Spravato® (esketamine)
A treatment for depression that has not responded to antidepressants
Spravato® is an esketamine nasal spray, FDA-approved for treatment-resistant depression. It acts on a different system in the brain from the antidepressants you have already tried, which is why it can work when those have not. We provide it in our REMS-certified clinic in Santa Monica.
- 2019
- FDA-approved for treatment-resistant depression
- 2 hrs
- of quiet, monitored rest in clinic after each dose
- Often
- covered by insurance — we verify your plan first
- 2019
- FDA-approved for treatment-resistant depression
- 2 hrs
- of quiet, monitored rest in clinic after each dose
- Often
- covered by insurance — we verify your plan first
01
Does it actually work?
For a meaningful number of people, yes — and faster than the antidepressants they have already tried.
Spravato® was approved in 2019 on the strength of randomized trials in adults whose depression had not responded adequately to at least two antidepressants. In those trials it was given alongside a newly started oral antidepressant and compared against that antidepressant alone.
- Speed.
- Improvement was measured in days rather than the six to eight weeks an oral antidepressant typically needs.
- Staying well.
- In the maintenance trial, people who responded and continued Spravato® relapsed substantially less often than those who stopped.
- Not everyone responds.
- A proportion of people in every trial did not, and that is not knowable in advance — which is why the first weeks are treated as a trial, with progress measured.
02
Will insurance cover it?
Often — and this is the biggest practical difference between Spravato® and ketamine therapy. Because Spravato® is FDA-approved, most major plans have a pathway to cover it. Ketamine therapy, prescribed off-label, is usually paid out of pocket.
Coverage almost always depends on documentation that other antidepressants have not worked well enough — which is exactly the situation most people arrive in. We check your benefits and tell you what you will pay before you commit.
One thing worth knowing: in January 2025 the FDA approved Spravato® as a standalone treatment, but many plan policies still expect a concurrent oral antidepressant. That gap is a paperwork question, and we handle it.
03
Am I eligible?
Eligibility is decided in a medical consultation. Here is the shape of it.
Usually a fit
- You are an adult with major depressive disorder
- At least two antidepressants have not worked well enough
- You can take it alone or alongside an oral antidepressant — both paths are FDA-approved
- You can stay in clinic for two hours after each dose
- You can arrange a ride home on treatment days
Not appropriate
- Certain blood vessel conditions, including aneurysmal vascular disease
- A history of bleeding in the brain
- Any condition where a rise in blood pressure would pose a serious risk
- Known allergy to esketamine or ketamine
04
What happens in a session?
Roughly two and a half hours door to door, most of which is sitting in a quiet room while a clinician keeps an eye on you.
Before
Arrange a ride. You cannot drive afterward. No food for two hours, no drink for the last thirty minutes.
Arrival
Blood pressure, and a short conversation about how you have been.
The dose
A nasal spray you administer yourself. No needle, no IV. About a minute.
Two hours
A private room, a recliner, headphones. A clinician stays with you and checks your blood pressure. This window is required by the REMS program and cannot be shortened.
Going home
Someone drives you. No driving or machinery until you have slept a full night.
- Before
Arrange a ride. You cannot drive afterward. No food for two hours, no drink for the last thirty minutes.
- Arrival
Blood pressure, and a short conversation about how you have been.
- The dose
A nasal spray you administer yourself. No needle, no IV. About a minute.
- Two hours
A private room, a recliner, headphones. A clinician stays with you and checks your blood pressure. This window is required by the REMS program and cannot be shortened.
- Going home
Someone drives you. No driving or machinery until you have slept a full night.
Most people describe a sense of distance during the first forty minutes, which clinicians call dissociation. It passes well before you leave, and it is one of the reasons the two hours exist.
05
Spravato® or ketamine therapy?
Neither is better in the abstract. They are related medicines used differently, and the right one depends on your insurance, your history, and how much psychotherapy you want built around the treatment.
| Question | Spravato® | Ketamine therapy | Another antidepressant |
|---|---|---|---|
| FDA approved for depression | Yes | No, prescribed off-label | Yes |
| Usually covered by insurance | Often | Rarely | Usually |
| Where you take it | In clinic, always | In clinic | At home |
| Time per session | Two hours | Two to three hours | None |
| Can you drive after | No | No | Yes |
| How quickly it acts | Days to weeks | Days to weeks | Six to eight weeks |
| Therapist in the room | Optional | Yes, by design | No |
Swipe to compare
FDA approved for depression
- Spravato®
- Yes
- Ketamine therapy
- No, prescribed off-label
- Another antidepressant
- Yes
Usually covered by insurance
- Spravato®
- Often
- Ketamine therapy
- Rarely
- Another antidepressant
- Usually
Where you take it
- Spravato®
- In clinic, always
- Ketamine therapy
- In clinic
- Another antidepressant
- At home
Time per session
- Spravato®
- Two hours
- Ketamine therapy
- Two to three hours
- Another antidepressant
- None
Can you drive after
- Spravato®
- No
- Ketamine therapy
- No
- Another antidepressant
- Yes
How quickly it acts
- Spravato®
- Days to weeks
- Ketamine therapy
- Days to weeks
- Another antidepressant
- Six to eight weeks
Therapist in the room
- Spravato®
- Optional
- Ketamine therapy
- Yes, by design
- Another antidepressant
- No
FDA approved for depression
- Spravato®
- Yes
- Ketamine therapy
- No, prescribed off-label
- Another antidepressant
- Yes
Usually covered by insurance
- Spravato®
- Often
- Ketamine therapy
- Rarely
- Another antidepressant
- Usually
Where you take it
- Spravato®
- In clinic, always
- Ketamine therapy
- In clinic
- Another antidepressant
- At home
Time per session
- Spravato®
- Two hours
- Ketamine therapy
- Two to three hours
- Another antidepressant
- None
Can you drive after
- Spravato®
- No
- Ketamine therapy
- No
- Another antidepressant
- Yes
How quickly it acts
- Spravato®
- Days to weeks
- Ketamine therapy
- Days to weeks
- Another antidepressant
- Six to eight weeks
Therapist in the room
- Spravato®
- Optional
- Ketamine therapy
- Yes, by design
- Another antidepressant
- No
06
Is it safe?
Ketamine and its derivatives have been used in medicine for over fifty years, and Spravato® is given only in certified clinics under supervision — which is why the side effects are manageable.
Common side effects
Dissociation, dizziness, nausea, sedation, and a rise in blood pressure. These begin during the session and settle before you leave. Less commonly, anxiety or vomiting.
What we do about it
Your blood pressure is checked before the dose and during the monitoring window. A clinician stays with you throughout. We review your full medical history first.
08
Other questions
Is it covered by insurance?
Often, yes — one of the practical differences between Spravato® and ketamine therapy. Spravato® is FDA-approved, so many plans cover it, usually on documentation that other antidepressants have not worked well enough. We check your benefits before you commit and tell you what it will cost.
How is this different from ketamine therapy?
Spravato® is esketamine, a nasal spray that is FDA-approved for treatment-resistant depression, given in a certified clinic and often covered by insurance. Ketamine therapy uses a related medicine, is prescribed off-label, is usually paid out of pocket, and allows more flexibility in dose, route, and how much psychotherapy is built around it. Neither is better in the abstract. Which one suits you depends on your history, your insurance, and what you want the treatment to do.
Who is eligible?
Spravato® is approved for adults with treatment-resistant depression — depression that has not responded adequately to at least two antidepressants — and for depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. Since January 2025 it is approved both on its own and alongside an oral antidepressant, though many insurance plans still expect the combination, which we document around. Eligibility is decided in a full medical consultation.
How quickly would I know if it is working?
Faster than with the antidepressants you have taken before. Trials measured meaningful change within days to a couple of weeks rather than the six to eight weeks an oral antidepressant typically needs. The decision to continue is made on how you respond over the first few weeks.
Spravato® is a registered trademark of Janssen Pharmaceuticals, Inc.