If you or a loved one has struggled with treatment-resistant depression or major depressive disorder with suicidal thoughts, you may have heard of SPRAVATO® (esketamine)—a nasal spray medication offering hope to those who haven’t found relief from traditional antidepressants. FDA-approved and available at REMS-certified centers like Active Path Mental Health, SPRAVATO is reshaping how we treat severe depression.
Naturally, with any new treatment, questions come up. You might be wondering what to expect, how long sessions last, what insurance covers, and how effective the treatment is.
We’ve answered the most common questions here to help you feel informed and confident in your decision. For more detailed information, refer to the full SPRAVATO FAQs from healthcare providers.
Ready to explore SPRAVATO for treatment-resistant depression? Contact Active Path or call 503.719.4648 to schedule a consultation.
What Is SPRAVATO and How Does It Work?
SPRAVATO is the brand name for esketamine, a derivative of ketamine, which has long been used as an anesthetic and, more recently, as a breakthrough treatment for depression. SPRAVATO is FDA-approved for:
- Adults with treatment-resistant depression (TRD)
- Adults with major depressive disorder (MDD) with suicidal thoughts or actions
SPRAVATO treatments are specifically designed for adults with treatment-resistant depression and are administered under strict medical supervision.
Unlike traditional antidepressants that can take weeks to start working, SPRAVATO targets a different brain pathway, the glutamate system, and often works much faster. Many patients report feeling relief within hours or days of treatment.
The medication is administered as a nasal spray in a clinical setting under medical supervision. Patients remain at the center for at least two hours after each session to monitor for side effects.
Who Is a Candidate for SPRAVATO Treatment?
SPRAVATO is typically prescribed for individuals who:
- Have not responded to two or more oral antidepressants
- Have been diagnosed with treatment-resistant depression
- Have active suicidal thoughts, in some cases
A provider will review your medical history to determine eligibility and will consider your medical history, current medications, and overall mental health. SPRAVATO is not recommended for individuals with certain medical conditions, including:
- A history of aneurysms or intracerebral hemorrhage
- Uncontrolled high blood pressure
- Substance use disorders, particularly those involving ketamine
- Blood vessel disease
- An abnormal connection between your blood vessels
If you’re unsure whether you qualify, the team at Active Path can conduct a psychiatric evaluation to determine your eligibility.
What Happens During a SPRAVATO Session?
SPRAVATO is not a take-home medication. Every dose is administered in a REMS-certified treatment center like Active Path. Here’s what to expect:
- Arrival & Check-In: You’ll be greeted by staff and guided to a comfortable treatment room.
- Administration: You’ll self-administer the nasal spray under supervision.
- Vitals & Screening: Your vital signs will be taken before the treatment begins, and every 40 minutes throughout the session
- Observation Period: You’ll stay in the treatment center for two hours so the Active Path staff can monitor you for any immediate side effects like dizziness, dissociation, or changes in blood pressure.
- Transportation Home: Due to potential side effects such as sedation, there is a driving restriction. You cannot drive or operate machinery for the rest of the day. Ensure you have a ride home and avoid activities that require full mental alertness until the next day, following a restful sleep.
Most patients find the experience calming and report feeling safe and well-supported throughout the process.
How Long Is SPRAVATO Treatment?
The SPRAVATO treatment protocol happens in two phases:
The first phase is the induction phase, which typically lasts for four weeks. During this period, patients receive SPRAVATO twice a week. The second phase is the maintenance phase, where the frequency of administration is reduced based on the patient’s response to the treatment. It is crucial to follow the healthcare provider’s recommendations regarding the dosing frequency to achieve the best results.
1. Induction Phase (Weeks 1–4):
- Two sessions per week
- Helps jump-start symptom relief
2. Maintenance Phase (Weeks 5+):
Once-weekly for four weeks until week 8, and then either weekly or biweekly sessions, depending on your progress.
- Designed to help maintain the benefits of the initial phase
Many patients continue SPRAVATO for several months, some even continue indefinitely if they are experiencing the response they are looking for. Your treatment plan after week 8 will be individualized based on your response and needs.
Be sure to plan for transportation on treatment days due to potential side effects.
What Are the Potential Side Effects?
Like any medication, SPRAVATO has potential side effects, though most are mild to moderate. Common side effects include:
- Dizziness
- Nausea
- Dissociation (feeling like you are outside of your body or in a dreamlike state)
- Sedation or drowsiness
- Increased blood pressure (temporarily)
- Reduced sense of touch and sensation
These side effects typically resolve within a few hours. That’s why observation after treatment is so important. Your provider will monitor your symptoms closely and adjust the treatment plan as needed.
How Effective Is SPRAVATO?
SPRAVATO has shown promising results in clinical trials and real-world practice:
- Most patients experience rapid relief within hours or days
- Studies show a significant reduction in depressive symptoms for those with treatment-resistant depression. Clinical studies demonstrate significant improvements in depression symptoms compared to placebo after specific treatment durations.
- Patients with suicidal thoughts often report a noticeable decrease in symptoms, especially in the first month
While results vary from person to person, SPRAVATO can be life-changing for those who haven’t found success with traditional antidepressants. It is important to assess whether the potential benefits of SPRAVATO, such as alleviating depressive symptoms, outweigh possible adverse outcomes like sedation and increased blood pressure.
Is SPRAVATO Safe and FDA-Approved?
Yes. SPRAVATO was FDA-approved in 2019 as an FDA-approved nasal spray for adults with treatment-resistant depression, and later expanded to include those with MDD and suicidal ideation. It is only available at certified REMS (Risk Evaluation and Mitigation Strategy) treatment centers, like Active Path.
The REMS program ensures that:
- SPRAVATO is administered only in safe, monitored environments
- Patients are observed for side effects
- Proper follow-up care is provided
How Much Does SPRAVATO Cost?
The cost of SPRAVATO treatment can vary depending on:
- Your insurance coverage
- The number of sessions required
- In-network vs. out-of-network status with your provider
Does Insurance Cover SPRAVATO?
In most cases, yes. Most major insurance plans, including Medicare and Medicaid, cover SPRAVATO for treatment-resistant depression, especially when:
- You’ve tried and failed two or more antidepressants
- You have severe depression by a primary care physician or mental health provider
- Your provider submits the necessary prior authorization paperwork
Active Path works directly with insurance companies to help you navigate coverage, minimize out-of-pocket costs, and ensure proper authorization.
In addition, Johnson & Johnson (the maker of SPRAVATO) offers a Patient Savings Program, SpravatowithMe, which may help eligible individuals reduce their costs.
What Should I Do Before Starting SPRAVATO?
If you’re considering SPRAVATO, start by scheduling a free phone consultation at Active Path. Our intake team will do a quick screening and gather your insurance information. If you are a good candidate for Spravato, you will be scheduled for an evaluation with an Active Path psychiatric provider.
Here’s how to prepare for the evaluation:
- Document your treatment history: List all past and current medications for depression.
- Gather medical records: Especially if you’ve been hospitalized or seen a psychiatrist.
- Discuss all medications and supplements: Some may interfere with SPRAVATO.
- Ask questions: Be open about your concerns, goals, and expectations.
Your provider will conduct a comprehensive evaluation to ensure SPRAVATO is a safe and effective option for you.
How Is SPRAVATO Different From Ketamine Infusion Therapy?
SPRAVATO and ketamine are related, but they’re not the same. SPRAVATO is a nasal spray made from esketamine (a part of the ketamine molecule), while ketamine infusion therapy involves an IV drip of full-spectrum ketamine. The biggest difference? SPRAVATO is FDA-approved to treat depression in adults who haven’t responded to other treatments, including those with suicidal thoughts. Ketamine infusions are used off-label, meaning they’re not officially approved for mental health treatment, even though they’re widely offered.
Because SPRAVATO is FDA-approved, it’s more likely to be covered by insurance and comes with stricter safety protocols. It must be given at a REMS-certified clinic, where you’re monitored for two hours after each dose. Ketamine infusions, on the other hand, often require out-of-pocket payment and are usually less regulated. Overall, SPRAVATO offers a more structured, insurance-friendly option for people with treatment-resistant depression.
Is SPRAVATO Right for Me?
SPRAVATO is offering hope to people who’ve long felt stuck in the darkness of depression. If you’ve tried multiple antidepressants with little relief—or if you’re living with suicidal thoughts—SPRAVATO may be a breakthrough option worth exploring.
At Active Path Mental Health, we specialize in evidence-based, compassionate care for individuals facing serious mental health challenges. Our team is here to answer your questions, coordinate with your insurance provider, and walk with you through every step of your treatment journey.
It is crucial to consult with a healthcare professional before starting SPRAVATO treatment to ensure it is administered safely and effectively.
Ready to Learn More?
Contact Active Path today or call 503.719.4648 to schedule a consultation and find out if SPRAVATO is right for you. Relief might be closer than you think.
