Key Takeaways
- SPRAVATO, also known as esketamine, is an FDA-approved nasal spray designed specifically for treatment-resistant depression.
- Most people considered for SPRAVATO have already tried two or more antidepressants without adequate relief.
- Treatment is administered in a clinical setting under supervision, with a required monitoring period after each dose.
- SPRAVATO is generally used together with an oral antidepressant rather than as a stand-alone replacement.
- Foundation Psychiatry evaluates candidacy for SPRAVATO during a consultation, and understanding the eligibility criteria beforehand can help you set realistic expectations for that first appointment.
What SPRAVATO Actually Is
SPRAVATO is the brand name for esketamine, a nasal spray that works differently from traditional antidepressants. Rather than adjusting serotonin levels the way many oral medications do, esketamine targets a different neurotransmitter system involved in mood regulation, which is part of why it can act more quickly. According to the National Institute of Mental Health, esketamine typically begins relieving depression symptoms within a couple of hours of administration, compared to the four to eight weeks many antidepressant pills require.
SPRAVATO is delivered as a nasal spray at a certified clinic, under the direct supervision of a healthcare professional. This isn't a treatment patients take home and administer on their own.
Who SPRAVATO Is Designed For
SPRAVATO isn't intended as a first-line treatment for depression, and not every patient with depression is a candidate. According to Mayo Clinic, esketamine nasal spray is used for patients who have previously tried at least two antidepressant treatments that did not provide adequate relief, a pattern clinically referred to as treatment-resistant depression.
You may be a candidate for SPRAVATO if:
- You've tried two or more antidepressant medications without lasting improvement.
- You're currently taking, or willing to continue taking, an oral antidepressant alongside SPRAVATO.
- You're able to attend in-person appointments and remain on-site for monitoring after each dose.
- You don't have certain medical conditions that a psychiatrist would need to rule out during your evaluation, such as uncontrolled blood pressure.
SPRAVATO is also approved for adults with major depressive disorder who are experiencing suicidal thoughts, used alongside an oral antidepressant, per the NIMH.
What the Evaluation and Referral Process Looks Like
Before starting SPRAVATO, Foundation Psychiatry conducts a full evaluation to confirm it's an appropriate option. This typically includes:
- A review of your prior antidepressant trials, including dosage and how long each was used.
- A discussion of your current symptoms and any medical conditions that could affect eligibility.
- An explanation of what a treatment session involves, including the monitoring period afterward.
- A plan for continuing an oral antidepressant alongside SPRAVATO, if appropriate.
If your psychiatrist determines that SPRAVATO isn't the right fit, they may recommend an alternative such as Transcranial Magnetic Stimulation instead.
SPRAVATO vs. TMS: Comparing Two Options for Treatment-Resistant Depression
| SPRAVATO (Esketamine) | TMS | |
|---|---|---|
| How it's administered | Nasal spray, given in-office | Magnetic pulses delivered through a coil near the scalp |
| Typical time to notice a difference | Often within hours to days | Often within the first few weeks of the protocol |
| Monitoring required | Stay on-site for a required period after each dose | No required monitoring period; resume activities right after |
| Usually combined with | An oral antidepressant | Can be used with or without medication |
| Session frequency | Twice weekly during the initial phase, per your treatment plan | Typically five days a week for several weeks |
What to Expect During Your First Consultation
Your first appointment will focus on understanding your treatment history rather than starting treatment that day. Bring a list of any antidepressants you've tried, including approximate dates and dosages if you have them. Your psychiatrist will use this information, along with a discussion of your current symptoms, to determine whether SPRAVATO, TMS, or another approach makes the most sense for you.
Find Out If SPRAVATO Is Right for You at Foundation Psychiatry
Not everyone with depression needs SPRAVATO, but for people who've tried multiple antidepressants without relief, it can offer a faster-acting option than starting another pill. Foundation Psychiatry evaluates each patient individually to determine candidacy before any treatment begins.
If you think you may be a candidate for esketamine treatment, schedule a consultation with Foundation Psychiatry to discuss SPRAVATO and other options for treatment-resistant depression.
Frequently Asked Questions
Is SPRAVATO the same as ketamine used outside of a medical setting?
No. SPRAVATO contains esketamine, a specific, FDA-approved formulation administered under medical supervision in a controlled clinical setting. It is not the same as ketamine obtained outside of a licensed medical provider.
How long does a SPRAVATO appointment take?
Appointments typically include the time to administer the nasal spray plus a required monitoring period afterward, often around two hours total. Your care team will give you a specific timeframe based on your treatment plan.
Will I need someone to drive me home after treatment?
Yes. Patients are not permitted to drive themselves home the day of treatment and should arrange transportation in advance.
Do I have to stop taking my current antidepressant to start SPRAVATO?
Usually not. SPRAVATO is typically used together with an oral antidepressant rather than in place of one. Your psychiatrist will confirm your specific plan during your evaluation.
