Relief for depression that arrives in hours, not weeks.
Spravato is a rapid acting, FDA approved nasal spray for depression that has not responded to other medication, including depression with acute suicidal thoughts. Given in our office, monitored, and covered by most insurance.
Available in Cincinnati · Dayton · Indianapolis · In network with most plans
A different mechanism, and a fast one
Rapid acting
Spravato works on the brain's glutamate system, a different pathway than standard antidepressants, and relief can begin the same day rather than weeks later.
24 hrs
improvement in depressive symptoms in trials, versus the weeks an oral antidepressant takes
Works when other medications haven't
Spravato is FDA approved specifically for treatment resistant depression, depression that has not responded to two or more antidepressants. It opens a different door when the usual ones have not worked.
Approved for the hardest moments
Spravato is approved for adults with major depression who are experiencing acute suicidal thoughts, given with full clinical care. It is the first medicine shown to ease depressive symptoms within 24 hours in this group.
What esketamine is, and how it relates to ketamine
Spravato is closely related to ketamine, but it is not the same thing. The difference is in the molecule and in how it is given.
Ketamine is a racemic molecule, which means it is a mix of two mirror image forms, an R version and an S version, like a left and a right hand. Esketamine, the medicine in Spravato, is just the S form, purified out on its own.
That S form binds the brain's NMDA receptor more tightly, which is part of why a smaller, standardized dose can be delivered as a nasal spray. The same glutamate based mechanism that makes ketamine rapid acting is what makes Spravato rapid acting too.
Racemic ketamine
The original, given off label
Both mirror image forms together, most often delivered by IV infusion and used off label for depression, since it is not FDA approved for it. Dosing and coverage vary by clinic.
Esketamine · Spravato
The purified form, FDA approved
The single S form, delivered as a standardized nasal spray, FDA approved for depression, given under monitoring in a certified setting, and covered by most insurance. Same family, more defined and more accessible.
An acute series, then maintenance
Treatment comes in two phases. Click through to see each one.
The induction phase
The induction phase, where the rapid effect is built. Most people come in twice a week, and many notice a shift early in this stretch.
Given with an oral antidepressant, or on its own where appropriate.
Holding the gains
Once the acute series has done its work, visits space out to hold the gains in place. The schedule is tailored to how you respond.
Your prescriber adjusts the interval based on your response.
What every visit looks like
- You self administer the nasal spray with the team guiding you
- A temporary sense of detachment is normal and passes
- We monitor you for at least two hours afterward
- You cannot drive that day, so bring someone to drive you home
Approved, and broadened over time
Treatment resistant depression
Approved with an oral antidepressant for depression that has not responded to two or more medications.
Depression with acute suicidal thoughts
Approved to rapidly reduce depressive symptoms in adults with major depression and acute suicidal ideation or behavior.
Approved on its own
Now the first and only esketamine monotherapy for treatment resistant depression, no longer requiring a second daily pill.
Real results in people who had run out of options
In treatment resistant depression, Spravato response rates typically run from 50 to 70 percent, where a response means a 50 percent or greater reduction in depressive symptoms. Full remission, meaning minimal or no symptoms, is reached by 30 to 50 percent of patients, with the strongest results in those who complete the full course.
The effect is also fast. In the trials behind the suicidal depression approval, depressive symptoms improved within 24 hours of the first dose, in a severely ill group usually left out of antidepressant research.
These are averages, not promises, and exact figures shift with the rating scale, the number of sessions, and the person. What stays consistent is that esketamine produces rapid, measurable relief for many people with treatment resistant depression, including some for whom every prior medication had fallen short.
Coverage
Covered by most insurance
Because Spravato is FDA approved rather than off label, it is broadly covered, which is one of its real advantages over IV ketamine. We handle the prior authorization and confirm your benefits before you start.
Common questions about Spravato
They are closely related. Esketamine, the medicine in Spravato, is one half of the ketamine molecule, the S mirror image form. Spravato is an FDA approved nasal spray given under monitoring and covered by insurance, while IV ketamine for depression is usually given off label.
Much faster than a standard antidepressant. In trials, depressive symptoms improved within 24 hours of the first dose, compared with the weeks an oral antidepressant usually takes.
No. After each dose you are monitored for at least two hours, and you cannot drive for the rest of the day, so you will need someone to drive you home.
Spravato is broadly covered by most commercial plans and by Medicaid, and we stay in network across Ohio and Indiana. We verify your specific benefits before treatment begins.
Usually yes. Spravato is most often given alongside an oral antidepressant, though it is now also FDA approved on its own. Your prescriber decides what fits your situation.
See if Spravato is right for you
A free consultation is the first step. We will talk through your history, answer your questions, and verify your benefits before anything begins.