Spravato is an FDA-approved esketamine nasal spray for adults whose depression has not improved enough after two or more antidepressants taken at an adequate dose and duration. Because it works through a different mechanism, some people notice improvement sooner even when other treatments haven't worked. Spravato usually has the fullest insurance coverage of our three ketamine options.
Here is how it works from start to finish:
Before your first visit: You do an intake with one of our experienced doctors, reviewing your history and determining if Spravato is right for you. You will have a chance to ask all of the questions you have and get prepared for your treatments. We verify your insurance and handle the prior authorization. On your treatment day, we will ask you not to eat for two hours and not to drink for 30 minutes before your appointment, which lowers the chance of nausea. You will need a ride home, so arrange that ahead of time.
The appointment itself: You sit in a recliner in a comfortable private treatment room. The doctor speaks with you, helps with grounding, and setting intention for the treatment. We check your blood pressure, then you spray the medication into your own nose. After that, you rest. We have eye-shades and headphones with calm playlists you can listen to. Many people feel a floaty, dreamy sensation called dissociation, where your surroundings or sense of your body can feel very different from your day-to-day experience. It usually starts within minutes and eases within an hour. Clinical staff monitor you and remain available throughout. We check your blood pressure again along the way, and you stay with us for at least two hours.
Going home: You cannot drive for the rest of the day, so a friend, family member, or ride service takes you home. Most acute effects resolve the same day, but you should not drive until the next morning after a full night's sleep and only if you feel fully alert.
The schedule: For the first four weeks you come twice a week. For the next four weeks, once a week. After that, most people settle into once every two weeks, and we taper the frequency to the lowest that holds your progress. Spravato is usually taken alongside a daily antidepressant pill, though it can be used on its own.
How we track it: You fill out a short depression questionnaire, the PHQ-9, at each visit. You also meet with a physician to discuss side effects, what the session felt like, and how your response should guide the next step. This is part of preparation and integration throughout treatment.
Some patients want more dedicated psychotherapy around ketamine. Ketamine-assisted psychotherapy (KAP) is available on a limited basis with select clinicians. Its structure and ketamine format vary, so ask during screening if this is what you are seeking.
Spravato tends to fit adults who have tried at least two antidepressants without enough relief and who can commit to the visit schedule and the two-hour stay.
It is not the right choice for some people. We will steer you elsewhere if:
We also take a careful history of substance use. Ketamine can be misused, so if that is part of your story, we talk it through before deciding together.
Spravato is one of three ketamine-based treatments we offer. They differ mainly in how the medicine is given, whether the FDA has approved it for depression, and how insurance treats it. All three are given in our office.
An FDA-approved esketamine nasal spray, self-administered in our office under supervision.
Generic ketamine given in the office as an intramuscular injection or a slow intravenous infusion.
There is no single right answer. Because Spravato is FDA approved, it usually has the fullest insurance coverage of the three. We will talk through which one fits your situation and your insurance.
Spravato is not classically a psychedelic but can cause perceptual changes during the treatment which many people find pleasant or meaningful. While Spravato is often milder in intensity than IM/IV ketamine, people often report a sense of peace, joy, timelessness or insight. Sometimes people will get a feeling of connection and deep meaning. These experiences are sometimes referred to as “mystical experiences” in the psychedelic literature. While not required to have benefit with Spravato, often these experiences can help someone view the world and their situation differently.
Spravato helps a meaningful share of people with treatment-resistant depression, but not everyone, and it is not a one-time fix.
In the trials that led to FDA approval, about half of people reached remission within four weeks when Spravato was started at the same time as another antidepressant (Turkoz et al., JCP 2021).
Spravato has also been compared head-to-head against a common next step, adding a second medication, in the ESCAPE-TRD trial (Reif et al., NEJM 2023) published in the New England Journal of Medicine. More Spravato patients were in remission at eight weeks, and by the end of the study about half of the Spravato group had reached remission.
In the largest follow-up study called SUSTAIN-3, people were tracked for an average of about three and a half years, some beyond six, and those who continued maintenance treatment stayed in remission at about the same rate, with no new safety problems (Zaki et al, IJNP 2025).
In real-world use tracked across more than a million treatment sessions, serious problems were rare (fewer than 1 in 500 sessions), and reports of misuse were very uncommon. That fits how it is used here: only in a monitored office, never sent home with you.
The first step is a brief phone screening to confirm basic fit, and at the screening you get a cost estimate based on your insurance. From there we schedule an hour-long consultation with a psychiatrist to decide together whether Spravato, another ketamine option, or something else entirely is the right next step. Before your first treatment, we handle the prior authorization and enroll you in the federal safety program.
No. Spravato can make you drowsy and slow your reactions for the rest of the day. You will need a friend or family member to drive you, or you can use a ride service. You should not drive again until the next morning, after a full night's sleep.
Some people feel a difference within the first day or two, and a small lift in the first week is common. For most, a clearer change builds over the first month of twice-weekly visits. If you see no benefit after about four to six weeks, we will stop and reconsider rather than keep going out of habit.
Ketamine can be misused, which is why Spravato is only given in a certified office and is never sent home with you. At the doses we use, in a monitored setting, the risk of addiction is low. We screen for any history of substance use and talk through your concerns first.
Yes. Each Spravato appointment takes place in a comfortable private treatment room with a recliner. You do not share the room with other patients. Clinical staff monitor you throughout the required observation period.
What you think about during the Spravato treatments can be strongly affected by what you are doing before. We recommend giving yourself at least 15-30min to help recenter yourself before treatment, especially if what you were doing is stressful. We also recommend trying to incorporate changes in your behavior the few days after your treatment. Research shows that Spravato/ketamine increase neuroplasticity for 72 hours after the medication is given - which is a great window to work on change!
Some patients find coming in with an “intention”, or short focus to reflect on during the session, to be helpful. This can range from a mantra such as “I am worthy”, “I am safe”, etc. Or an open, self-reflective question such as, “What things bring me meaning?”, “How can I view this situation/relationship differently?” etc. You likely won’t stick to it the whole session, but starting in a self-reflective positive headspace can often make the experience better! We also recommend journaling afterwards to help with integrating the experience.
With Spravato, the FDA requires you to be monitored for 2 hours after administration. So, plan for ~2.5 hours for the overall appointment time. Often people will feel mostly back to normal in ~90 minutes. We recommend using that extra time for self-care. Journaling or reading is a great option. We recommend not jumping right into reading stressful work emails, reading the news, etc.
Request an appointment. We’ll check your insurance and help you get started.
