A: Spravato contains esketamine, the S-enantiomer of ketamine. Both work on the same brain pathways, but Spravato is the only FDA-approved version specifically studied and approved for treatment-resistant depression and for depressive symptoms in adults experiencing acute suicidal ideation. 

Developed by Janssen Pharmaceuticals, Spravato received FDA approval in March 2019 and, in January 2025, became the first treatment FDA-approved as monotherapy for treatment-resistant depression. Spravato is administered as a nasal spray in REMS-certified clinics.

A: Common side effects include dissociation (a temporary feeling of being disconnected from yourself or your surroundings), dizziness, nausea, sedation, increased blood pressure, headache, anxiety, and altered perception. 

The dissociative experience varies by person. Some describe it as floating or dream-like; others find it disorienting at first.

Our clinical team monitors you throughout each session.

A: Duration varies by individual. Many patients move to weekly or bi-weekly maintenance, while others taper off under medical supervision. 

Your treatment plan is reviewed and adjusted as you progress.

A. Spravato is FDA-approved and is administered under direct medical supervision in our clinic. You will self-administer the nasal spray under Dr. Roth’s or one of our clinician's oversight and remain in our clinic for a two-hour monitoring period following each dose. 

Most patients experience mild dissociative effects or dizziness that resolve before they leave. You cannot drive on the day of a Spravato session, so you will need a ride home. 

Spravato is approved as a monotherapy for treatment-resistant depression and as an add-on treatment with an oral antidepressant. 

It works through a different brain pathway than traditional antidepressants, providing rapid-acting relief for patients who have not responded to other treatments.

A: For treatment-resistant depression, Spravato can now be used as monotherapy OR alongside an oral antidepressant (per the January 2025 FDA approval). 

For the second indication, MDD with acute suicidal ideation, Spravato is used in combination with an oral antidepressant. 

Either way, you will discuss the best approach with your clinician.

A: Spravato is covered by most major commercial insurance plans, for patients who meet treatment-resistant depression criteria, generally documented inadequate response to at least two antidepressants. Coverage typically includes both the medication and the in-clinic monitoring visit, so most patients pay a specialist copay or coinsurance per session. Janssen also runs a patient savings program called SpravatowithMe for eligible commercially insured patients. Our patient care team runs a full benefits check and gives you a per-session estimate before your first appointment.

A: Duration varies. After the induction phase of twice weekly for four weeks, most patients move to weekly, then every other week as symptoms stabilize. Some continue maintenance long term, others taper off under supervision. There is no fixed endpoint, and the plan is reviewed as you progress.

A: Esketamine is a controlled substance and carries a boxed warning for abuse and misuse potential, which is precisely why it is dispensed only in REMS-certified clinics and never taken home. You never have possession of the medication. You self-administer it in our clinic under direct supervision and are monitored for 2 hours afterward and you are not allowed to drive yourself home. This structure exists specifically to make treatment safe.