When antidepressants do not work, it is easy to wonder if the problem is you. It is not.
Up to 33% of people with depression do not respond to conventional antidepressants, making treatment-resistant depression one of the most challenging areas in mental health care.
Spravato® (esketamine nasal spray) takes a completely different approach to treat depressive symptoms. It works through a distinct brain pathway and can produce results far faster than traditional medications.
This guide walks you through everything you need to know before coming in to discuss whether Spravato® is right for you.
What Is Spravato® (Esketamine) Nasal Spray?
Spravato® is the brand name for esketamine nasal spray, a prescription medication the FDA approved in 2019 to treat adults with specific forms of depression. Unlike antidepressants you take at home, Spravato®® is administered through a single-use nasal spray device at a certified medical office like Oasis, under direct supervision from our clinical team.
Here is what makes Spravato® different from other depression treatments:
- Active ingredient: Esketamine is derived from ketamine, an anesthetic that has been used for years to treat depression. It is a more potent version that has earned FDA approval as a nasal spray.
- How it works in the brain: Unlike conventional antidepressants that target serotonin, norepinephrine, or dopamine, esketamine works by increasing glutamate, the most abundant chemical messenger in the brain. This allows it to impact more brain cells at once.
- FDA-approved uses: Treatment-resistant depression (TRD) in adults, and depressive symptoms in adults with major depressive disorder (MDD) who have acute suicidal ideation or behavior. Both uses are typically combined with an oral antidepressant.
- Who it is for: Adults 18 and older with a clinician-diagnosed depression who meet specific criteria. Spravato® is not approved for children, pain relief, or as a first-line depression treatment.
Who Is Spravato® For? (Treatment-Resistant Depression and Suicidal Ideation)
Understanding whether Spravato® might be right for you starts with knowing what treatment-resistant depression actually means.
What is treatment-resistant depression?
Treatment-resistant depression is when major depressive disorder has not improved enough after trying at least two different oral antidepressants. Each medication must have been taken at the right dose for a minimum of six weeks.
If you have been through this and still have not found relief, you may meet the criteria for treatment-resistant depression.
You may be a candidate for Spravato® if you:
- Have ongoing severe depression that is significantly affecting your work, relationships, and daily life
- Have had limited or no response to prior medications, therapy, or a combination of both
- Have persistent symptoms despite trying multiple medication classes at adequate doses
What about suicidal thoughts?
Spravato® is also FDA-approved for adults with major depressive disorder who are experiencing acute suicidal ideation or behavior. In these situations, the goal is rapid symptom relief in a closely monitored setting like Oasis. It is important to note that while Spravato® can reduce depressive symptoms quickly, its effectiveness in preventing suicide has not been demonstrated.
Who may not be a good candidate:
- People with uncontrolled high blood pressure or certain heart or brain conditions
- Those with aneurysmal vascular disease or a history of bleeding in the brain
- People with active substance abuse concerns, though careful evaluation applies rather than automatic exclusion
- Anyone with blood vessel abnormalities or aneurysm of the abdominal aorta
At Oasis, we conduct a thorough evaluation before recommending Spravato® to make sure it is the right and safe option for your specific situation. Our psychiatrists assess whether the benefits outweigh the risks for you personally before any treatment begins.
What to Expect During Spravato® Treatment
Spravato® is administered in a clinic setting because of its potential to temporarily affect your perception during the first two hours after treatment. Here is exactly what the process looks like when you come to Oasis.
Where treatment happens:
Spravato® can only be administered at outpatient healthcare settings that are enrolled in the FDA-mandated REMS program. Oasis is a certified Spravato® treatment center, meaning our facility and clinical team meet all the requirements to safely administer and monitor this medication.
A typical treatment visit:
When you arrive at Oasis for your Spravato® appointment, here is what to expect:
- Arrival and check-in: Your blood pressure is measured, a mental health assessment is completed, and our team reviews all medications you are currently taking including any over the counter medicines.
- Administration: You self-administer three doses of esketamine nasal spray, spaced five minutes apart, alternating nostrils while our clinical team observes throughout.
- Monitoring period: You remain at Oasis for at least two hours after treatment. Our team checks your blood pressure regularly and monitors for any side effects such as dissociation, sedation, or changes in breathing.
- Departure: You cannot drive yourself home after a Spravato® session. You must arrange for someone to take you home, and you should avoid driving, operating machinery, or making important decisions until the next day.
Dose and treatment schedule:
Spravato® treatment happens in phases. Our team at Oasis guides you through each one:
- Induction phase: Two sessions per week for the first four weeks
- Transition phase: One session per week for several weeks
- Maintenance phase: One session every one to two weeks, sometimes extending to every four weeks depending on your response
Your maintenance phase is adjusted based on how you are responding. Your healthcare provider determines when it is the right time to move to the next phase, and at Oasis we never rush that decision.
Important considerations:
- Spravato® can be used on its own or alongside an oral antidepressant, depending on your treatment plan. As of January 2025, the FDA approved Spravato® as the first monotherapy for treatment-resistant depression, removing the previous requirement to take it with an oral antidepressant.
- Psychotherapy can be recommended alongside medication for best outcomes.
- If you develop trouble urinating or notice frequent or urgent need to urinate, let our team know immediately as these can signal bladder concerns.
- Avoid nasal decongestant medicine or nasal corticosteroids within an hour of treatment.
Safety, Side Effects, and Risk Evaluation and Mitigation
Spravato® is strictly regulated under the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program. This is not meant to frighten you. It simply means Spravato® can only be given at certified clinics equipped to safely monitor patients treated with this medication. Oasis is a fully certified REMS provider.
Why the REMS exists: Because esketamine can cause sedation, dissociation and respiratory depression risks, and blood pressure spikes, the FDA created this evaluation and mitigation strategy. The program called the Spravato® REMS ensures that only healthcare settings certified to monitor patients can dispense and administer the medication.
Common temporary side effects: People can experience a wide range of side effects from esketamine therapy, including feelings of dissociation from reality. The most frequently reported include:
Side Effect | Frequency | Timing |
|---|---|---|
Dissociation | Very common | Peaks ~40 minutes, resolves within 2 hours |
Dizziness | Very common | Similar timing pattern |
Nausea | Common | Usually mild |
Increased blood pressure | Common | Monitored throughout visit |
Headache | Common | May persist after visit |
Altered taste, nasal numbness | Less Common | Temporary |
Side effects from esketamine therapy tend to peak at around 40 minutes after administration and generally wear off within two hours. The most intense side effects of esketamine typically occur during the first two treatments, with symptoms usually lessening after that.
While uncommon, these serious adverse outcomes are exactly why every Spravato® session at Oasis is conducted under direct clinical supervision.
Serious but less common risks:
- Significant blood pressure spikes (managed on-site with rest, positioning, or medication if needed)
- Respiratory arrest or breathing problems (extremely rare)
- Severe dissociation requiring extended monitoring
- New or sudden changes in behavior or mood
Abuse and misuse potential:
Spravato® has abuse potential as a Schedule III controlled substance, and long-term use can sometimes lead to bladder issues, though severe bladder pathology like ulcerative or interstitial cystitis is rare. The clinic-only administration model with no take-home dispensing is a key mitigation strategy against physical and psychological dependence.
Your responsibilities:
- Report chest pain, sudden severe headache, or new or worse irritability between visits.
- Disclose any history of drug addiction or substance use to your healthcare professional.
- Follow transportation requirements. Have a caregiver or family member or friend drive you home.
- Report any breathing problems or signs of central nervous system depression.
Women exposed to Spravato® during pregnancy should be aware of a national pregnancy registry to monitor outcomes, and untreated depression during pregnancy also carries risks that should be weighed carefully.
How to Talk With Your Clinician About Spravato®
Walking into your first conversation with a healthcare provider about Spravato® can feel daunting, especially if you have been struggling for a long time without answers. At Oasis, we make that conversation as straightforward as possible.
Here is how to prepare so you get the most out of your consultation.
- Prepare your history
- When your depression symptoms first started
- Which antidepressants you’ve tried, at what doses, and for how long
- What side effects you experienced with each medication
- Any periods of improvement and what contributed to them
- Have your complete medication list
- All current prescriptions
- Over the counter medicines and supplements
- Any history of taking monoamine oxidase inhibitors or other psychiatric medications
- Medical conditions, especially involving heart or brain problems, high blood pressure, or blood vessel abnormalities
- Set realistic expectations
Spravato® can work quickly for some people, but it is not a cure. Depression requires ongoing management, and the best outcomes come when patients follow the treatment plan recommended by our team. At Oasis, we help you understand exactly what to expect before your first session so there are no surprises.
One important thing to keep in mind:
Doing your research before coming in is a good thing. But advocating for yourself is different from diagnosing yourself.
When you come to Oasis, our licensed healthcare professionals conduct a thorough evaluation that goes beyond what any self-assessment can catch. Sometimes what looks like treatment-resistant depression turns out to be related to thyroid issues, trauma, bipolar features, or other serious mental illnesses that require a completely different approach.
We want to make sure you get the right treatment, not just the one you came in asking for.
Ready to Find Out If Spravato® Is Right for You?
If you have struggled with treatment-resistant depression and feel like you have exhausted every option, you do not have to keep searching alone. At Oasis Mental Health Centers in New Jersey, we specialize in treatments like Spravato® for patients who have not found relief through conventional antidepressants.
If you are ready to take the next step toward lasting relief from depression, reach out to us today and let’s find out if Spravato® is the right fit for you.
Frequently Asked Questions
Is Spravato® the same as ketamine infusions?
No, but they are related. Spravato® contains esketamine, a more refined form of ketamine that works at lower doses. IV ketamine is off-label, meaning it has no formal FDA approval for depression.
Spravato® is FDA-approved, follows strict dosing protocols, and is more commonly covered by insurance. Both work quickly through the glutamate system, but Spravato® has more long-term clinical trial data behind it.
How quickly will I know if Spravato® is helping my depression?
Some patients notice changes as early as 24 hours after their first session, which is one of Spravato®’s biggest advantages over traditional antidepressants that can take four to six weeks to work. Clinical data shows a 75.9% response rate and a 55.7% remission rate among patients treated with Spravato®.
That said, lack of improvement after one or two doses does not mean the treatment will not work. A formal reassessment is typically conducted after the four-week induction phase to evaluate your progress, and your care team will set clear timeline expectations with you before treatment begins so there are no surprises.
Can I use Spravato® if I have a history of substance use disorder?
A history of substance or alcohol use disorder does not automatically disqualify you. It requires a careful evaluation. At Oasis, we may involve addiction specialists, increase monitoring, or recommend an alternative treatment if the risk of misuse is too high. Being fully honest with our team about your history helps us design the safest possible plan for you.
How much does Spravato® cost and is it covered by insurance?
In New Jersey, all major health insurers cover Spravato® for FDA-approved uses when prior authorization criteria are met. This includes Medicare, Medicaid, Tricare, and commercial insurance plans. Our team verifies your coverage and provides a written cost estimate before you begin.
For commercially insured patients, the Spravato® withMe Savings Program often reduces out-of-pocket costs to as little as $10 per treatment, making an already covered treatment even more affordable.
Will I need Spravato® forever once I start?
Not necessarily. Treatment moves through phases, starting with twice-weekly sessions for the first month, then gradually reducing to weekly and eventually every one to two weeks. Data from the long-term SUSTAIN-3 extension study shows that remission rates rise to over 50% after one year, meaning results continue to improve the longer you stay with treatment.
Some patients eventually stop Spravato® entirely and maintain their progress with oral medications and therapy alone. At Oasis, we build a long-term plan with you from the start so you always know what comes next.