to leave to get it?
• Which evidence-based therapies are offered, and do clinicians adapt them for the specific combination of conditions the patient has?

Dual Diagnosis and Behavioral Health Treatment

Programs that treat co-occurring disorders exist at every level of care, from outpatient therapy to inpatient treatment. The right level depends on medical stability, safety, and how much structure a person needs, and that judgment belongs to a clinician rather than to a website.

Our browsable directory lists mental and behavioral health treatment centers. Many feature dual diagnosis programs so you can compare options by location, level of care, and the conditions each program treats.

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Courtney Myers, MS

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Courtney Myers has more than 15 years of experience in online writing and editing. Since graduating from N.C. State University with an MS in Technical Communication, she’s helped clients improve their visibility and reach through expert-level content creation. She specializes in addiction recovery and behavioral healthcare topics.

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Peter Lee, PhD

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Peter W.Y. Lee is a writer and historian of American history during the Cold War. His primary focus is the relationship between youth and popular culture and its impact on U.S. society during the twentieth century. He has published widely on how the public has used popular culture as a mechanism to address political and social shifts throughout time