Spravato® (esketamine) for treatment-resistant depression.
When standard antidepressants have not relieved depression, Spravato® is an FDA-approved nasal spray that acts on the brain's glutamate system. It is given only in REMS-certified healthcare settings, under the direct observation of a healthcare provider. Spravato® is offered at our Orland Park and Willowbrook offices.
A different mechanism for treatment-resistant depression.
Traditional oral antidepressants (SSRIs and SNRIs) act on monoamines like serotonin and norepinephrine in the brain and usually take four to eight weeks to work. For people with Treatment-Resistant Depression (TRD), these oral medications have not provided enough relief.
Spravato® (esketamine) nasal spray works on a different system: it is an NMDA receptor antagonist that acts on the brain's glutamate system. The exact way it relieves depression is not known; research suggests it may support changes in brain connections (neuroplasticity). In clinical studies, a difference from placebo was seen as early as about 24 hours after the first dose, although results vary from person to person.
Who May Be Considered for Spravato®?
- Treatment-Resistant Depression (TRD): Adults with major depressive disorder who, in the current episode, have not responded adequately to at least two different oral antidepressants of adequate dose and duration (the definition used in the clinical studies).
- Depressive Symptoms with Acute Suicidal Ideation: FDA-approved, in conjunction with an oral antidepressant, to treat depressive symptoms in adults with MDD with acute suicidal ideation or behavior. (FDA limitation of use: effectiveness in preventing suicide or in reducing suicidal ideation or behavior has not been demonstrated; hospitalization may still be needed if clinically warranted.)
- Treatment-Resistant Depression & MDD with Suicidal Ideation: Prescribed as monotherapy or in conjunction with an oral antidepressant for TRD, and in conjunction with an oral antidepressant for MDD with acute suicidal ideation or behavior.
- Insurance Coverage: Coverage varies by plan. Please call our office to confirm whether your plan is accepted before your first visit.
What to Expect During Your Spravato® Session
Because esketamine can cause sedation, dissociation, respiratory depression and increased blood pressure, the FDA-required SPRAVATO REMS allows it to be given only in certified healthcare settings, where patients self-administer it under the direct observation of a healthcare provider.
Baseline Vitals & Assessment
Before each dose, a healthcare professional checks your blood pressure and how you are feeling that day.
Supervised Self-Administration
Under the direct observation of a healthcare provider, you self-administer the nasal spray (2 devices for a 56 mg dose or 3 devices for an 84 mg dose), resting 5 minutes after each device.
At Least 2 Hours of Clinical Monitoring
A healthcare provider monitors you for at least two hours, including your breathing (with pulse oximetry) and your blood pressure at about 40 minutes after the dose, until you are assessed as clinically stable and ready to leave.
FDA-Labeled Dosing Schedule for TRD
For treatment-resistant depression, the FDA-approved prescribing information recommends the schedule below, with dosing adjusted by your prescriber based on response and tolerability. (For MDD with acute suicidal ideation or behavior, the labeled dosing is twice weekly for 4 weeks, with an oral antidepressant.) Our practice's own treatment steps may add to this; ask our office for details.
Weeks 1 Through 4
2 sessions per week, 56 mg or 84 mg per session. At the end of this phase, your prescriber evaluates whether there is enough benefit to continue treatment.
Weeks 5 Through 8
1 session per week, 56 mg or 84 mg per session, while your provider continues to monitor your response.
Week 9 and Beyond
1 session every week or every 2 weeks, individualized to the least frequent schedule that maintains your response.
Authoritative Medical References & Prescribing Guidelines
- • U.S. Food and Drug Administration (FDA): FDA-approved SPRAVATO® (esketamine) nasal spray prescribing information (Janssen Pharmaceuticals, revised March 2026), including the Boxed Warning and SPRAVATO REMS requirements.
- • National Institute of Mental Health (NIMH): Depression (NIH Publication No. 24-MH-8079, revised 2024), including how long antidepressants usually take to work.
- • SPRAVATO REMS Program: Requirements for certified healthcare settings, patient enrollment and post-dose monitoring (www.SPRAVATOrems.com).