What Is Spravato®?
Spravato® (esketamine) is an FDA-approved nasal spray for adults with treatment-resistant depression (TRD) — a form of major depressive disorder (MDD) where symptoms have not adequately improved after trying at least two different oral antidepressants.
Unlike traditional antidepressants that primarily target serotonin, norepinephrine, or dopamine, Spravato® works through a different mechanism by acting on the brain’s glutamate system. This unique approach promotes the formation of new neural connections, potentially offering relief when other treatments have not been effective.
In January 2025, the FDA expanded its approval of Spravato®, making it the first and only monotherapy for adults with treatment-resistant depression. Since its original approval in 2019, Spravato® has been administered to more than 140,000 patients in 77 countries worldwide.
Who Is Spravato® For?
Spravato® may be appropriate for you if:
- You have been diagnosed with major depressive disorder (MDD)
- You have tried at least two different oral antidepressants without adequate improvement
- Your symptoms continue to significantly affect your daily life and functioning
- You are looking for an alternative approach to managing treatment-resistant depression
How Does Spravato® Work?
Spravato® is a non-selective, non-competitive antagonist of the NMDA (N-methyl-D-aspartate) receptor. By modulating glutamate — the brain’s most abundant chemical messenger — it helps restore synaptic connections in brain areas affected by depression.
This mechanism is fundamentally different from traditional antidepressants. While conventional medications can take weeks to show effect, Spravato® has been shown to provide improvement in depressive symptoms that some patients notice within 24 hours of their first treatment session.
Clinical Results
In clinical studies, Spravato® demonstrated significant improvement in depression symptoms compared to placebo:
- Rapid symptom relief observed as early as 24 hours after initial treatment
- By week 4, 22.5% of patients achieved remission compared to 7.6% on placebo
- Sustained improvement when continued as a maintenance treatment
What to Expect During Treatment
Spravato® is administered as a nasal spray in our certified treatment center under direct medical supervision. Here is what a typical treatment journey looks like:
Initial Consultation
Your psychiatrist evaluates your treatment history, current symptoms, and overall health to determine if Spravato® is appropriate for you.
Treatment Sessions
You self-administer the nasal spray under supervision at our clinic. Each session involves three doses, spaced five minutes apart. Sessions are typically scheduled twice per week during the first month.
Monitoring Period
After each treatment, you remain in our clinic for at least two hours so our medical team can monitor your blood pressure and overall response to the medication.
Maintenance Phase
Once your symptoms have improved, the frequency of treatment sessions is gradually reduced to once weekly or once every two weeks, based on your individual response.
Safety & Side Effects
Spravato® is available only through an FDA-mandated Risk Evaluation and Mitigation Strategy (REMS) program, ensuring it is administered safely at certified healthcare settings like ours.
The most common side effects include:
- Dissociation (feeling disconnected from yourself, your thoughts, or your surroundings)
- Dizziness or vertigo
- Nausea
- Sedation or drowsiness
- Temporary increase in blood pressure
- Headache
Side effects typically peak around 40 minutes after treatment and generally resolve within two hours. Most patients find that side effects are most noticeable during the first one or two sessions and tend to diminish with subsequent treatments.
Important Safety Information
- You must not drive or operate heavy machinery until the following day after each treatment session
- Treatment must be administered in a certified healthcare setting under medical supervision
- Inform your provider about all medications you are currently taking
- Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding
Why Choose Crasmere Psychiatric Services for Spravato®?
- REMS-Certified Treatment Center: Our practice is certified under the FDA’s REMS program to administer Spravato® safely and effectively
- Experienced Psychiatric Team: Our board-certified psychiatrists have extensive experience in treating treatment-resistant depression
- Comfortable Treatment Environment: Our clinic provides a calm, private setting designed for your comfort during treatment sessions
- Comprehensive Care: Spravato® treatment is integrated into a broader, personalized treatment plan that may include therapy, medication management, and ongoing support
- Multiple Locations: Conveniently located offices across Staten Island, Manhattan, and Long Island
Frequently Asked Questions
Plan to spend approximately 2.5 to 3 hours at our clinic for each session. The nasal spray administration takes about 15 minutes, followed by a mandatory two-hour observation period where our team monitors your vitals and well-being.
Many insurance plans do cover Spravato® treatment, though coverage varies by provider. Our team will work with you to verify your insurance benefits and explore available options, including the Spravato® savings program for eligible patients. Contact our office to discuss your specific situation.
Some patients experience improvement in depressive symptoms within 24 hours of their first treatment. However, the timeline varies for each individual. Your psychiatrist will assess your progress at each session and adjust your treatment plan accordingly.
Spravato® is now approved both as a standalone treatment and in combination with an oral antidepressant. Your psychiatrist will determine the best approach for your individual situation during your consultation.
Spravato® (esketamine) is closely related to ketamine but is not identical. Esketamine is the S-enantiomer of ketamine and is the only form FDA-approved specifically for treatment-resistant depression. Unlike compounded ketamine infusions, Spravato® has undergone rigorous clinical trials and is available through a structured REMS safety program.
