What Is SPRAVATO®?

When depression has not improved with traditional treatments, SPRAVATO® may offer another path forward.

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SPRAVATO® is the brand name for esketamine. It is an FDA-approved prescription nasal spray for certain adults living with depression. Unlike standard antidepressants, it acts on the brain’s glutamate system. 

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Who may benefit from SPRAVATO?

SPRAVATO®may be considered for adults with:

• Treatment-resistant depression, generally meaning depression that has not responded adequately to previous antidepressant treatments

• Major depressive disorder with acute suicidal thoughts or behavior, when used with an oral antidepressant

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For treatment-resistant depression, SPRAVATO is FDA-approved either by itself or with an oral antidepressant. A psychiatric evaluation is required to determine whether it is appropriate for you.

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SPRAVATO has not been shown to prevent suicide or eliminate the possible need for hospitalization during a mental health crisis.

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How It Works

Most traditional antidepressants primarily affect serotonin, norepinephrine, or dopamine. SPRAVATO® works differently by affecting the brain’s NMDA receptors and glutamate signaling.

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SPRAVATO® isn't a medication you take home. It's administered in our office, under direct medical supervision, as part of a structured treatment program:

• You self-administer the nasal spray while a member of our clinical team observes directly.

• You're then monitored on-site for a minimum of two hours to check blood pressure, heart rate, and overall well-being before you're cleared to leave.

• Because of the monitoring requirements, you'll need someone to drive you home as you cannot drive or operate machinery for the rest of the day.

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Treatment typically follows this schedule:

• Weeks 1–4: twice-weekly sessions

• Weeks 5–8: weekly sessions

• Week 9 and beyond: individualized to the least frequent schedule that maintains your response, either every other week or weekly

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Every session includes real-time monitoring by our clinical team, and your provider stays closely involved in adjusting your treatment plan as you progress.

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How might treatment feel?

Experiences vary.

 

Some people report temporary changes in perception, a dreamlike sensation, dizziness, sleepiness, or feeling disconnected from their surroundings. These effects commonly occur shortly after administration and are why every session includes medical monitoring.

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Common side effects may include:

• Dissociation or altered perception

• Dizziness or vertigo

• Sleepiness or sedation

• Nausea or vomiting

• Increased blood pressure

• Anxiety

• Headache

• Numbness or reduced sensation

• Feeling temporarily intoxicated

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SPRAVATO® also carries serious risks, including respiratory depression, sedation, dissociation, and the potential for abuse or misuse. It is a federally controlled substance and is available only through the SPRAVATO® REMS safety program.

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Is SPRAVATO® Right for You?

SPRAVATO is not appropriate for everyone. Before treatment, tell your clinician about all medical conditions, medications, supplements, substance-use history, and any possibility of pregnancy.

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SPRAVATO® may be worth discussing with your provider if:

• You've tried two or more antidepressants at an adequate dose and duration without sufficient improvement, or

• You're experiencing major depressive disorder with acute suicidal thoughts or behaviors

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SPRAVATO® should not be used by people with certain blood-vessel conditions, an arteriovenous malformation, a history of bleeding in the brain, or an allergy to esketamine or ketamine. Extra caution may be necessary for people with cardiovascular problems, uncontrolled high blood pressure, or other medical concerns.

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Your provider will review the potential benefits and risks with you before recommending treatment.

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Insurance & Cost

SPRAVATO® is typically covered by insurance for eligible clients. SPRAVATO® offers several rebate programs to help clients with costs associated with treatment.

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Coverage is not guaranteed, and eligibility requirements differ among insurance plans.

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Take the next step

Depression that has not responded to previous treatment can feel discouraging, but it does not mean you are out of options. Our team will listen to your experience, review your treatment history, and help determine whether SPRAVATO should be part of your care.

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