Spravato and IV ketamine
Spravato contains esketamine and has specific FDA-approved adult depression indications. IV ketamine for psychiatric treatment is off-label and has a separate infusion protocol. Their formulations, routes, visit safeguards and benefit pathways differ. A previous response to one does not guarantee the same result with the other. Ask why the proposed option fits your treatment history and how benefit will be assessed. Do not transfer Spravato’s dose schedule or eating instructions to an infusion, or assume a home compounded product has Spravato’s approval and REMS pathway.
Spravato (esketamine nasal spray)
Spravato is the brand name for esketamine nasal spray. Its current US label covers treatment-resistant depression in adults, either on its own or with an oral antidepressant. A separate indication covers depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behaviour; that use requires an oral antidepressant. Spravato has not been shown to prevent suicide or reduce suicidal thoughts or behaviour, and it does not replace hospitalization when that is needed.
Eligibility: Spravato (esketamine nasal spray)
Assessment reviews the diagnosis, previous treatments and whether they were taken at an adequate dose and duration. The clinician checks blood pressure, cardiovascular and cerebrovascular history, psychosis, substance-use risks, pregnancy and interacting medicines. Aneurysmal vascular disease, arteriovenous malformation, a history of intracerebral hemorrhage and hypersensitivity are labelled contraindications. Insurer criteria can differ from the clinical label.
What to expect: Spravato (esketamine nasal spray)
Review treatment history and the intended indication
Bring antidepressant names, doses, dates, response, adverse effects and relevant hospital records. Clarify whether the proposed treatment is TRD care or the separate acute suicidal MDD indication. Discuss other suitable treatments and continuing therapy.
Plan a supervised treatment visit
Spravato is administered through its REMS in a certified healthcare setting. Patients self-administer the nasal spray under direct supervision. Blood pressure is checked before dosing, around 40 minutes afterwards and further as needed. Breathing is monitored, including pulse oximetry, for at least two hours. Release occurs only when the clinician finds the patient stable. Some visits take longer.
Review benefit and frequency
TRD treatment is twice weekly for the first four weeks, then weekly in weeks five through eight. From week nine, dosing is weekly or every two weeks according to response. The clinician assesses benefit after the initial four weeks. The acute suicidal MDD regimen is a separate twice-weekly four-week course. Longer use for that indication has not been systematically evaluated.
Preparing for your appointment
Arrange transport home and leave time for the observation period. Do not eat for at least two hours before a dose or drink liquids for at least 30 minutes before it. If using a nasal corticosteroid or decongestant, follow the label’s timing of at least one hour before Spravato. Bring the medicine list and report alcohol, sedatives, opioids or new symptoms. Do not change other medicines without instructions.
Risks and when to seek help
The boxed warning covers sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviours associated with antidepressants in younger people. Do not drive, operate machinery or undertake activities requiring full alertness until the next day after a restful sleep. Arrange a ride home even if you feel ready to drive. Blood-pressure elevation can make a session unsuitable. Spravato may harm the fetus during pregnancy and breastfeeding is not recommended during treatment. Urgent worsening depression or a suicide crisis needs immediate clinical or emergency care rather than waiting for the next session.
Follow-up and treatment review
Track depression symptoms, daily function, adverse effects and missed sessions with the treating team. A late session is not a reason to double a dose. If maintenance sessions are missed and symptoms worsen, the clinician may consider returning to a previous frequency. Continuing care includes psychiatric review and safety planning, not just attendance at nasal-spray visits.
Appointments, costs and coverage
Ask for separate confirmation of medication coverage, administration and monitoring charges, authorization dates and the number of approved visits. A previous approval does not guarantee a new dose, renewal or paid claim. Ask about appeals and documentation if denied. Confirm the selected site’s REMS status, appointment capacity and transport policy directly. Ask whether the medicine is ready and which charges are approved.
Questions about your care
Is at-home ketamine FDA-approved for depression?
Compounded ketamine supplied for home depression treatment is not FDA-approved. Spravato is a distinct approved nasal-esketamine product administered under direct supervision in a REMS-certified healthcare setting, with at least two hours of monitoring. A home or mailed ketamine program cannot borrow that approval or monitoring pathway. Discuss the exact product, setting and risks with a qualified clinician.
Can I use insurance for Spravato?
Have your insurance card ready when booking. Share member details through the clinic’s confirmed secure intake process. Check with the clinic and your insurer that the exact plan covers the clinician and requested service. Ask about visit charges, any separately billed tests or medicines, and any referral or authorization requirement. Coverage and your copay or deductible depend on the plan; request a written estimate if paying yourself.
Can I drive home if I feel normal after two hours?
No. Follow the label’s restriction until the next day after a restful sleep. Arrange transport home. Two hours is a minimum observation period, not driving clearance.
Does the treatment only work at 84 mg?
No such general claim is supported. The current TRD regimen uses 56 mg or 84 mg according to the prescribed plan and tolerability. Insurer authorization and clinical dose selection are separate decisions.
What if insurance begins denying claims after treatment starts?
Contact the clinic and insurer promptly to check authorization dates, approved services and claim reasons before assuming future sessions are covered. Ask for the clinical documentation and appeal process. Prior treatment alone does not establish continued payment.
What should I know about at-home ketamine and clinic Spravato?
Spravato nasal spray and IV ketamine are different treatments. Ketamine is not FDA-approved for a psychiatric disorder. Do not assume their eligibility rules, monitoring or coverage are interchangeable.
More information about treatment and visits
Can Spravato be mailed to my home? Why do Spravato patients stay after treatment?
Bring antidepressant names, doses, dates, response, adverse effects and relevant hospital records. Clarify whether the proposed treatment is TRD care or the separate acute suicidal MDD indication. Discuss other suitable treatments and continuing therapy.
Spravato is administered through its REMS in a certified healthcare setting. Patients self-administer the nasal spray under direct supervision. Blood pressure is checked before dosing, around 40 minutes afterwards and further as needed. Breathing is monitored, including pulse oximetry, for at least two hours. Release occurs only when the clinician finds the patient stable. Some visits take longer.
TRD treatment is twice weekly for the first four weeks, then weekly in weeks five through eight. From week nine, dosing is weekly or every two weeks according to response. The clinician assesses benefit after the initial four weeks. The acute suicidal MDD regimen is a separate twice-weekly four-week course. Longer use for that indication has not been systematically evaluated.
The boxed warning covers sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviours associated with antidepressants in younger people. Do not drive, operate machinery or undertake activities requiring full alertness until the next day after a restful sleep. Arrange a ride home even if you feel ready to drive. Blood-pressure elevation can make a session unsuitable. Pregnancy may harm the fetus and breastfeeding is not recommended during treatment. Urgent worsening depression or a suicide crisis needs immediate clinical or emergency care rather than waiting for the next session.
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