Spravato (Esketamine)

FDA-approved rapid relief for treatment-resistant depression

Spravato (esketamine) is a nasal spray derived from ketamine that works within hours — not weeks — for patients whose depression hasn't responded to antidepressants. Evolve is a certified Spravato treatment center.

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FDA
Approved for treatment-resistant depression & MDD with suicidal ideation
2×
Weekly sessions during the initial induction phase
Hours
Rapid antidepressant effects — not weeks like traditional medications
REMS
Certified center — Evolve is trained and authorized to administer Spravato
What is Spravato?

A different kind of antidepressant — with a different kind of speed

Spravato (esketamine) works on the NMDA receptor — a completely different target than SSRIs and SNRIs. This distinct mechanism is why it can work for people when traditional antidepressants have failed.

Traditional antidepressants take 4–8 weeks to build up and often require multiple trials. Spravato can begin providing relief within hours to days, which is why the FDA also approved it specifically for patients with MDD and active suicidal ideation.

Spravato is administered in our office and patients are monitored for at least 2 hours after each session — a requirement of the REMS program. You cannot drive yourself home after treatment.
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Who may benefit from Spravato

▸ Adults with treatment-resistant depression (tried 2+ antidepressants)
▸ Adults with MDD and active or recent suicidal ideation
▸ Patients who need faster relief than traditional medications provide
▸ Patients unable to tolerate standard antidepressant side effects

FDA Approvals

Treatment-Resistant Depression (TRD): For adults who have not responded to at least two different antidepressants at adequate doses.


MDD with Acute Suicidal Ideation: For adults with MDD who have active or recent suicidal thoughts or behaviors. Used as a short-term bridge treatment.

The Process

How Spravato treatment works

Spravato is given in two phases: an initial induction phase followed by a maintenance phase. All sessions happen in our office.

1

Evaluation

Your provider reviews your depression history, prior medications, and current symptoms to confirm Spravato candidacy and discuss what to expect.

2

Induction Phase

Sessions 2x/week for 4 weeks (8 sessions total). You self-administer the nasal spray under your provider's supervision, then rest for 2 hours.

3

Optimization

Sessions 1x/week for 4 weeks. Your provider monitors your response and adjusts your maintenance medication plan alongside Spravato.

4

Maintenance

Sessions 1–2x/month ongoing, based on your response. Most patients continue on a combination of Spravato and oral antidepressants.

Insurance & Cost

Spravato is covered by most major insurers

Spravato is FDA-approved and covered by most major commercial insurance plans and Medicare Part D. Coverage typically requires documented treatment-resistant depression and prior authorization.

Janssen (the manufacturer) also offers a patient assistance program for eligible patients who are uninsured or underinsured. Our team can walk you through your options.
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Plans that cover Spravato

✓ Most commercial insurance plans
✓ Medicare Part D (with prior auth)
✓ Aetna, BCBS, UHC, Cigna, Empire
✓ Oscar Health
✓ Many Medicaid managed care plans (varies by state)

Prior authorization is typically required. Our team handles the PA process on your behalf and will confirm coverage before your first session.

FAQ

Common questions about Spravato

Is Spravato the same as ketamine infusions? +
Not exactly. Spravato (esketamine) is derived from ketamine but is a different compound (S-ketamine vs. racemic ketamine). It's administered as a nasal spray rather than an IV infusion, and it's the only FDA-approved ketamine-derived treatment for depression. IV ketamine infusions are used off-label. Spravato has a larger evidence base for depression specifically and is typically covered by insurance, whereas IV ketamine usually is not.
How does Spravato feel during the session? +
Most patients experience dissociative effects — a feeling of being "disconnected" from themselves or their surroundings — during the session. These effects typically peak around 40 minutes after administration and resolve within the 2-hour monitoring period. Some patients also experience dizziness, nausea, or drowsiness. This is why you cannot drive after a session.
How quickly does it work? +
Many patients notice mood improvements within hours to days of their first or second treatment. However, the full benefits of the treatment course typically develop over the 4-week induction phase. For patients with acute suicidal ideation, the rapid onset of action is a key clinical advantage over traditional antidepressants.
What if Spravato doesn't work for me? +
If you don't respond to Spravato after the induction phase, your provider will discuss alternative options, including TMS therapy, medication changes, or combination strategies. Not every treatment works for every patient — that's why Evolve offers multiple advanced treatment options under one roof.
Can I take Spravato with my other medications? +
Spravato is typically used alongside an oral antidepressant — not instead of one. Certain medications may interact with Spravato, including some stimulants, MAOIs, and CNS depressants. Your provider will review all your current medications before starting treatment and manage any interactions.

Find out if Spravato is right for you

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