If antidepressants haven’t worked for you, you’ve probably done some searching. And at some point, you may have come across Spravato. Maybe your doctor mentioned it. Maybe you stumbled onto it online. Either way, you likely have questions.

Here are the ones we hear most often.

What is Spravato?

Spravato is the brand name for esketamine, a nasal spray derived from ketamine. It was approved by the FDA in 2019 specifically for treatment-resistant depression (TRD), meaning depression that hasn’t responded adequately to at least two different antidepressant treatments.

In 2020, it was also approved for major depressive disorder with acute suicidal ideation or behavior, where fast-acting relief is the priority.

It works differently than traditional antidepressants. Rather than targeting serotonin or norepinephrine, esketamine acts on glutamate receptors in the brain. For many people who’ve tried multiple antidepressants without success, this different mechanism is exactly what makes it effective.

How is it administered?

Spravato is not something you take at home. It’s administered in a certified healthcare setting, like our office, under supervision. Here’s how a typical session works:

  1. You self-administer the nasal spray under your provider’s observation
  2. You stay at the office for about two hours while staff monitor you
  3. You’re not able to drive yourself home that day, so you’ll need a ride

The monitoring period matters. Spravato can cause temporary effects like dissociation, dizziness, or nausea immediately after administration, which is why the supervised setting is required by the FDA.

How often do you go?

The induction phase is typically twice a week for four weeks. After that, most patients move to once a week, then once every one to two weeks for maintenance. Your provider will adjust based on how you’re responding.

Does it actually work?

For people with treatment-resistant depression, the clinical data is meaningful. Studies have shown significant improvement in depressive symptoms compared to placebo, and for some patients the effects are noticeable within days rather than weeks.

That said, Spravato isn’t a cure and it isn’t right for everyone. It’s typically used alongside an oral antidepressant, not instead of one. And it requires a consistent commitment to the treatment schedule, especially in the early weeks.

Who is a good candidate?

You may be a candidate for Spravato if:

  • You’ve been diagnosed with major depressive disorder
  • You’ve tried at least two antidepressants at adequate doses without sufficient relief
  • You’re medically stable enough for the treatment (your provider will screen for this)

There are also contraindications, conditions or medications that make Spravato a poor fit. Your provider will review your full history before recommending it.

What about cost and insurance?

Spravato is covered by many insurance plans including Medicare, though prior authorization is typically required. Coverage for Medicaid varies by state. If cost is a concern, there are also manufacturer assistance programs worth asking about.

Where is it available?

We offer Spravato treatment at our Toledo and Monroe locations. If you’ve been struggling with depression that hasn’t responded to medication, it’s worth a conversation. Contact us to learn more or get started.