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Spravato FAQs

What is Spravato?

Spravato (esketamine) is an FDA-approved prescription drug delivered as a nasal spray to be used with and without an antidepressant taken by mouth to treat adults diagnosed with treatment-resistant depression (TRD) or with an antidepressant taken by mouth to treat the symptoms of major depressive disorder (MDD) with suicidal thoughts or behaviors. It is a derivative of ketamine and works differently than traditional antidepressants by targeting NMDA receptors in the brain.

Spravato acts on the glutamate system by blocking NMDA receptors, leading to increased neural connections and improved mood regulation. This mechanism differs from traditional antidepressants, which primarily target serotonin, dopamine, or norepinephrine.

Spravato is prescribed for adults diagnosed with treatment-resistant depression (TRD), which means they have not responded adequately to at least two previous antidepressant treatments. It is also indicated for individuals with major depressive disorder (MDD) who experience suicidal thoughts or behaviors.

Spravato is a nasal spray administered in a certified healthcare setting under medical supervision. Patients must remain at the facility for at least two hours after administration for monitoring due to potential side effects. The standard treatment schedule includes:

  • Twice-weekly doses for the first four weeks
  • Once-weekly doses for weeks five to eight
  • Maintenance doses as determined by the healthcare provider

The most common side effects include the following. These effects typically subside after the treatment session.

  • dizziness
  • dissociation (feeling disconnected from reality),
  • nausea
  • feeling sleepy
  • feeling a spinning sensation
  • feeling anxious
  • feeling numbness
  • lack of energy
  • increased blood pressure
  • headache

Spravato contains esketamine, which is a modified form of ketamine. While both drugs work similarly, Spravato is FDA-approved for depression and must be administered in a medical setting, whereas ketamine is often used off-label for depression in IV infusion therapy.

Some patients report noticeable improvement in depressive symptoms within hours or days of starting treatment. However, response times vary, and multiple doses may be needed to achieve significant benefits.

No. Due to the sedative and dissociative effects, patients are advised not to drive or operate heavy machinery until the following day after a full night’s sleep.

Many insurance plans, including Medicare and Medicaid, cover Spravato for eligible patients. However, coverage varies by provider, and prior authorization may be required. Patients should check with their insurance company for details.

The duration of treatment depends on individual response and the severity of depression. Some patients continue maintenance treatments, while others may transition off Spravato under their doctor’s guidance.

Spravato has a potential for misuse due to its similarities to ketamine. However, it is administered under strict medical supervision in certified clinics, reducing the risk of misuse or addiction.

If you miss a scheduled dose, contact your healthcare provider to determine the best course of action. Consistency in treatment is important for optimal results.

Unlike traditional antidepressants, which can take weeks to show effects, Spravato may provide faster relief for severe depression. It is often used when other medications have failed to provide adequate improvement.

Spravato is only available at certified healthcare facilities that follow the Risk Evaluation and Mitigation Strategy (REMS) program guidelines. Patients must take it under supervision in an approved treatment center.

If you have questions about Spravato treatment, schedule a consultation with the psychiatric experts at Empire State Psychiatry. Widely regarded as one of the top providers of esketamine-based therapies in New York City, Empire State Psychiatry is committed to delivering expert, patient-centered care. Their office is located in Midtown Manhattan, and they serve patients from the Upper East Side and surrounding New York City neighborhoods.


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