Spravato® (Esketamine)

FDA-Approved Relief for Treatment-Resistant Depression

Spravato® is a groundbreaking, FDA-approved treatment for adults with treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal thoughts or behaviors.

Unlike traditional antidepressants that may take weeks to work, Spravato® can provide relief within hours to days for many patients.

How Spravato® Works

• Spravato® is delivered as a nasal spray in a medically supervised setting.
• It contains esketamine, a more potent mirror-image form of ketamine.
• Unlike typical antidepressants that target serotonin or norepinephrine, Spravato® acts on the NMDA receptors in the brain, affecting glutamate — a neurotransmitter involved in mood regulation.
• This process promotes neuroplasticity — the brain’s ability to rewire, heal, and form new connections — which may help restore healthy mood patterns.
• Especially effective for those experiencing suicidal thoughts, providing a fast-acting bridge while other treatments take effect.

Who Spravato® Is For

Spravato® is approved for adults who:

• Have treatment-resistant depression (tried at least two antidepressants such as SSRIs, SNRIs, NDRIs, TCAs, or MAOIs without sufficient improvement)
• Have MDD with suicidal ideation or behavior
• Are under the ongoing care of a healthcare provider for depression treatment

Who Should Not Use Spravato®

Spravato® may not be appropriate for people with:

• Aneurysmal vascular disease (brain, chest, or abdomen)
• History of intracerebral hemorrhage
• Uncontrolled high blood pressure
• History of seizures or epilepsy
• History of psychosis
• Current manic episode or frequent mania (more than 3 episodes per year)
• Active drug or alcohol abuse
• Allergy to ketamine or esketamine
• Pregnancy

Your provider will review your full medical history to ensure Spravato® is safe for you.

Insurance Coverage

Most insurance plans cover Spravato® once treatment-resistance criteria are met.
Our team will:

• Handle prior authorization requests
• Coordinate directly with your insurance provider
• Ensure you understand any copays or out-of-pocket costs

Treatment Schedule

Spravato® is given in 3 phases:

1. Induction Phase (Weeks 1–4): 2 treatments per week
2. Optimization Phase (Weeks 5–8): 1 treatment per week
3. Maintenance Phase (Week 9+): Every 1–2 weeks, adjusted to your needs

Each treatment plan is personalized based on your progress and symptoms.

What to Expect During a Session

Length: About 2 hours in-office

Step-by-step:

1. Check-In – Vital signs taken, mental health reviewed
2. Self-Administration – You’ll use the nasal spray under provider guidance
3. Observation Period – Rest in a comfortable recliner while we monitor your blood pressure, heart rate, and overall well-being
4. Discharge – You’ll need a ride home; no driving until the next day

Possible experiences during treatment:

• Feeling light or floating
• Deep relaxation or mild dissociation (feeling separate from your body)
• Changes in time perception
• Visual imagery with eyes closed (colors, patterns, fractals, silhouettes)
• Emotional shifts — peacefulness, curiosity, or introspection

What to Bring

To make your session more comfortable and focused:

• Relaxing music playlist (calming or meditative)
• Noise-cancelling headphones
• Eye mask to help block light and focus inward
• Comfortable clothing
• Blanket (optional)

What to Avoid Before Treatment

For your safety and best results, avoid:

• Stimulants, caffeine, nicotine – Can raise heart rate and blood pressure
• Recreational drugs and alcohol – Can cause unsafe and unpredictable effects
• Benzodiazepines (Xanax®, Ativan®), opioids, Suboxone®, lamotrigine (Lamictal®) – Safe to take but may reduce treatment effectiveness; higher doses may be needed

Tip: Always tell your provider about every medication, supplement, or substance you take.

How Quickly Does It Work?

• Some patients feel improvements after the first few sessions
• Those with suicidal thoughts may notice reduced intensity within hours to days
• Full benefits often develop over several weeks of treatment

Side Effects

Common (short-term, during or shortly after treatment):

• Dissociation
• Dizziness or lightheadedness
• Nausea
• Increased blood pressure
• Sleepiness or fatigue

Rare but Serious:

• Blood pressure elevation requiring intervention
• Prolonged sedation requiring monitoring
• Abuse potential (rare in medical settings)
• Urinary/bladder symptoms (extremely rare)

All treatments are done in a REMS-certified clinic with trained staff for safety.

Why Choose Spravato®

• Fast-acting relief for TRD and suicidal thoughts
• Covered by most insurance once criteria are met
• Safe, structured, and calming environment
• Personalized care and close monitoring
• Expertise in mood disorders and advanced depression treatments

How to Get Started with Spravato® Treatment

We’ve made the process simple and supportive from the start. Follow these easy steps to begin your journey with Spravato®:

Step 1: Complete the Pre-screening Questionnaire

-Start by filling out the brief questionnaire and your contact information at the bottom of this page. This helps us determine if Spravato® treatment is safe and appropriate for you.

Step 2: Receive a complimentary 15-minute consult

-If you are a good candidate, our office will call you for your free 15-minute consultation in order to confirm whether you are a good candidate and also answer any questions you may have. At the end of the call, you will be invited to book an official medical clearance.

-If you are not a right candidate for Spravato® treatment, you may receive a call from our office if you are a good candidate for other treatments we offer.

-If you are not a right candidate for any of the treatments we offer, you will receive an email.

Step 3: Book Your Medical Clearance Appointment

-This is a full evaluation with one of our licensed medical providers for them to get to know you.

-We’ll go over your medical and psychiatric history, discuss how Spravato® works, review potential benefits and side effects, and answer any questions you may have.

-If you’re medically cleared, you will be scheduled your preparation session and a prior authorization will be sent to your insurance. Once we receive approval for treatment from your insurance, our office will be giving you a call to schedule your treatments.

Step 4: Attend Your Preparation Session

-This session helps you feel mentally, emotionally, and spiritually ready for treatment.

-You’ll have space to ask questions, understand what to expect, and set an intention for your upcoming Spravato® sessions.

-Our goal is to help you feel fully supported and empowered before your first treatment.

Ready to Begin?

Click below to complete the Pre-screening Questionnaire and take the first step toward healing.