Spravato (esketamine) is a prescription nasal spray approved by the FDA to treat treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal thoughts or behavior. The treatment process is structured, medically supervised, and must be administered in a certified clinic. Here’s a detailed breakdown:
1. Initial Psychiatric Evaluation
Before beginning Spravato, patients undergo a comprehensive evaluation with a licensed psychiatrist or mental health provider.
This assessment includes:
- A review of your medical and psychiatric history
- An evaluation of previous antidepressant treatments
- Determining if you meet the criteria for treatment-resistant depression (usually defined as having tried two or more antidepressants without success)
If you’re a candidate, you’ll be enrolled in the Spravato REMS (Risk Evaluation and Mitigation Strategy) program, which ensures the medication is administered safely.
2. Treatment Planning & Consent
Once approved, you’ll work with your provider to build a treatment plan. This includes:
- The dosing schedule
- Frequency of visits
- Coordination with your current therapy or medications
You’ll also sign consent forms acknowledging possible side effects and the clinic’s safety protocols.
3. In-Clinic Spravato Administration
Spravato is not taken at home. You must visit a certified treatment center for each dose.
Here’s what to expect:
- You self-administer the nasal spray under supervision
- Each treatment session lasts 2–2.5 hours
- Healthcare providers monitor you closely for side effects like dizziness, dissociation, or elevated blood pressure
You cannot drive or operate machinery after treatment and must arrange transportation home.
4. Monitoring After Each Dose
After taking Spravato, you’ll remain in the clinic for at least two hours.
During this time:
- Your vital signs (blood pressure, heart rate) are monitored
- Mental status is assessed
- Any side effects are addressed promptly
This observation period ensures patient safety and is required for every session.
5. Treatment Schedule and Duration
Spravato follows a phased treatment schedule:
- Induction Phase (Weeks 1–4): Two treatments per week
- Maintenance Phase (Weeks 5–8): One treatment per week
- Long-Term Phase (Week 9+): One treatment every 1–2 weeks, depending on response
This flexible schedule is adjusted based on how well you respond to the medication and how stable your mood remains.
6. Ongoing Mental Health Support
Spravato is most effective when combined with:
- An oral antidepressant
- Regular therapy sessions (CBT, talk therapy, etc.)
- A supportive care team who can monitor progress and adjust care
It is not a standalone cure, but a powerful tool as part of a comprehensive treatment plan.
FAQs
Q: How soon will I feel results?
Many patients report improvement in mood and reduced depressive symptoms within 2 to 4 weeks, especially in suicidal ideation. However, individual responses vary.
Q: Is Spravato the same as ketamine infusions?
No. Spravato is esketamine, a related but distinct molecule derived from ketamine. It is FDA-approved, delivered as a nasal spray, and must be used in certified clinics — unlike off-label IV ketamine infusions.
Q: Who should avoid Spravato?
People with uncontrolled hypertension, certain heart conditions, or a history of substance abuse may not be good candidates. Your provider will determine your eligibility.
Summary:
Spravato treatment is a structured, in-clinic nasal spray therapy designed for patients with treatment-resistant depression. It requires an evaluation, close monitoring, and works best as part of a holistic mental health care plan. Most patients attend 2+ sessions per week for the first month, with the frequency tapering over time. It is safe, FDA-approved, and monitored by professionals.