Spravato (Esketamine) — Rapid Relief for Treatment-Resistant Depression
An FDA-approved nasal spray that works differently from traditional antidepressants. Administered in-office under medical supervision, Spravato can reduce depressive symptoms within hours — not weeks.
What Is Spravato?
Spravato (esketamine) is an FDA-approved nasal spray used to treat major depressive disorder in adults who have not responded adequately to other antidepressant therapies. First approved by the FDA in March 2019, it represents a fundamentally new approach to treating depression — one that works through the glutamate system rather than the serotonin pathways targeted by traditional antidepressants.
Esketamine is derived from ketamine, a well-established anesthetic medication used in medicine for decades. However, Spravato is not the same as IV ketamine infusions. It is a purpose-built, standardized pharmaceutical product administered as a nasal spray under strict medical supervision as part of the FDA's Risk Evaluation and Mitigation Strategy (REMS) program.
What makes Spravato unique among depression treatments is its speed. Traditional antidepressants can take 4–6 weeks or longer to produce meaningful improvement. Spravato can begin reducing symptoms within hours to days — a critical advantage for patients suffering from severe depression, particularly those with suicidal ideation who cannot afford to wait weeks for relief.
How a Spravato Session Works
Every Spravato treatment follows a structured, medically supervised protocol to ensure your safety and comfort.
Self-Administer Nasal Spray
Under clinical supervision, you self-administer the Spravato nasal spray in a comfortable, private treatment room. The process takes just a few minutes.
2-Hour Monitored Observation
Per the FDA-mandated REMS protocol, you remain in the clinic for a full 2-hour observation period. Your care team monitors vital signs and ensures your comfort throughout.
Go Home with a Driver
Due to potential sedation and dissociative effects, you cannot drive for the rest of the day after treatment. Arrange for a trusted friend, family member, or rideshare to take you home.
REMS Safety Protocol
Spravato is administered under a Risk Evaluation and Mitigation Strategy (REMS) — an FDA-mandated safety program that ensures the medication is used in the safest possible way. This is not a limitation; it's a layer of protection designed to give you the best possible treatment experience.
Certified Healthcare Setting Only
Spravato can only be administered in a clinic that is certified under the REMS program. You cannot receive it at home, and it cannot be dispensed by a retail pharmacy.
Supervised Administration
You self-administer the nasal spray under the direct supervision of a healthcare provider who is trained and certified in the REMS protocol.
2-Hour Post-Dose Monitoring
After each dose, you are monitored for a minimum of 2 hours. Your care team checks vital signs (including blood pressure) and assesses for sedation, dissociation, and any other adverse effects.
Transportation Requirement
You must arrange for someone to drive you home after every treatment session. You may not drive, operate machinery, or perform hazardous activities until after a restful sleep.
Our clinics are fully REMS-certified. All Restore Brain locations meet every requirement of the Spravato REMS program. Our clinical teams are trained in the protocol, our treatment rooms are designed for patient comfort during observation, and we handle all documentation and reporting requirements on your behalf.
Who Is a Candidate for Spravato?
Spravato is FDA-approved for two specific patient populations. You may qualify under either indication:
Treatment-Resistant Depression (TRD)
- Adults 18 years or older
- Diagnosed with treatment-resistant depression (failed 2 or more oral antidepressant therapies)
- Currently taking an oral antidepressant (Spravato is used in conjunction, not as a standalone)
- Medically cleared to receive treatment in a certified healthcare setting
MDD with Acute Suicidal Ideation or Behavior
- Adults with major depressive disorder (MDD)
- Experiencing acute suicidal ideation or behavior
- Requiring rapid reduction in depressive symptoms
- Currently taking an oral antidepressant
A Treatment Specifically Indicated for Suicidal Ideation
Spravato is the only FDA-approved treatment specifically indicated for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior. Its rapid onset of action makes it a critical option when patients need relief urgently — not in weeks, but in hours.
If you or someone you know is in crisis, contact the Suicide & Crisis Lifeline — call or text 988, available 24/7.
Treatment Schedule
Spravato follows a phased treatment schedule that starts with more frequent sessions and gradually reduces to a maintenance cadence based on your individual response.
Induction (Weeks 1–4)
Twice per weekDuring the first four weeks, you'll receive Spravato treatments twice weekly to build therapeutic levels and establish your response. Each visit includes the administration and full 2-hour monitoring period.
Maintenance (Weeks 5–8)
Once per weekIf you respond to treatment, your clinician will reduce the frequency to once weekly. Dosing is adjusted based on your individual response and tolerability.
Extended Maintenance (Week 9+)
Once weekly or every 2 weeksLong-term maintenance is tailored to your needs. Some patients continue once weekly, while others can extend to treatments every two weeks. Your clinician will regularly reassess to find the optimal schedule.
What to Expect During a Session
Each Spravato session follows the same general structure. You'll arrive at the clinic, have your blood pressure checked, and then be guided to a comfortable, private treatment room. You self-administer the nasal spray under your clinician's supervision — the process takes only a few minutes.
After administration, you recline and relax for the 2-hour observation period. Many patients choose to listen to music, close their eyes, or simply rest. Your care team is present throughout to monitor your vital signs and attend to any needs.
Common Temporary Effects During the Session
These effects are expected, typically mild, and almost always resolve before you leave the clinic:
Dissociation
A feeling of detachment from your surroundings or yourself. Usually mild and temporary, resolving within the 2-hour observation period.
Dizziness
Some patients experience lightheadedness or dizziness, which is why the observation period and transportation requirement exist.
Nausea
A small percentage of patients feel nauseous during or shortly after the session. This is typically mild and short-lived.
Increased blood pressure
Temporary elevation in blood pressure is monitored closely by your care team during the observation period.
Sedation
Feelings of drowsiness or sedation are common during the observation period and are a key reason you cannot drive afterward.
After the observation period,your care team will confirm you are stable, and your pre-arranged driver will take you home. You should not drive, operate machinery, or make important decisions until after a full night's sleep.
Rapid, Meaningful Results
The defining advantage of Spravato over traditional antidepressants is speed. In clinical trials, patients treated with Spravato plus an oral antidepressant showed statistically significant improvement in depression scores compared to those on an oral antidepressant alone — and many patients reported noticeable improvement within hours to days of their first dose.
This rapid onset is especially critical for patients experiencing suicidal ideation, where every day of delayed relief carries serious risk. Long-term studies have demonstrated that Spravato, when used as maintenance therapy, significantly delays relapse in patients who initially responded to treatment.
Hours to Days
Onset of Action
vs. 4–6 weeks for traditional antidepressants
51% Lower
Relapse Risk
with continued maintenance therapy vs. discontinuation
Insurance & Coverage
Most major insurance providers cover Spravato treatment, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare, and many commercial plans. Because Spravato is FDA-approved (not off-label), it has broader insurance acceptance than IV ketamine infusions.
Prior authorization is required for all patients before treatment can begin. Our patient coordinators manage this entire process — gathering clinical documentation, submitting the authorization request, and following up with your insurer. We'll confirm your coverage and explain any out-of-pocket costs before you start.
Janssen (the manufacturer of Spravato) also offers a patient savings program that may reduce your co-pay. Ask our team about additional financial assistance options during your consultation.
Frequently Asked Questions
See If Spravato Is Right for You
Schedule a free, no-obligation consultation. We'll review your treatment history, explain the process in detail, verify your insurance coverage, and help you decide if Spravato is the right next step.
Or call us: (469) 300-5529 (DFW) · (314) 392-2897 (St. Louis)