Spravato (Esketamine) Therapy

Spravato® (esketamine) is a prescription nasal spray antidepressant designed for adults with treatment-resistant depression (TRD). It’s a form of ketamine, a medicine long used safely in anesthesia and depression treatment, refined and approved by the FDA in 2019 specifically for difficult-to-treat depression. Spravato® is the only FDA-approved nasal spray for depression that hasn’t improved after at least two different antidepressant medications. It can be used in conjunction with a traditional oral antidepressant or as a monotherapy for TRD, according to the latest FDA approvals. Spravato® is also approved for adults with major depressive disorder and acute suicidal ideation or behavior, as a rapid intervention alongside standard treatment. Importantly, Spravato® is not a take-home medication – it’s only available at certified treatment centers due to safety requirements.

Spravato® works differently than typical antidepressants. Most antidepressant pills (SSRIs, SNRIs, etc.) work by adjusting neurotransmitters like serotonin or norepinephrine over time. Spravato®, however, targets the N-methyl-D-aspartate (NMDA) receptors in the brain, affecting the glutamate system. Glutamate is the brain’s most abundant excitatory neurotransmitter and is involved in forming neural connections and influencing mood. By modulating glutamate, Spravato® helps stimulate new connections between brain cells (a process called synaptic plasticity), which may “reset” brain circuits involved in depression. This mechanism is believed to lead to faster and more robust antidepressant effects, often within hours or days, rather than weeks. (While Spravato’s precise antidepressant mechanism is still being studied, its ability to rapidly enhance glutamate signaling marks a breakthrough in depression treatment.)

Spravato® is intended for adults 18 and over who have major depressive disorder with treatment-resistant depression – generally defined as depression that hasn’t improved after at least two adequate trials of antidepressant medications. It offers a new option for those who still suffer from debilitating depression despite therapy, medication, or other treatments. Spravato® may also be considered for patients with severe depression accompanied by suicidal thoughts, to rapidly reduce depressive symptoms as part of a broader safety plan.

Evaluation: Before starting Spravato®, our team will perform a thorough evaluation to ensure it’s appropriate. We will confirm your diagnosis, review past treatments, and check for any medical issues that could affect Spravato® use. Certain conditions – like uncontrolled high blood pressure, certain heart or vascular conditions (such as aneurysms), or a history of serious brain injury – may make Spravato® unsafe for you. We also carefully assess individuals with a history of substance abuse, since Spravato® (being related to ketamine) has a potential for misuse if not properly managed. If Spravato® is not a good fit or if it’s not effectively relieving your symptoms, we will work with you on alternative treatments or refer you to appropriate services – your well-being is our priority.

• Rapid Relief: Spravato® can reduce depressive symptoms far more quickly than conventional antidepressants. Many patients notice improvement within 24-48 hours of the first treatment, which is life-changing for those who have endured years of depression. In clinical studies, some patients even experienced significant mood improvement the same day as their first dose.
  
  
• High Success Rate in TRD: For people with treatment-resistant depression, Spravato® offers hope when other treatments have failed. A significant percentage of TRD patients show a meaningful improvement in symptoms after just a few Spravato® sessions. In trials, Spravato® (combined with an oral antidepressant) helped a majority of such patients achieve at least a 50% reduction in depression severity. This can translate to better day-to-day functioning, improved ability to work, and renewed interest in life’s activities.
  
  
• Reduction in Suicidal Thoughts: Spravato® is one of the only treatments shown to rapidly decrease suicidal ideation in depressed patients. Patients in acute crisis may feel their darkest thoughts lift noticeably within the first treatment sessions. (Spravato® is approved to treat depressive symptoms in the context of suicidal ideation or behavior, but it is used alongside standard care, such as close psychiatric monitoring or hospitalization when needed, to ensure safety.)
  
  
• Different Mechanism – New Possibilities: Because Spravato® works via the glutamate pathway, it often helps people who get little benefit from traditional antidepressants that target other brain chemicals. It opens the door to relief through a novel mechanism. Research also suggests Spravato® may help the brain form new neural connections and reverse stress-related damage from long-term depression, potentially providing more enduring recovery. Many patients describe feeling a “mental reset” or a new perspective that they couldn’t achieve with other treatments.
  
  

In-Clinic, Monitored Therapy: Though some might see the required clinic visits as a drawback, many find reassurance in the high level of care and supervision we provide. You are never alone during a Spravato® session – our trained staff is by your side to ensure your comfort and safety. The structured routine of regular visits can provide a therapeutic rhythm and additional support as you heal. Our clinic setting is calming, private, and designed to make your treatment experience as positive as possible.