Spravato® (esketamine) at Gravity

For adults whose depression hasn’t lifted with standard medications

Spravato® (esketamine) CIII nasal spray is an FDA-approved option for adults with treatment-resistant depression, and for depressive symptoms in major depressive disorder with suicidal thoughts or actions when taken with an oral antidepressant. At Gravity Psychiatry & Wellness, it’s delivered in a calm, REMS-certified setting that keeps safety, clarity, and dignity at the center.

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REMS-certified Spravato® clinic in Normal, Illinois

For adults with treatment-resistant depression (TRD)

In-office only, with at least 2 hours of monitoring

Two FDA-approved ways Spravato® is used

Spravato® (esketamine) nasal spray is a prescription medicine approved for adults in two specific situations:

Treatment-resistant depression (TRD) in adults — Spravato® can be used on its own (monotherapy) or together with an oral antidepressant when at least two other antidepressants have not provided enough relief.
Depressive symptoms in adults with major depressive disorder (MDD) who have acute suicidal thoughts or behavior — in this case, Spravato® is used together with an oral antidepressant.

Spravato® is taken only in a certified clinic under supervision. It is not approved for use in children and is not an anesthetic medicine.

Acts differently from many antidepressants

While many antidepressants act mainly on serotonin or norepinephrine, Spravato® targets glutamate pathways in the brain. This different mechanism can offer another option when standard medications haven’t been enough.

Always given in clinic

You self-administer the nasal spray in our office while a trained clinician observes and monitors you for at least two hours after each dose. It is never dispensed for home use.

One piece of a larger plan

At Gravity, Spravato® is one part of a broader care plan that can include medication management, therapy, skills, and lifestyle support. It’s not a quick standalone fix.

Important: The ability of Spravato® to prevent suicide or reduce suicidal thoughts or actions has not been proven. It does not replace hospitalization if a higher level of care is needed, even if you feel better after a dose.

Could Spravato® be right for you?

Spravato® is used for adults whose depression has stayed stubborn despite trying standard treatments. When we consider Spravato®, we look at both potential benefit and safety together.

Signs Spravato® could make sense

Age 18 or older
Major depressive disorder with limited response to at least two different antidepressants at adequate doses and durations
Ongoing symptoms that still affect mood, functioning, or quality of life despite treatment
Willing and able to attend frequent in-office visits, monitoring, and follow-up

Safety and history we always review

Past or current bipolar disorder, psychosis, or significant untreated trauma
Uncontrolled high blood pressure or certain heart and vascular conditions
Current substance use concerns or history of misusing medications or other substances
Pregnancy, plans for pregnancy, or breastfeeding, and what this means for timing

These factors do not automatically mean “no.” They guide whether Spravato® is safe for you right now, what extra monitoring you might need, or whether a different approach would be safer or more effective.

If you’re unsure where you fit, that’s normal. The goal of the consultation is not to “pass or fail” you. It’s to understand your story, review what you’ve already tried, and decide together whether Spravato® is the right move or if another path fits you better.

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How Spravato® treatment works over time

Spravato® is given on a structured schedule. The exact plan is personalized, but it usually follows an induction phase, an adjustment phase, and then maintenance.

Your treatment schedule

Weeks 1–4: Induction phase

Typically twice per week. This is where many people notice their first shifts in mood or energy, although the timing is different for everyone.

Weeks 5–8: Adjustment phase

Often once per week. We track symptoms, functioning, and side effects and fine-tune dose and frequency.

After Week 8: Maintenance phase

Treatments are usually weekly or every other week. We aim for the least frequent schedule that still maintains your response, with regular check-ins to decide if adjustments are needed.

What happens on treatment days

On days you receive Spravato®, there is a predictable rhythm to each visit so you know what to expect.

Before your visit: Plan for 2–2.5 hours in the office. Avoid food for 2 hours and liquids for 30 minutes before dosing. Arrange a trusted adult to drive you home afterward.
Arrival: We check in, review how you’ve been, confirm your ride home, and answer last-minute questions.
Dosing: You self-administer the nasal spray in a private room, with staff close by and monitoring you.
Observation: You remain in the office for at least 2 hours while we monitor vital signs, side effects, and comfort.
Afterward: You cannot drive, operate machinery, or do safety-sensitive tasks the rest of the day. Plan for a quiet, low-demand evening.

What research shows about Spravato®

Spravato® has been studied in multiple clinical trials and long-term follow-up studies in adults with treatment-resistant depression. These are examples of what has been seen in research; they do not predict exactly how any one person will respond.

Short-term symptom change

≈ 24 hours

In some studies, people on Spravato® plus an oral antidepressant showed more improvement in depression scores as early as 24 hours after the first dose compared with those on antidepressant plus placebo. Both groups often continued to improve over the first 4 weeks.

Remission at 4 weeks (example trial)

22.5% vs 7.6%

In one 4-week trial of adults with TRD, about 22.5% of people receiving Spravato® achieved remission (very low depression scores) compared with about 7.6% on placebo. Both groups also received background antidepressant treatment.

Relapse prevention

≈ 51–70% lower risk

In a relapse-prevention study of adults with TRD who had improved on Spravato® plus an antidepressant, those who stayed on Spravato® had about a 51% lower risk of relapse if they were in stable remission, and about a 70% lower risk if they were in stable response, compared with those who stayed on antidepressant and switched to placebo.

Monotherapy & long-term data

Newer approvals

Newer data and regulatory updates now allow Spravato® to be used on its own (not only with an oral antidepressant) for adults with treatment-resistant depression. Longer-term follow-up has not identified new major safety signals beyond what is already in the prescribing information, although side effects and risks remain significant and require close monitoring.

Important: These findings come from carefully selected groups in clinical trials. Real-world response, side effects, and durability vary. Research is one piece of the picture; your individual history and preferences matter just as much.

How Spravato® is thought to work in the brain

This short video from the manufacturer of Spravato® illustrates one of the leading scientific theories about how esketamine may help relieve symptoms of treatment-resistant depression by affecting glutamate signaling and synaptic connections.

A more technical look (optional)

The video uses medical language and is aimed at explaining a possible mechanism of action. You do not need to understand every detail for Spravato® to be a good option. Your clinician can highlight the parts that matter most for you.

Note: This video is produced by the manufacturer of Spravato® for educational purposes. It does not replace a full discussion of risks, benefits, and alternatives with your own healthcare provider.

Your Spravato® environment at Gravity

Your surroundings matter. Spravato® is provided in a calm, private setting designed to feel supportive and safe while we monitor you closely.

Illustrative calm therapy room; your treatment room at Gravity may look different.

Calm Treatment Room

A quiet, private space where you can rest during and after each Spravato® dose.

Illustrative clinic waiting room; Gravity's space is designed to be welcoming and low-stress.

Comfort & Monitoring

Comfortable seating and ongoing vital sign checks to keep treatment as safe as possible.

Welcoming Environment

A warm, welcoming office designed to feel less like a clinic and more like a safe landing.

Safety, side effects, and REMS monitoring

Spravato® has important risks and a Boxed Warning. We follow SPRAVATO REMS requirements and add our own extra layers of caution because your safety is non-negotiable.

Serious risks your clinician will discuss

Serious side effects can include:

Significant sleepiness or sedation
Feeling disconnected from yourself or your surroundings (dissociation)
Breathing problems, including slowed breathing
Increases in blood pressure
Risk of misuse, abuse, and dependence as a controlled substance
Increased risk of suicidal thoughts and behaviors in some people taking antidepressants, especially young adults

Because of these risks, Spravato® is only given in certified healthcare settings through the SPRAVATO REMS program, with monitoring during and after each treatment.

Common side effects people may notice

Common side effects often occur during or shortly after treatment and usually improve the same day. They can include:

Dissociation or feeling detached
Dizziness or spinning sensation
Nausea or vomiting
Feeling “drunk,” unsteady, or very sleepy
Headache
Increased blood pressure
Feeling unusually energized or “up” for a time

Emergency symptoms: If you ever have chest pain, trouble breathing, a sudden severe headache, vision changes, seizures, or intense agitation, seek emergency care or call 911 right away.

This is not a complete list of side effects or risks. For full prescribing information, including Boxed Warning and Medication Guide, talk with your healthcare provider and review the official Spravato® materials.

Cost, insurance, and support

Spravato® involves both the medication itself and the time and resources required to safely administer and monitor it in the clinic. We aim to give you a clear picture of what we know and where you’ll need to speak directly with your insurance plan.

How Gravity can help

Review your insurance information in relation to Spravato® treatment.
Clarify which parts of treatment are billed as clinic services and monitoring.
Provide cost estimates when your plan gives us enough information.
Submit required clinical documentation and prior authorization forms when needed.

Questions to ask your insurance plan

Once you and your clinician decide that Spravato® may be appropriate, call the number on your insurance card and ask:

Is the Spravato® medication covered under my medical or pharmacy benefit?
Are my Spravato® treatment visits covered under my medical plan or behavioral health benefit?
What are my copays, coinsurance, and deductible for these services?
Are there in-network offices that are certified to administer Spravato®? Am I allowed to receive treatment at Gravity Psychiatry & Wellness?

Manufacturer support & savings programs

The manufacturer of Spravato® offers patient support options (such as the SPRAVATO withMe program) that may help eligible patients understand their coverage and explore cost support for medication and, in some cases, observation costs.

These programs are run by the manufacturer, have their own rules, and may change over time. During your consultation, we can share current information so you can decide whether to look into these options.

We do not control these programs and cannot guarantee eligibility, coverage, or any particular savings. Information from support programs does not replace what you receive from your health plan, and it does not require you to use any specific product.

Important: Final out-of-pocket costs depend on your specific insurance plan, deductible status, and any assistance program decisions. We will be transparent about what we know, and honest about what we cannot control.

Frequently asked questions

Tap or click a question to expand the answer.

Will I feel “out of it” during treatment?

Many people feel different for a period of time after dosing — more detached, dreamy, or “floaty” than usual. These feelings usually peak within the first hour and fade as you rest under observation. We monitor you closely and adjust the environment to help you feel as safe and grounded as possible.

Can I drive myself home after Spravato®?

No. You cannot drive, operate machinery, or do anything that requires full alertness after Spravato® on the day of treatment. You will need a trusted adult to take you home. You should avoid driving and safety-sensitive tasks until the next day after a full night of sleep.

How long will I be in the office for each session?

Plan on about 2 to 2.5 hours per visit, including check-in, dosing, the observation period, and a final safety check before you leave.

Do I have to stop my current medications?

For treatment-resistant depression, Spravato® can be used alone or together with an oral antidepressant. For depressive symptoms in MDD with acute suicidal thoughts or behavior, it is used with an oral antidepressant. We also review your other medications and supplements to build a safe and coherent plan.

How quickly might I notice changes?

Some people notice shifts in mood, energy, or outlook within the first few weeks. For others, changes are more gradual. We track your symptoms over time and make decisions based on patterns, not a single visit.

Is Spravato® my “last resort”?

Spravato® is used when standard antidepressants have not worked well enough, but that does not mean you are out of options. For some people, it opens up space for improvement when nothing else has helped. For others, different treatments may still be a better fit. Our job is to walk through those choices honestly with you.

Can I keep seeing my current therapist or psychiatrist?

Yes. We value collaboration. With your permission, we can coordinate with your existing therapist or psychiatric provider so that Spravato® fits into the work you are already doing, rather than replacing it.

Grounded in care. Elevating mental wellness.

Choosing Spravato® is not about chasing a quick fix. It is about thoughtfully exploring another option when depression has been stubborn, while staying anchored in safety, relationship, and evidence. At Gravity Psychiatry & Wellness, Spravato® is offered within the same values that guide the rest of your care: grounded in respect, informed by science, and centered on you as a whole person.

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Spravato® (esketamine) is a registered trademark of Janssen Pharmaceuticals. This page is for educational purposes only and does not replace individualized medical advice. Treatment decisions should always be made in direct conversation with your healthcare provider.

Not a crisis service. If you are experiencing a psychiatric emergency, call 911 or go to your nearest emergency department. You may also call or text 988 to reach the Suicide & Crisis Lifeline.