Spravato for Depression Relief.

Spravato (esketamine) is a fast-acting nasal spray approved by the FDA in March 2019 for adults with treatment-resistant depression (TRD). Derived from ketamine, it has been adapted for its rapid antidepressant effects and is used alongside oral antidepressants in individuals who haven’t responded to traditional therapies.

Administration and Effectiveness

Administered under medical supervision in certified healthcare settings, Spravato is typically given twice a week for the first month, followed by a tapering schedule based on individual response. It can relieve symptoms within hours, especially in patients with suicidal ideation, and is dispensed under a Risk Evaluation and Mitigation Strategy (REMS) due to possible side effects like dizziness, dissociation, or increased blood pressure.

How It Works

Spravato targets the NMDA receptor and boosts glutamate signaling, key processes involved in mood regulation and brain plasticity. This distinct mechanism offers an alternative for patients who haven’t found relief with standard antidepressants that focus on serotonin or norepinephrine.

Guidance for Providers

Healthcare professionals must be trained in crisis management and provide a safe, monitored environment. Patients are observed for at least two hours after each dose. A thorough review of medical history is essential to identify contraindications, including substance use disorders or cardiovascular risks.

Scientific Foundation

Spravato engages the brain's glutamate system, promoting communication between nerve cells and potentially encouraging the formation of new neural connections. Unlike traditional antidepressants, this approach often delivers faster relief. Research shows encouraging outcomes, with over 60% of patients responding and 52% reaching remission, while maintaining a favorable safety profile.

Conclusion

Spravato offers a breakthrough for those living with treatment-resistant depression. Alongside its medical innovation, thoughtful imagery that reflects compassionate care can help reduce stigma, encourage treatment-seeking, and normalize the conversation around advanced mental health therapies.

Visual Representation in Care

Images representing Spravato treatment should convey professionalism, empathy, and trust.

  • Composition: Highlight collaborative interactions, such as treatment discussions, demonstrations, or supportive moments during care.

  • Authenticity: Use realistic, diverse portrayals of both patients and providers to reflect inclusivity.

  • Environment: Show clean, well-lit, and welcoming clinical spaces to reduce stigma and build confidence.

  • Emotional Impact: Capture genuine, positive interactions, shared smiles or moments of reassurance, that foster a sense of hope and healing.

Spravato: Helpful Tips from a Patient Perspective
Heather from the Nice People YouTube channel offers insights and practical tips based on her personal experience as a Spravato patient. This video is intended for informational purposes only. Please consult your Spravato provider to discuss your individual needs and treatment plan.

What is Spravato

Spravato® (Esketamine) – FAQs

  • Spravato® is an FDA-approved nasal spray medication containing esketamine, used to treat treatment-resistant depression (TRD). Unlike traditional antidepressants that target serotonin or norepinephrine, Spravato works on the brain’s glutamate system, enhancing neural connectivity and promoting rapid symptom relief.

  • Spravato is approved for adults diagnosed with treatment-resistant depression—meaning you've tried at least two other antidepressants without sufficient relief. It’s also used for major depressive disorder (MDD) with suicidal thoughts or behavior. A full clinical assessment with one of our providers will determine if you’re a good candidate.

  • Many patients begin noticing improvement in mood and relief from depressive symptoms within hours to days after the first few treatments. This rapid effect can be life-changing for those who have not responded to other medications.

  • Each session takes place in a safe, comfortable clinical setting. You’ll self-administer the nasal spray under supervision and remain at the clinic for at least two hours while we monitor your response and well-being. We recommend bringing a relaxing item (like music or an eye mask) to enhance your experience.

  • The typical schedule includes:

    • Twice weekly treatments for the first 4 weeks

    • Once weekly for weeks 5–8

    • Maintenance phase based on your progress (usually every 2–4 weeks)

    Your provider will customize the schedule to meet your specific needs.

  • Common side effects may include:

    • Dizziness or dissociation

    • Nausea

    • Increased blood pressure

    • Feeling drowsy or disconnected

    These effects are usually mild and temporary. You’ll be monitored closely during and after treatment to ensure your safety.

  • No. Due to possible sedation or altered perception, you must arrange for a ride home after each session. Do not drive or operate machinery until the next day and after a full night’s sleep.

  • Many insurance providers do cover Spravato, especially when prescribed for treatment-resistant depression. Our team will help verify your benefits and assist with any prior authorization paperwork needed. We accept major plans including United Healthcare, Aetna, Blue Cross Blue Shield, Medicare, and more.

Sublingual Ketamine: Overview and Clinical Use

Sublingual ketamine involves placing a lozenge or tablet under the tongue, allowing for direct absorption into the bloodstream. This method has gained increasing recognition for its rapid and effective relief of various mental health conditions, particularly depression, anxiety, and PTSD.

  • Pharmacology and Mechanism of Action

Ketamine is a well-established NMDA receptor antagonist, originally developed as an anesthetic. When administered sublingually:

  • It bypasses first-pass liver metabolism

  • Leads to faster onset of action and higher bioavailability compared to oral ingestion

The antidepressant and anxiolytic effects are thought to arise from:

  • Enhanced glutamate signaling

  • Increased synaptic plasticity

  • Stimulation of neurogenesis

These mechanisms contribute to symptom relief—often within hours of administration.

  • Administration and Dosage

  1. Form: Dissolvable lozenge or tablet

  2. Dosage: Individualized; typically ranges from 0.1 to 0.5 mg/kg

  3. Absorption Time: Effects begin within 10–15 minutes

  • Clinical Indications

Sublingual ketamine has been used in managing several treatment-resistant conditions:

  • Major Depressive Disorder (MDD): Especially in cases unresponsive to conventional therapies

  • Bipolar Depression: Effective in reducing acute depressive episodes

  • Post-Traumatic Stress Disorder (PTSD): May alleviate intrusive symptoms and hyperarousal

  • Anxiety Disorders: Including generalized anxiety disorder (GAD) and social anxiety

  • Duration and Maintenance

  1. Duration of effect: Varies from a few hours to several days

  2. Initial regimen: Often involves multiple sessions per week

  3. Maintenance: Reduced frequency, typically integrated with psychotherapy to optimize long-term outcomes

  • Side Effects and Risks

Common side effects include:

  • Dissociation or altered perception

  • Dizziness or lightheadedness

  • Nausea

  • Temporary increases in blood pressure

While generally well-tolerated, ketamine requires careful monitoring, especially in patients with cardiovascular risks.

  • Contraindications

Sublingual ketamine may not be suitable for individuals with:

  • Uncontrolled hypertension or cardiac conditions

  • History of substance use disorder

  • Allergy to ketamine or similar agents

  • Conclusion

Sublingual ketamine represents a rapid-acting and innovative option for individuals with severe or treatment-resistant mental health disorders. When used responsibly under medical supervision, it offers a promising path forward in psychiatric care, especially when combined with ongoing psychotherapeutic support.