Am I a Candidate for Spravato?

Spravato is for adults whose depression has not responded to at least two antidepressants. It is also approved for adults with major depressive disorder who have active suicidal thoughts. You take it alongside an oral antidepressant, not instead of one.

You are likely a candidate if

• You are 18 or older
• Two or more antidepressants have not given you enough relief
• You are currently taking an oral antidepressant, or willing to start one
• You can arrange a ride home on treatment days
• You can stay about two hours per visit

You are not a candidate if

• You have a history of aneurysm, or bleeding in the brain
• You have certain blood vessel conditions in the brain, chest, or abdomen
• You have had an allergic reaction to esketamine or ketamine

Pregnancy and breastfeeding need a separate conversation. Uncontrolled high blood pressure usually needs to be managed first, not ruled out permanently.

What a session actually involves

You spray it yourself, under supervision, in our office. Then you stay about two hours while we monitor blood pressure and how you are doing. You cannot drive for the rest of the day.

The usual schedule is twice a week for four weeks, then weekly, then every one to two weeks depending on response.

This is the FDA-approved form of esketamine given under the REMS safety programme. It is not IV, intramuscular, or compounded ketamine.

What insurance usually requires

Most commercial plans, Medicare, and Medi-Cal cover Spravato for treatment-resistant depression with prior authorisation, typically after documented antidepressant trials. See Spravato cost in California, Medi-Cal and Spravato, and fees and insurance.

Does it work?

In the trial supporting approval, adults who added esketamine to a newly started antidepressant improved more than those who took the antidepressant alone (Popova 2019). Response varies and is not guaranteed.

Spravato or TMS?

Both treat the same problem differently. Spravato tends to suit people who need faster relief or have struggled to tolerate pills. TMS suits people who want no sedation, no transport arrangements, and no medication exposure. Many people are candidates for both. See TMS therapy and treatment-resistant depression.

If you are having thoughts of hurting yourself, say so at your appointment. If you are in danger now, call or text 988.

Common questions

Who qualifies for Spravato?

Adults whose depression has not responded to two antidepressants, and adults with depression and active suicidal thoughts.

Who cannot have it?

People with a history of aneurysm or brain bleeding, certain vascular conditions, or ketamine allergy.

Do I need a ride home?

Yes. You cannot drive for the rest of the day.

How long is each visit?

About two hours.

Is it covered by insurance?

Usually, with prior authorisation.

References

• Popova V, Daly EJ, Trivedi M, et al. Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression. Am J Psychiatry. 2019;176(6):428-438. PubMed

Medically reviewed by Nefretiri Abat, J.D., PMHNP-BC, board-certified Psychiatric-Mental Health Nurse Practitioner.