Spravato (Esketamine)

About Spravato

If you've tried two or more antidepressants and they haven't helped, or if you're having thoughts of suicide right now, you need to know about Spravato. It's not another pill to add to your routine. It's an FDA-approved treatment — a nasal spray called esketamine — that works differently than traditional antidepressants. And for some people, it works fast.

Treatment-resistant depression is real. It's not a sign that you're not trying hard enough or that therapy isn't working. It means your brain chemistry needs a different approach. Spravato is designed specifically for that. It works through different brain pathways than the antidepressants you may have already tried, which is why it can help when other medications haven't.

Spravato is also FDA-approved for people in acute crisis — if you're having thoughts of suicide or harming yourself, this treatment can provide rapid relief. We're talking hours to days, not weeks.

This isn't ketamine infusion therapy. Spravato is a specific formulation of esketamine with FDA approval, insurance pathways, and a structured treatment protocol. It's administered in our office, not at a clinic or surgery center, and it's covered by most insurance plans.

Who Is Spravato For

You might be a candidate for Spravato if you:

• Have major depressive disorder and have tried at least two antidepressants at adequate doses for adequate time without sufficient improvement
• Are experiencing acute suicidal ideation or have recent suicidal behavior
• Are looking for faster relief than traditional antidepressants provide
• Have tried therapy and medication but still feel stuck
• Can commit to the treatment schedule and have someone to drive you home after each session
• Don't have uncontrolled high blood pressure or certain other medical conditions that would make Spravato unsafe for you

Spravato isn't right for everyone. Some medical conditions, certain medications, or uncontrolled blood pressure can make it unsafe. We'll do a full evaluation to make sure this is the right fit for you.

This treatment works best as part of a larger plan — it's always combined with an oral antidepressant and often paired with therapy. Spravato isn't meant to replace other treatment; it's meant to jump-start improvement when you've been stuck.

How Spravato Treatment Works

Spravato is administered through what's called a REMS program — that's a FDA requirement that ensures it's given safely in a certified healthcare setting with proper monitoring. Here's what the process actually looks like:

Before your first session: We'll check your blood pressure, talk through your medical history, and make sure you understand what to expect. You'll need an oral antidepressant on board before starting Spravato.

During treatment: You come to our office in Toledo or Monroe. You'll self-administer the nasal spray under our supervision — we guide you through it. The dose is small and absorbed through the nasal membranes. You'll sit in a comfortable monitoring area for about 2 hours afterward. We'll check your vital signs, watch for side effects, and make sure you're safe before you leave.

You cannot drive yourself home. You need someone to pick you up after every session. This is non-negotiable — dissociation and dizziness are common side effects that wear off during the monitoring period, but you're not safe to drive.

Treatment schedule: Most people start with twice-weekly sessions for the first four weeks. Then it usually drops to once weekly for weeks 5-8. After that, many people transition to maintenance dosing — typically once weekly or every two weeks, depending on how you're responding.

Improvement timeline: Some people notice changes within hours or a few days. Others take longer — full response might take 2-4 weeks of treatment. We'll monitor how you're doing and adjust the schedule if needed.

What to Expect

Your first appointment will be an evaluation. We'll talk about your depression history, what medications you've tried, your current situation, and whether Spravato makes sense for you. We'll also discuss your medical history, check your blood pressure, and go over what treatment involves in detail. This is your chance to ask questions and be honest about whether you can commit to the schedule.

Side effects during treatment: Dissociation is common — that's a floating or detached feeling that most people experience during or right after the nasal spray. It usually fades during your monitoring period. Dizziness, nausea, sedation, increased blood pressure, and headache also happen for some people. Most of these effects resolve within the 2-hour monitoring window. We're there watching and ready to help if you need it.

What you'll feel during monitoring: You might feel spacey, relaxed, or a little emotional. Some people describe it as similar to coming out of anesthesia at the dentist. You'll be in a private space, not in a waiting room. You can bring headphones, a book, or just rest. Someone will check on you regularly.

After you leave: You might feel tired or a bit out of it for a few hours. Rest, eat something light, and let that oral antidepressant keep working. Most people are back to normal by the next morning.

Week to week: As you progress through treatment, your mood might start shifting. Some people feel less heaviness, more motivation, or notice that dark thoughts have quieted down. Others notice small improvements before the big ones hit. It's not linear — some weeks are better than others, and that's expected.

Insurance and logistics: We handle prior authorization and insurance verification. Coverage varies by plan, but most major insurers cover Spravato. We'll talk through costs upfront and work with you on what's feasible. You'll need transportation arranged for each session — whether that's a family member, friend, or car service, plan ahead.

FAQ

How is Spravato different from ketamine infusion therapy? Spravato is FDA-approved esketamine in nasal spray form, given in a structured clinical setting with insurance coverage. Ketamine infusions use a different formulation and are typically given by IV in specialty clinics. Spravato has the FDA pathway and insurance approval behind it; infusions don't. Both can be effective, but Spravato is the regulated, insured option.

What if the first few sessions don't help? Give it time. Some people respond immediately; others need 2-4 weeks of consistent treatment. We'll monitor your progress and talk about whether to continue, adjust the dose, or try something different. If Spravato isn't working after giving it a fair shot, we'll explore other options with you.

Can I take Spravato and therapy at the same time? Yes — actually, we recommend it. Spravato helps stabilize your mood and reduce depression symptoms. Therapy gives you tools and helps you process what's been happening. Together, they're more effective than either alone. Many people find that once Spravato has lifted the worst of the depression, they can actually engage in therapy.

What happens after I feel better? You'll move into a maintenance phase — typically once weekly or every two weeks, depending on how you're responding. The goal is to keep you stable with the lowest effective dose. As your depression improves and your oral antidepressant kicks in more fully, we might be able to space out Spravato doses or eventually stop it. This is something we'll plan together as you progress.

Is Spravato addictive? No. It's not an addictive medication. It's designed to treat depression, not to create dependency. That said, it does have dissociative effects, which is why it's given in a monitored setting. The REMS program exists to keep it safe and appropriate.

What if I can't get someone to drive me to appointments? Transportation is a real barrier, and we get it. Talk to us about this upfront. We can sometimes problem-solve options — whether that's adjusting appointment times, connecting you with local transportation services, or exploring other treatment paths that might work better for your situation. Don't let transportation stop you from asking; we'll figure it out together if we can.