- 21297 Foothill Blvd, Ste 203 Hayward, CA 94541
- (415) 636-9700
- hello@exxceedwellness.com
Spravato (esketamine) is an FDA-approved nasal spray for adults with treatment-resistant depression and for major depressive disorder with active suicidal ideation. At Exxceed Wellness in Hayward, CA, Spravato is delivered in-office under the federally required REMS program by Nefretiri Abat, PMHNP-BC.
Spravato is the brand name for esketamine, the S-enantiomer of ketamine, formulated as a nasal spray for use in clinical settings. It received FDA approval in 2019 for treatment-resistant depression and in 2020 for major depressive disorder with active suicidal ideation, making it the first novel mechanism approved for depression in decades.
Unlike SSRIs and SNRIs, which raise serotonin or norepinephrine levels gradually over weeks, Spravato acts on the brain’s glutamate system through the NMDA receptor. The clinical effect can begin within hours of the first dose for some patients, with the fullest benefit typically emerging across the induction phase.
The most useful way to think about candidacy is not whether you self-diagnose with TRD, but whether your situation matches the criteria below. Final candidacy is always determined together during a clinical consultation.
Spravato is generally not appropriate for people with aneurysmal vascular disease, a history of intracerebral hemorrhage, hypersensitivity to esketamine or ketamine, or who are pregnant or breastfeeding. Active substance-use disorders or unstable psychiatric conditions may also affect candidacy. We review all of this together at your initial consultation.
SSRIs and SNRIs work by raising the available levels of serotonin or norepinephrine. They take time, often four to six weeks, to produce a clinical response. They also rely on neural systems that, in some forms of depression, simply don’t respond regardless of dose adjustment.
Spravato takes a different route. It is an NMDA glutamate receptor antagonist. By modulating glutamate signaling, esketamine triggers a downstream cascade that promotes synaptic plasticity, the formation of new neural connections in regions of the brain implicated in depression, particularly the prefrontal cortex.
This different mechanism is the reason some patients who have not responded to multiple oral antidepressants do respond to Spravato.
Treatment is structured in three phases. Your specific schedule may be adjusted based on response, side effects, and clinical judgment.
Twice weekly for 4 weeks. The goal of this phase is to establish whether Spravato will work for you. We assess response throughout.
Weekly for the next 4 weeks. If you’re responding to Spravato, frequency steps down as benefit consolidates.
Every 1 to 2 weeks, individualized. Long-term frequency is determined by your clinical response and discussed at every visit.
Spravato can only be administered in clinical settings that are certified under the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program. This is a federal requirement, not a practice preference.
The REMS program exists because esketamine can produce dissociation, sedation, and short-term changes in blood pressure or perception during and after dosing. Post-dose monitoring catches these effects in the rare cases they need attention, and ensures every patient is medically stable before leaving the clinic.
Our practice is REMS-certified. Nefretiri Abat, PMHNP-BC is a registered Spravato provider in the SPRAVATO REMS program.
Plan for each appointment to take roughly two to two and a half hours total, including check-in and monitoring.
Spravato is generally well tolerated under REMS-program supervision, but it has a side-effect profile worth understanding clearly before treatment begins.
Most of these resolve during the monitoring window. We discuss what to do if any persist or escalate.
Ketamine and Spravato are related but not the same. Understanding the difference matters because they have different regulatory status, different evidence bases, and different access models.
| Spravato | IV/IM ketamine | |
|---|---|---|
| FDA status | FDA-approved for TRD and MDD with active suicidal ideation | Off-label for depression (FDA-approved as anesthetic only) |
| Form | Nasal spray (esketamine, S-enantiomer) | Intravenous or intramuscular infusion (racemic ketamine) |
| Setting | REMS-certified clinic only | Clinic-based, varies by provider |
| Insurance coverage | Often covered for TRD with prior authorization | Typically cash-pay (off-label) |
At Exxceed Wellness, we offer Spravato. We do not provide IV or IM ketamine. The reasons are clinical and regulatory: Spravato has the FDA approval, the published safety monitoring requirements, and the insurance pathway that make it the appropriate first-line interventional option for most patients with TRD.
Spravato and TMS are both FDA-approved interventional treatments for depression, with different mechanisms, time commitments, and side-effect profiles. Many patients are candidates for either, and the right choice depends on personal context.
| Spravato | TMS therapy | |
|---|---|---|
| Mechanism | NMDA glutamate receptor modulation | Focused magnetic stimulation of cortical regions |
| Session length | About 2 hours (dose plus monitoring) | 3 to 37 minutes depending on protocol |
| Driving day-of | Not allowed; designated driver required | Permitted |
| Treatment course | Twice-weekly induction, then taper to maintenance | Daily 5x/week for ~6 weeks, then taper |
| Best fit when | Faster onset preferred; active suicidal ideation; prefer pharmacologic option | Want to avoid sedation; OCD also needs treatment (Deep TMS); prefer non-medication path |
The right choice is best determined together at consultation.
Spravato is commonly covered by major California insurance plans for treatment-resistant depression, with prior authorization required by virtually all carriers. Coverage details, copays, and patient cost share vary by plan tier.
Our team handles the prior authorization process with your insurer once you’re scheduled for a Spravato consultation. We also help you navigate the SPRAVATO withMe patient support program, which can offset cost-share for eligible patients.
Spravato sessions at Exxceed Wellness are delivered by Nefretiri Abat, J.D., PMHNP-BC, a board-certified Psychiatric-Mental Health Nurse Practitioner with twenty years of clinical training and a Juris Doctor in addition to her psychiatric credentials. Her training in interventional psychiatry, combined with the careful clinical oversight that REMS requires, is what every Spravato session at our clinic is built around.
All Spravato sessions are delivered in-office at our Hayward, CA clinic. Telehealth medication management is available statewide for ongoing follow-up between sessions.
Spravato is esketamine, the S-enantiomer of ketamine, formulated as a nasal spray and FDA-approved specifically for treatment-resistant depression. IV/IM ketamine is the racemic form and is used off-label for depression. We offer Spravato; we do not provide IV ketamine.
About two hours total: a few minutes for self-administration, then approximately 90 minutes of post-dose monitoring before discharge to your designated driver.
Often yes, for treatment-resistant depression, with prior authorization. Our team handles the prior auth process with your plan once you’re scheduled for a Spravato consultation.
Some patients notice changes within hours of the first dose. Full clinical benefit typically emerges across the induction phase (the first four weeks). Response is monitored at every visit.
No. You cannot drive for the rest of the day after each session. You will need a designated driver or rideshare arranged in advance.
Induction is typically 8 sessions over 4 weeks (twice weekly), followed by 4 weekly transition sessions, then individualized maintenance. Total course length depends on response.
If Spravato doesn’t produce adequate response, TMS therapy, combination strategies, and other interventional options remain available. We don’t end the conversation when one treatment falls short.
No. You can schedule a Spravato consultation with our practice directly. We’ll request your medication history and any prior treatment records at intake.
Schedule a Spravato consultation at our Hayward, CA clinic. We’ll review your full medication history, talk through candidacy, and start the prior-authorization process if you’re a good fit.
