Spravato care

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.

Spravato is an esketamine nasal spray for adults with treatment-resistant depression, either as monotherapy or with an oral antidepressant. It is also indicated with an oral antidepressant for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior. It must be given under direct supervision in a REMS-certified setting with at least two hours of monitoring, including respiratory assessment and pulse oximetry.

Choosing a Spravato treatment site

Confirm the actual REMS-certified treatment site, medication arrival, accepted order and session availability. Ask how the clinic provides the minimum two-hour observation, breathing and blood-pressure monitoring, and release assessment. Check the local transport policy and arrange a ride home. You cannot drive until the next day after a restful sleep. Ask the selected clinic directly whether it can provide your prescribed Spravato treatment in a certified setting. Make sure clinical and practical arrangements are confirmed before taking time away from work.

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. These indications should not be merged into one promise. Spravato has not been shown to prevent suicide or reduce suicidal thoughts or behaviour, and it does not replace hospitalization when that is needed.

How Spravato (esketamine nasal spray) works

Esketamine affects NMDA receptors in the brain. Its antidepressant mechanism is not fully understood. It differs from standard oral antidepressants and from IV ketamine. Feeling dissociated during a session is not a test of whether the depression treatment will work. The clinician judges benefit from symptoms, daily function and safety over time.

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. 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.

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

Can Spravato be used without an oral antidepressant?

Yes, the current label permits monotherapy for adult treatment-resistant depression. The separate acute suicidal MDD depressive-symptom indication still requires an oral antidepressant. The prescriber must identify which indication applies.

Does it prevent suicide?

The label says effectiveness in preventing suicide or reducing suicidal ideation or behaviour has not been demonstrated. A severe crisis may still require hospitalization and urgent safety care.

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.

Medical sources

What happens before and during a Spravato session

1. Psychiatric and benefits evaluation

Confirm diagnosis, prior treatments, current symptoms, safety, treatment goals, REMS steps, insurance, and transportation before the first dose.

2. Treatment-day checks

Review medicines and symptoms, assess blood pressure, confirm food and liquid instructions, and verify a safe ride home.

3. Supervised nasal administration

The patient uses the prescribed devices under direct healthcare supervision in the certified setting.

4. At least two hours of observation

Monitor sedation, dissociation, respiratory status including pulse oximetry, blood pressure, and clinical stability before discharge.

Established Spravato location access