Key Takeaways
- SPRAVATO® (esketamine) is a nasal spray for adults with treatment-resistant depression, and it's usually one part of a broader treatment plan rather than a standalone fix.
- Spravato can be prescribed alone or with an oral antidepressant, and many providers also recommend ongoing psychotherapy (talk therapy).
- Spravato and therapy do different jobs: Spravato may ease symptoms, while therapy helps build coping skills and address what's underneath.
- You don't need to already be in therapy to start Spravato, but your provider may suggest adding it.
- Foundation Psychiatry offers both Spravato and psychotherapy in Atlanta, and you can request an appointment to build your treatment plan.
A Common Question: 'Does Spravato Replace Therapy?'
Many people starting Spravato wonder if it means they can stop therapy. It's an understandable thought. After months or years of trying to feel better, a new treatment can feel like the answer on its own.
In practice, Spravato and psychotherapy are often paired. They're not competing choices. Think of them as two tools that work on different parts of the same problem. This guide explains why providers often recommend both, what that combination can look like, and how the two pieces of care get coordinated.
What Spravato Is and How It's Used
Spravato is the brand name for esketamine, a nasal spray used to treat depression. According to the MedlinePlus drug guide for esketamine nasal spray, it's used alone or with an oral antidepressant to manage treatment-resistant depression (TRD) in adults. TRD means depression that hasn't improved enough with standard treatment.
A few key facts help set expectations:
- It's given in a medical office. You use the spray yourself, but only in a certified clinic, under supervision.
- You're monitored afterward. MedlinePlus notes that your provider monitors you for at least 2 hours after each dose.
- You'll need a ride home. You shouldn't drive until the next day after a restful night's sleep.
- It follows a schedule. For TRD, doses are usually twice a week for weeks 1–4, once a week for weeks 5–8, and then once a week or every 2 weeks after that.
- It's for adults. Spravato is not approved for children.
Possible Side Effects
Most people tolerate Spravato well, but side effects can happen. The most common include feeling disconnected from your surroundings (dissociation), dizziness, nausea, drowsiness, and a short-term rise in blood pressure. These effects usually ease within hours of a dose, which is why you're monitored in the office before heading home. Your provider will review the full safety information with you, including who Spravato may not be right for, before you start.
Spravato With or Without an Oral Antidepressant
When Spravato was first approved in 2019, it was used together with an oral antidepressant. In January 2025, the FDA also approved it as a standalone (monotherapy) option for adults with TRD. As Psychiatric Times reported on the monotherapy approval, this applies to adults who had an inadequate response to at least 2 oral antidepressants.
This means your provider can choose the approach that fits you best. Either way, Spravato is usually one part of a full treatment plan.
Why Therapy Is Often Recommended Alongside Spravato
Spravato and psychotherapy work in different ways. That's why they can complement each other.
What Spravato May Help With
Spravato works differently from traditional antidepressants. For some people, it may ease depression symptoms more quickly. When symptoms lift, even a little, everyday tasks can start to feel more manageable.
What Psychotherapy Helps With
Psychotherapy gives you a space to work on the things medication can't reach. The National Institute of Mental Health's depression overview lists talk therapy among the core treatments for depression, alongside medication and brain stimulation.
In therapy, you and a trained professional can work on:
- Understanding patterns that feed your depression
- Building healthy coping skills for stress and hard days
- Working through relationships, grief, or life changes
- Noticing early warning signs if symptoms start to return
- Setting realistic goals as you begin to feel more like yourself
Why the Combination Makes Sense
When Spravato helps take the edge off symptoms, some people find they have more energy to engage in therapy. Therapy, in turn, may help you hold on to progress by building skills you can use long after a session ends. Many providers recommend this pairing because therapy may help you hold on to progress by building skills that last beyond each session. Research on combining the two is still developing, and every person's response is different.
Separate Providers vs. Integrated Care: How Coordination Works
There are two common ways to combine Spravato and therapy. Both can work. The main difference is how much of the communication you have to manage yourself.
| Factor | Separate Providers | Integrated Care |
|---|---|---|
| Where you get care | Spravato at one practice, therapy at another | Spravato and therapy through one practice |
| Communication between providers | Depends on releases and outreach; may be limited | Built in; your care team can share updates directly |
| Who tracks your progress | You often relay updates between offices | Your team reviews progress together |
| Scheduling | Two separate offices and calendars | Coordinated through one front desk |
| Best for | People who already have a therapist they love | People starting fresh or wanting one team |
If you already have a therapist you trust, you don't need to switch. Your Spravato provider can work with your current therapist, with your permission. If you don't have a therapist yet, integrated care can make things simpler.
Do You Need to Be in Therapy to Start Spravato?
No. You don't need to already be in therapy to begin Spravato. However, your provider may recommend adding therapy as part of your plan. It's a conversation worth having at your first appointment.
Here are a few questions to bring:
- Would therapy be helpful for me while I'm on Spravato?
- Should I keep my current therapist, or would integrated care make more sense?
- How will my Spravato provider and therapist stay in touch?
- How will we measure whether my plan is working?
For more answers about getting started, read Foundation Psychiatry's guide, Is Spravato Safe? Answering the Questions Most Patients Ask Before Starting.
How Foundation Psychiatry Brings It Together
Foundation Psychiatry was built on the idea that there isn't just one solution to complex mental health conditions. Dr. Tumeh and the care team combine psychotherapy and medication management with advanced options like Spravato and TMS.
That means you can explore SPRAVATO® treatment at Foundation Psychiatry and psychotherapy and other treatments under one roof. Your plan is shaped around your history, your goals, and how you respond over time.
Build a Spravato Treatment Plan That Includes the Support You Need
Spravato can be a meaningful option for treatment-resistant depression, and pairing it with psychotherapy gives you support on more than one front. Foundation Psychiatry can help you create a plan that brings both together in a way that fits your life.
To get started, request an appointment for a Spravato consultation at Foundation Psychiatry or call (404) 902-6184. Ask about adding psychotherapy to your esketamine treatment plan.
Frequently Asked Questions
Do I need Spravato and therapy at the same time?
Not always, but many providers recommend it. Spravato may help ease depression symptoms, while therapy helps you build coping skills and work through underlying issues. Your provider will help decide what's right for you.
What does an esketamine treatment plan usually include?
An esketamine treatment plan usually includes supervised Spravato sessions on a set schedule, regular check-ins with your prescriber, and often ongoing psychotherapy. Some plans also include an oral antidepressant, depending on your needs.
Can I keep my current therapist while combining Spravato with psychotherapy?
Yes. If you already have a therapist you trust, you can keep them. With your permission, your Spravato provider can coordinate with your therapist so your care stays aligned.
Is Spravato used without an antidepressant?
It can be. In January 2025, the FDA approved Spravato as a standalone option for adults with treatment-resistant depression. It can also still be used together with an oral antidepressant.
Where can I find Spravato in Atlanta?
Foundation Psychiatry offers Spravato in Atlanta at its office on Collier Road NW, serving the Buckhead and Midtown area. The practice also offers psychotherapy and medication management, so your care can be coordinated in one place.
