Depression can be stubborn.
If you’ve tried multiple medications without relief, you’re not out of options. Spravato (esketamine nasal spray) is an FDA‑approved treatment for adults with treatment‑resistant depression and can offer faster relief than standard antidepressants for some people.
Premier Psychiatry provides Spravato in a safe, supportive setting to help you decide if it’s the right next step.
What Is Spravato (Esketamine)?
Spravato is an esketamine nasal spray given only in a certified clinic under medical supervision.
It’s approved for adults with treatment‑resistant depression (TRD), either as a stand‑alone treatment or along with an oral antidepressant.
It’s also approved for depressive symptoms in major depressive disorder (MDD) with acute suicidal ideation or behavior when used with an oral antidepressant. Because of safety risks, patients are monitored on site after each dose.
Spravato is part of a restricted REMS program and is not taken at home.
If you’re exploring what is esketamine, it’s the S‑enantiomer of ketamine and works differently from typical antidepressants. It acts on a brain pathway that affects glutamate.
How Does Spravato Work?
In simple terms, Spravato is a non‑competitive NMDA receptor antagonist.
While the exact antidepressant mechanism isn’t fully understood, research shows it modulates the brain’s glutamate system, which is key to mood and learning, and may support rapid changes in brain connections (neuroplasticity).
This is different from medications that primarily target serotonin or norepinephrine.
Who Can Benefit from Spravato?
Spravato is designed for adults with treatment‑resistant or therapy-resistant depression. It is often defined in studies as depression that hasn’t improved after trying at least two antidepressants at an adequate dose and duration.
It can also be used for depressive symptoms in MDD with acute suicidal ideation or behavior when combined with an oral antidepressant in a monitored setting. Your clinician will review your history, current symptoms, and safety considerations to see if you’re a good fit.
Safety and Side Effects
Because Spravato can cause sedation, dissociation (feeling detached), and increases in blood pressure, you’ll stay in the clinic for observation for at least two hours after each session.
Common, usually short‑lived side effects include:
- Dissociation or “spacey” feeling
- Dizziness or vertigo
- Nausea or vomiting
- Feeling sleepy
- Temporary rise in blood pressure
- Headache or “feeling drunk” sensations
You cannot drive or operate machinery until the next day after a restful sleep, so arrange a ride home.
Spravato isn’t for everyone; people with certain vascular conditions (like aneurysms), a history of intracerebral hemorrhage, or a known allergy to esketamine/ketamine should not receive it. Your clinician will screen carefully for safety.
What to Expect During Treatment
- Before your visit: Don’t eat for 2 hours before dosing and avoid liquids for 30 minutes. If you use a nasal steroid or decongestant, take it at least 1 hour before treatment. Arrange transportation home.
- Arrival and check‑in: We’ll check your blood pressure and review how you feel that day.
- Dosing: Spravato is a nasal spray that you self‑administer under direct supervision.
- Observation: You’ll rest on site for at least two hours while we monitor your breathing, blood pressure (including a check around 40 minutes post‑dose), and overall stability.
- Going home: A clinician will clear you when you’re ready to leave. No driving until the next day.
How quickly can it work?
In clinical studies, many patients saw meaningful improvement within about 24 hours of starting treatment, with benefits assessed across the first 4 weeks. Response varies, and ongoing care is important.
Typical schedule for TRD:
- Weeks 1–4 (Induction): Two sessions per week
- Weeks 5–8: Once weekly
- Week 9 and beyond: Once weekly or every other week (the least frequent schedule that keeps you well)
Why Choose Premier Psychiatry for Spravato
We deliver Spravato in a controlled, supportive setting that meets REMS requirements, with continuous monitoring for comfort and safety.
Our providers tailor care to your history, goals, and schedule, and coordinate with your broader treatment plan. From your evaluation to ongoing medication management, we help you stay on track and make informed choices at every step.
Thinking about Spravato?
If your depression hasn’t improved with other treatments, Spravato may be a strong next step.
Reach out to our team to ask questions or schedule an appointment. We’re here to help you find a plan that works.