Spravato
WHAT IT ISA Guided, Evidence-Based Option When Depression Won’t Let Go
Spravato (esketamine) is an FDA-approved treatment derived from ketamine, designed for adults experiencing treatment-resistant depression or depressive symptoms with acute suicidal thoughts. It is delivered as a nasal spray in a medically supervised office setting, where you self-administer the medication under guidance and then rest while we monitor your response.
Unlike traditional antidepressants, Spravato works on glutamate pathways in the brain, supporting neuroplasticity — the brain’s ability to form new connections and shift out of stuck patterns. When combined with ongoing care, it can help reduce symptoms, improve emotional flexibility, and create space for meaningful change when other treatments haven’t been enough.
HOW IT WORKSA Treatment That Supports the Brain’s Ability to Adapt
Spravato works primarily through the brain’s glutamate system, which plays a central role in learning, memory, and adaptability. Unlike traditional antidepressants that focus on serotonin, Spravato influences NMDA receptors linked to glutamate signaling, helping trigger changes that support neuroplasticity — the brain’s ability to form new connections. In long-standing depression, mental patterns can become rigid and repetitive, reinforcing loops of hopelessness or rumination. By temporarily shifting these pathways, Spravato may help the brain become more flexible and responsive, creating space for new perspectives, emotional movement, and symptom relief. Many people notice improvement more quickly than with traditional medications, though responses vary by individual.
WHO IT MAY BE FOR
A Treatment for Persistent Depression
Spravato may be a meaningful option for adults who are experiencing depression that has not improved enough with traditional treatments, or for those facing severe symptoms that require additional support. It is most often considered when standard antidepressant medications and therapy have provided only partial relief or feel insufficient.
Spravato is FDA-approved for adults with treatment-resistant depression and for major depressive disorder with acute suicidal thoughts or behaviors when used alongside an oral antidepressant.
The best way to determine whether Spravato is appropriate is through a careful evaluation of your history, current symptoms, medical considerations, and goals for treatment.
You may be a good candidate if you:
Have major depressive disorder that has been difficult to treat
Have tried one or more antidepressant medications without adequate improvement
Are experiencing persistent symptoms such as low mood, numbness, loss of motivation, or hopelessness
Need a treatment that works through a different biological pathway than traditional medications
Are open to structured, in-office care with medical monitoring and follow-up
PROCESSA thoughtful, step-by-step approach designed to support change safely, gently, and over time. Each phase builds on the last, allowing treatment to evolve in a way that feels steady and personalized.
01 / Evaluation
We begin with a comprehensive intake to understand your history, symptoms, prior treatments, and current medications. Together, we assess whether Spravato is an appropriate and safe option for you, answer your questions, and create a plan that feels clear and collaborative before treatment begins.
02 / Supported Treatment
Spravato is administered in-office under medical supervision. You’ll self-administer the nasal medication and then rest comfortably during the required monitoring period (at least two hours) while we track vital signs and ensure you feel stable before leaving. The environment is calm, contained, and designed to support your nervous system throughout the experience.
03 / Continued Support
We monitor your response closely during the induction phase and adjust treatment frequency thoughtfully over time. The goal is always individualized care — finding the least intensive schedule that maintains benefit while supporting lasting stability and progress.
FREQUENT QUESTIONSThoughtful context to help you orient to the process, the experience, and what to expect along the way.
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During a Spravato session, many people notice shifts in perception, a gentle sense of distance from usual thought patterns, or a dreamlike, reflective state. Some experience dissociation or sleepiness, while others simply feel quiet, calm, or tired. These effects are temporary and typically fade within a few hours.
Because Spravato can affect alertness and coordination, treatment is always given under medical supervision with monitoring afterward. You’ll need someone to drive you home, and you should plan to rest for the remainder of the day.
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Common short-term side effects may include dizziness, nausea, headache, sleepiness, or temporary increases in blood pressure, which usually resolve the same day.
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Spravato follows a structured schedule designed to build momentum early, then taper to the least frequent dosing that still maintains benefit. Most people begin with an induction phase of twice-weekly sessions for the first four weeks, followed by once-weekly sessions for weeks five through eight. After that, ongoing maintenance is individualized, often every one to two weeks, depending on your response and clinical needs. The goal is always to find the lowest frequency that continues to support meaningful improvement over time.
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In most cases, the ideal time for therapy is about 24–48 hours after your session, when you’re typically more clear and grounded but still close to the window where emotional and cognitive shifts can be integrated into daily life. If next-day therapy isn’t possible, within 72 hours is still very helpful. Some people also choose to see their therapist the same day, though sessions are usually more supportive and reflective rather than deeply analytical so your nervous system has time to settle. The goal is to help translate insights into lasting change while you’re most receptive.
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Spravato is a form of esketamine delivered as a nasal spray in a certified medical setting with required monitoring. It is FDA-approved for treatment-resistant depression in adults. IV and IM ketamine typically use racemic ketamine and are most often provided off-label for depression and related conditions. All approaches aim to support similar brain pathways, but they differ in delivery method, structure, and regulatory status.
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Research suggests that both Spravato and IV/IM ketamine can be effective for depression, with many people experiencing meaningful improvement. Some studies suggest IV ketamine may be slightly more effective on average, but the best choice often depends less on which is “stronger” and more on what you can tolerate, sustain, and integrate into your life with appropriate support.
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Spravato is absorbed through the nasal route and may feel gentler for some individuals, though dissociation and sedation can still occur. IV ketamine allows very precise control of dose and timing throughout the session and can be adjusted or stopped quickly if needed. IM ketamine often has a faster onset and more wave-like experience with less moment-to-moment adjustability. The right fit depends on your sensitivity, goals, and clinical needs.
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Because Spravato is FDA-approved, it is often covered by insurance when eligibility criteria are met, though prior authorization is usually required. IV and IM ketamine are typically off-label, so coverage is less consistent; however, clinics may provide documentation (superbills) for possible reimbursement depending on your plan.
COVERAGECare that is Careful, Individualized, & Grounded
MBLDN Psychiatry & Wellness is in network with select plans, including Aetna, Anthem, Cigna, Optum, and Blue Shield of California. When eligible, Spravato is often covered, though prior authorization is typically required and final costs depend on your individual benefits. Because treatment occurs in a monitored setting under the REMS program, insurance may process the medication and administration separately. Our team will help verify coverage and guide you through expected costs based on your copay, coinsurance, and deductible.
Care Begins with a Conversation
LET'S GET STARTEDThrough an initial consultation, we explore your history, symptoms, and goals to determine the most appropriate integrative or interventional treatment approach for you.