⚡ Key Takeaways
- Rapid results: Many patients notice improvement within 24 hours of first treatment
- Proven effective: 69% of patients respond to treatment, 52% achieve remission
- Different approach: Works on glutamate pathways, not serotonin like traditional antidepressants
- Insurance covered: Most major insurers cover Spravato for treatment-resistant depression
- Supervised care: All treatments administered in-office with 2-hour monitoring for your safety
“When I got Spravato, it was honestly like a difference between night and day. My general outlook on life just got a lot better, and life in general felt a lot lighter and not like a burden.”
— Spravato PatientWhat Is Spravato?
Spravato (esketamine) is an FDA-approved nasal spray that treats depression differently than traditional medications. While most antidepressants work on serotonin and take weeks to show effects, Spravato targets the glutamate system and can provide relief within hours.
Here’s the thing about treatment-resistant depression: when you’ve tried two or more antidepressants without adequate improvement, your brain needs a different approach. Spravato works by promoting neuroplasticity, essentially helping your brain form new connections and “reset” the pathways involved in mood regulation.
🧠 How It Works
Spravato is the S-enantiomer of ketamine, delivered as a nasal spray. It acts on NMDA receptors in your brain, promoting synaptogenesis (new neural connections) and providing rapid antidepressant effects. Think of it as helping your brain “wake up” areas that have become underactive due to depression.
The treatment was FDA-approved in 2019 and has since been administered over 6.6 million times worldwide. In January 2025, the FDA expanded its approval to allow Spravato as a standalone treatment (monotherapy), meaning it can now be used without requiring a daily oral antidepressant.
Clinical Results: What the Research Shows
Let me be direct about what the clinical trials actually show. In Janssen’s Phase 3 TRANSFORM-2 study, Spravato demonstrated statistically significant improvement in depression symptoms compared to placebo:
The SUSTAIN-1 relapse prevention study found that patients who continued Spravato treatment were 51% less likely to relapse compared to those who stopped. Real-world data from clinics across Europe and the US shows response rates of 64-78% at 3-6 months of treatment.
The ESCAPE-TRD study compared Spravato directly to quetiapine (Seroquel), a common augmentation strategy. Patients on Spravato were 1.54 times more likely to reach remission and 1.55 times more likely to stay relapse-free over the study period.
What to Expect During Treatment
Spravato is only available through certified healthcare facilities under the REMS (Risk Evaluation and Mitigation Strategy) program. This isn’t a prescription you take home; each treatment is supervised in our office for your safety.
A Typical Treatment Session
Each visit takes about 2-2.5 hours total. Here’s what happens:
Before treatment: Don’t eat for 2 hours before your appointment. No liquids 30 minutes before. We’ll check your blood pressure and make sure you’re ready.
Self-administration: You’ll spray the medication yourself under our guidance. Each device delivers 28mg, and you’ll typically use 2-3 devices (56mg or 84mg total) with 5-minute breaks between sprays. The whole administration takes about 10-15 minutes.
Monitoring period: After administration, you’ll relax in a comfortable treatment room for 2 hours. We monitor your blood pressure and general state during this time. Many patients describe feeling relaxed; some experience a floating sensation or mild perceptual changes.
After treatment: You cannot drive until the following day after a restful sleep. Please arrange transportation home. Most patients are ready to leave right at the 2-hour mark.
⚠️ Important Safety Requirements
Spravato is a Schedule III controlled substance. You must have someone drive you home after each treatment, and you cannot drive, operate machinery, or make important decisions until the next day after restful sleep. These requirements are non-negotiable for your safety.
Side Effects: What to Know
I believe in being upfront about what you might experience. Based on REMS program data from over 32,000 patients:
Dissociation
Sedation
Nausea
Blood Pressure Increase
✓ Good News About Side Effects
Most side effects are mild to moderate and resolve on the day of treatment. They typically decrease over time as you continue treatment. Importantly, research shows that dissociation is NOT required for the antidepressant effect to work, so don’t worry if you don’t experience it or if it fades with subsequent treatments.
Who Should Not Take Spravato
Spravato is not appropriate for everyone. You should not receive this treatment if you have:
Aneurysmal vascular disease (including aortic, intracranial, or peripheral aneurysms), arteriovenous malformation, history of intracerebral hemorrhage, uncontrolled hypertension, or known hypersensitivity to esketamine or ketamine.
If you’re pregnant or planning to become pregnant, Spravato should not be used due to potential fetal harm.
Cost & Insurance Coverage
Let’s talk about the financial side honestly. Spravato is expensive before insurance, but most patients pay far less than the sticker price.
| Scenario | Estimated Cost |
|---|---|
| Medication cost (without insurance) | $590-$1,663 per session |
| First month without insurance (8 sessions) | $4,700-$8,200 |
| With insurance (after deductible) | $10-$500 per month |
| With Janssen Savings Program | $10 per treatment |
| Medicare Part B (after deductible) | 20% coinsurance |
Insurance Companies That Cover Spravato
The SpravatoWithMe Savings Program
Janssen offers a savings program that can reduce your out-of-pocket cost to as little as $10 per treatment, with a maximum annual benefit of $8,150. This program is available to commercially insured patients. We can help you enroll during your consultation.
Is Spravato Right for You?
Spravato is specifically FDA-approved for:
Treatment-Resistant Depression (TRD): Adults with major depressive disorder who haven’t responded adequately to at least 2 oral antidepressants at proper doses for adequate duration.
Major Depressive Disorder with Suicidal Ideation: Adults with MDD and acute suicidal thoughts or behavior (used alongside an oral antidepressant).
You Might Be a Good Candidate If:
- You’ve tried 2+ antidepressants without adequate improvement
- Your depression significantly impacts your daily functioning
- You can commit to the twice-weekly schedule during the induction phase
- You have reliable transportation (you cannot drive yourself)
- You don’t have contraindicated conditions (uncontrolled hypertension, aneurysmal disease)
The only way to know for sure is a conversation. Every person’s depression history, medical background, and treatment goals are different. Dr. Erkut personally evaluates each patient to determine whether Spravato, TMS, or another approach makes the most sense for your situation. Schedule a consultation to discuss your options.
Spravato vs. Other Treatments
Compared to traditional antidepressants: Spravato works faster (hours vs. weeks) and through a different brain pathway. It’s used when pills alone haven’t worked.
Compared to IV ketamine: Spravato is FDA-approved and insurance-covered; IV ketamine infusions are typically out-of-pocket. Spravato is self-administered via nasal spray; IV ketamine requires an IV line.
Compared to TMS: Different mechanisms entirely. TMS therapy uses magnetic pulses to stimulate brain regions; Spravato is a medication. Some patients benefit from combining both approaches.
Compared to ECT: Spravato doesn’t require anesthesia, has no memory side effects, and doesn’t require hospitalization. However, ECT may be more appropriate for severe, acute cases.
Your Spravato Provider
Cara J. Erkut, M.D.
Dr. Erkut is a board-certified psychiatrist and psychoanalyst who brings academic teaching, advanced psychotherapy, and neuromodulation expertise to her practice. As a Clinical Instructor at the University of Washington, Harborview Medical Center, she stays current with the latest treatment advances and helps train the next generation of psychiatrists.
Her training at Mayo Medical School and psychiatry residency at the University of Washington, where she served as Chief Resident, provides the foundation for her comprehensive approach to treatment-resistant depression.
Frequently Asked Questions
Some patients notice improvement within 24 hours of the first treatment. However, everyone responds differently. Most patients see meaningful improvement within 2-4 weeks of starting treatment. The induction phase (first 4 weeks) involves twice-weekly sessions to build the therapeutic effect.
Patients describe it differently. Some feel a floating sensation, like they’re watching themselves from outside. Others describe it as dreamlike or spacey. Some find it pleasant and relaxing; others find it uncomfortable initially but adjust over time. It typically peaks around 40 minutes and resolves within 90 minutes. Importantly, dissociation is NOT required for the treatment to work.
Treatment duration varies. After the initial 4-week induction phase, you’ll transition to weekly and then potentially every-other-week maintenance treatments. Some patients continue for 6-12 months; others may need longer-term maintenance. We’ll work together to find the right approach for you.
In most cases, yes. Spravato can be used alongside oral antidepressants. However, there are some interactions to be aware of. CNS depressants (benzodiazepines, opioids) can increase sedation. Psychostimulants may increase blood pressure effects. We’ll review all your medications during consultation.
Not everyone responds to every treatment. If Spravato doesn’t provide adequate relief, we have other options including TMS therapy, medication adjustments, or combination approaches. Treatment-resistant depression often requires trying multiple strategies to find what works for you.
Spravato is a Schedule III controlled substance, meaning there is some potential for misuse. However, it’s only available under medical supervision through the REMS program, you never take it home. In clinical trials and real-world use, addiction has not been a significant concern when used as prescribed in certified healthcare settings.
Serving Seattle & the Eastside
Our Mercer Island office provides Spravato treatment for patients throughout the greater Seattle area:
Mercer Island
Our office locationSeattle
10-15 minute driveBellevue
10-15 minute driveKirkland
15-20 minute driveRedmond
20-25 minute driveIssaquah
15-20 minute driveRenton
15 minute driveNewcastle
10 minute driveSchedule a Spravato Consultation
Find out if Spravato is right for your treatment-resistant depression. We’ll review your history, discuss your options, and answer all your questions.
BOOK A CONSULTATION⚠️ Medical Disclaimer
This information is for educational purposes only and does not constitute medical advice. Spravato carries important safety considerations and is only appropriate for certain patients. Individual results vary. Please consult with Dr. Erkut to determine if Spravato is right for your specific situation.
For Psychiatrists & Mental Health Practices: This advanced AI-powered website is built and maintained by Staffingly Inc. Running a Spravato program requires significant administrative coordination, including REMS certification tracking, twice-weekly patient scheduling, 2-hour monitoring logistics, and insurance prior authorizations. If you’re a psychiatrist or practice owner looking for operational support, Staffingly Inc offers HIPAA-compliant healthcare virtual assistants specializing in Spravato program management, patient intake, and insurance verification.