Spravato treatment for adults
The current Spravato label permits treatment-resistant depression in adults either alone or with an oral antidepressant. A separate indication covers depressive symptoms in adult major depressive disorder with acute suicidal thoughts or behaviour, and that use requires an oral antidepressant. Spravato has not been shown to prevent suicide or reduce suicidal thoughts or behaviour. It does not replace hospitalization when needed. Treatment involves supervised nasal dosing in a REMS-certified setting, medical monitoring and continuing psychiatric review, not an unsupervised home spray.
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
What side effects should I report?
Common Spravato effects include dissociation, dizziness, nausea, sleepiness, vertigo, vomiting, numbness and a rise in blood pressure. Tell the supervising team about troubling effects during the session. Breathing difficulty, severe headache, chest pain, fainting, neurological symptoms or dangerous worsening mood need immediate assessment. Observation lasts at least two hours and until clinically stable; feeling better does not remove the next-day-after-rest driving restriction.
Can I work right after Spravato?
Spravato can impair alertness even when you feel recovered. Do not drive, operate machinery or do activities needing full alertness until the next day after a restful sleep. Arrange a safe ride home and ask the certified service whether it requires an escort or accepts your proposed public-transit arrangement. Monitoring for at least two hours does not remove the restriction or establish that work immediately afterward is safe.
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.
Does Spravato help with anxiety?
Spravato is not FDA-approved to treat an anxiety disorder. Its approved uses concern specific forms of adult depression. Anxiety symptoms that accompany depression need their own assessment, and improvement is not guaranteed. Anxiety can also occur as a side effect during treatment. Tell the prescriber about panic, anxiety medicines and symptoms during a session so the plan addresses both safety and your treatment goals.
Does Spravato cause weight gain?
Weight gain is not listed among the most common adverse reactions in the current Spravato prescribing information. That does not prove it can never occur or explain a weight change in an individual patient. Tell your clinician about changes in weight or appetite and review all your medicines and health conditions. Do not stop Spravato or another prescribed medicine without instructions from the prescribing clinician.
Is Spravato addictive?
Spravato has a risk of abuse, misuse and dependence. That risk is one reason it is restricted to supervised treatment through the REMS program. The prescriber reviews substance-use history and monitors for misuse during care. Tell the clinician about cravings, taking medicines differently from instructions or a history of addiction. Supervision reduces opportunities for misuse but does not make the medicine risk-free. Do not change doses, obtain extra doses or stop treatment without a clinical plan.
Is Spravato a controlled substance?
Yes. Esketamine in Spravato is a federally controlled Schedule III substance. Spravato is dispensed to a REMS-certified healthcare setting and used there under direct supervision. It is not a take-home nasal spray. The controlled status concerns abuse and dependence risk. It does not tell you whether treatment is appropriate for your depression or whether insurance will pay.
More information about treatment and visits
How long am I monitored after Spravato? Can Spravato raise blood pressure?
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.
What does Spravato feel like?
Some people feel sleepy, dizzy, nauseated, numb or disconnected from their body or surroundings. Time or space may seem distorted, and some people feel anxious or intoxicated. Experiences vary. Tell the supervising team about frightening or uncomfortable effects. These sensations are not proof that the medicine is treating depression. The team checks blood pressure and breathing, including pulse oximetry, and monitors you for at least two hours and until you are clinically stable. Arrange a ride home. Do not drive until the next day after a restful sleep.
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