Spravato® (Esketamine): A Breakthrough for Treatment-Resistant Depression
FDA-Approved, Evidence-Based, and Compassionately Delivered
Schedule a Personalized ConsultationSpravato® (Esketamine) at Gravity Psychiatry & Wellness
Spravato® (esketamine) nasal spray is an FDA-approved medication specifically indicated for adults with treatment-resistant depression (TRD)—those who haven’t achieved adequate relief from at least two different antidepressants. Unlike traditional SSRIs or SNRIs that primarily modulate serotonin, Spravato® engages the NMDA receptor, potentially accelerating and enhancing antidepressant effects.
Expert Insight: In landmark trials published in the American Journal of Psychiatry and JAMA Psychiatry, esketamine therapy has shown promise in forming new neural pathways (synaptogenesis), contributing to faster and more durable improvements in mood for some patients.
A Comprehensive, Evidence-Backed Method
- Peer-Reviewed Studies: Trials like TRANSFORM-2 and SUSTAIN-1 show significant improvement in depressive symptoms compared to placebo.
- Rapid Relief Potential: Some individuals notice mood changes within the first few sessions, though results vary.
- Part of an Integrated Plan: Spravato® works best when combined with ongoing therapy, healthy coping strategies, and medication management.
Who Is It For?
Defining Treatment-Resistant Depression
TRD typically involves ongoing depression that persists despite trials of at least two different classes of antidepressants, taken at therapeutic doses and durations. Individuals may experience persistent sadness, hopelessness, or functional impairment. We also conduct thorough evaluations to rule out misdiagnoses such as bipolar disorder or unaddressed trauma.
Patient Suitability
- Screening & Consultation: We review medical history and discuss your full treatment journey.
- Medical and Psychiatric History: Additional lab work or assessments may be recommended.
- Shared Decision-Making: We present a balanced picture of potential benefits, risks, and alternatives.
The Spravato® Experience at Gravity Psychiatry & Wellness
Our process is designed to ensure safety, comfort, and optimal outcomes at every step.
Preparation & Education
We conduct a pre-treatment consultation to review the FDA’s Risk Evaluation and Mitigation Strategy (REMS) for Spravato®. You’ll receive guidance on how to self-administer the nasal spray and what to expect during the observation period.
Administration & Monitoring
- Relaxing Environment: A private, calming space is provided for administration, with warm lighting and comfortable seating.
- Self-Administration: Under direct supervision, you’ll administer Spravato® nasally.
- Observation: You’ll remain in our clinic for at least two hours for monitoring of vital signs and any side effects.
- Transportation: We require patients to arrange a safe ride home due to possible sedation or perception changes.
Follow-Up & Long-Term Support
Spravato® is typically administered twice weekly for four weeks, then tapered if improvement is noted. We pair it with talk therapy, lifestyle interventions, and continued medication management.
Safety, Side Effects & Regulatory Compliance
Potential Side Effects
- Dissociation or perceptual changes
- Dizziness, nausea, headache
- Increased blood pressure
A full list of side effects is detailed in the Spravato® Prescribing Information and the REMS Program. Our staff is trained to monitor and address any adverse reactions in real-time.
Boxed Warning & REMS Program
Spravato® carries a Boxed Warning for sedation, dissociation, and potential misuse. A certified facility (like ours) must administer it, ensuring strict patient monitoring and adherence to the REMS safety measures.
Clinical Evidence & References
Key Research Highlights
- TRANSFORM-2 Trial – Demonstrated significant symptom reduction in TRD patients (Journal of Psychiatric Research, 2019).
- SUSTAIN-1 Trial – Showed potential for relapse prevention with maintenance esketamine treatment (The Lancet Psychiatry, 2020).
- Real-World Data – Preliminary studies indicate promising remission rates outside of controlled trials.
Testimonials & Ethical Patient Stories
Ready to Explore Spravato®?
Contact our team for a thorough evaluation and personalized guidance on whether Spravato® might be right for you.
Schedule NowSpravato® (Esketamine) at Gravity
Relief for Treatment-Resistant Depression, Grounded in Care
Spravato® (esketamine) CIII nasal spray is an FDA-approved option for adults whose depression has not improved enough with standard medications. At Gravity Psychiatry & Wellness, it’s delivered in a calm, REMS-certified setting that keeps safety, clarity, and dignity at the center.
What Is Spravato®?
Spravato® (esketamine) nasal spray is a prescription medicine approved for:
- Treatment-resistant depression (TRD) in adults — used on its own or together with an oral antidepressant.
- Depressive symptoms in adults with major depressive disorder (MDD) who have acute suicidal thoughts or behavior — used together with an oral antidepressant.
It is taken only in a certified clinic under supervision. Spravato® is not approved for use in children and is not an anesthetic medicine.
Works Differently
Many antidepressants act mainly on serotonin or norepinephrine. Spravato® targets glutamate pathways instead, offering a different option for people who have not had enough benefit from standard medications.
Clinic-Based Only
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 not dispensed for at-home use.
Part of a Bigger Plan
At Gravity, Spravato® is never a stand-alone fix. It is integrated into a complete care plan that can include medication management, therapy, skills, and lifestyle support.
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.
Who Might Be a Good Fit for Spravato®?
Spravato® is used for adults whose depression has not responded well enough to standard treatments. When we think about “fit,” we look at two things together:
1) how closely you match the picture of someone likely to benefit, and 2) health and safety factors we need to understand before going ahead. Having something in the “safety and history” column does not automatically rule you out; it simply means we will talk more carefully about risks, timing, and alternatives.
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 are still affecting 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.
What to Expect with Spravato® at Gravity
Your brain is already carrying a lot. We want the process itself to feel predictable and clear.
1. Consultation & Medical Clearance
- Comprehensive psychiatric evaluation with a Spravato®-certified clinician.
- Review of your depression history, prior medications, and response patterns.
- Screening for medical conditions, blood pressure concerns, and substance use risk.
- Coordination with your primary care provider and therapist, when appropriate, to keep everyone on the same page.
2. Treatment Phases
We usually follow the FDA-approved schedule and personalize within that framework:
Weeks 1–4: Induction Phase
Typically twice per week. This is where many people notice their first shifts, although the timing is different for everyone.
Weeks 5–8: Optimization Phase
Often once per week as we track mood, energy, and functioning and fine-tune dose and frequency.
Ongoing: Maintenance Phase
After that, treatments are usually weekly or every other week. We aim for the least frequent schedule that still maintains your response.
3. Preparing for Treatment Day
- Plan for about 2 to 2.5 hours in the office for each session.
- Avoid food for 2 hours and liquids for 30 minutes before dosing.
- Arrange a trusted adult to drive you home afterward — no driving yourself.
- Wear comfortable clothing; you’ll mostly be resting or reclining.
- Consider bringing calming items (music, blanket, fidget, etc.), as long as they do not interfere with monitoring.
4. During and After the Visit
- 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.
See What a Spravato® Visit Can Look Like
Sometimes it’s easier to watch than to read. This short video walks through one person’s experience with Spravato®, so you can get a feel for the process before you decide.
Watch Before Your Consultation
Use this as a starting point, not a substitute for a medical visit. Your own plan may look a little different based on your history, safety needs, and goals. During your consultation at Gravity, we’ll talk through how Spravato® would specifically apply to you.
Note: This video is general education, not personal medical advice. It does not replace a full evaluation or a conversation about your unique situation.
Inside a Spravato® Session at Gravity
Your environment matters. Spravato® is provided in a calm, private setting designed to feel supportive and safe while we monitor you closely.
Safety, Side Effects, and REMS Monitoring
Spravato® has important risks and a Boxed Warning. We follow REMS requirements and add our own extra layers of caution because your safety is non-negotiable.
Key Serious Risks
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
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.
Insurance, Cost, and Support Programs
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 Our Office 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.
Use This Checklist When You Call Your Insurance
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
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.
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.