Spravato® is gaining recognition as a breakthrough treatment option for individuals battling treatment-resistant depression (TRD) or major depressive disorder (MDD) with suicidal thoughts. Approved by the FDA and backed by years of clinical research, Spravato offers a new path forward for patients who haven’t found relief with traditional antidepressants. But what exactly is Spravato, how does it work, and is it covered by insurance? Here’s what you need to know about this cutting-edge therapy.
What Is Spravato?
Spravato is the brand name for esketamine, a nasal spray derived from ketamine. Specifically, it’s the S-enantiomer of ketamine—meaning it’s one half of the ketamine molecule, refined for medical use. Unlike traditional antidepressants, which are taken orally and work over time, Spravato is administered intranasally under the supervision of a certified healthcare provider in a clinical setting.
For the first 5 years it was available, Spravato had to be used alongside an oral antidepressant, but in 2025, the FDA approved Spravato for use by itself. This means providers and patients can work together to decide whether it is best for them to keep using a traditional antidepressant with Spravato or not. It’s FDA-approved for adults who:
- Have tried other antidepressant treatments without success (treatment-resistant depression)
- Experience depressive symptoms in the context of MDD along with suicidal ideation or behavior
If it feels like you’re going in circles after trying two or more antidepressants… Turn to a different treatment.
How does it compare to traditional antidepressants?
Unlike pills that work subtly over weeks, Spravato’s effects may be noticeable within hours or days. This rapid response can be life-changing for someone experiencing severe depression, especially when combined with the guidance of a trusted care team.
What is treatment-resistant depression (TRD)?
TRD refers to depression that hasn’t improved after trying at least two different antidepressants at adequate doses. It’s more common than many people realize—and often more debilitating. Spravato was developed specifically for this population, offering a new avenue when others haven’t worked.
What happens during a Spravato treatment session?
Each treatment takes place in a calm, controlled setting at a certified clinic. You’ll self-administer the nasal spray under the supervision of medical staff and then relax in a comfortable space for at least two hours of monitoring. Most patients describe the experience as peaceful or mildly dissociative.
Treatment with Spravato must take place in a Risk Evaluation and Mitigation Strategy (REMS)-certified clinic due to potential side effects and the need for post-administration monitoring.
Spravato® (esketamine) is administered as a self-guided nasal spray under clinical supervision.
Who Makes Spravato?
Spravato is manufactured by Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson. Janssen focuses heavily on neuroscience, immunology, and infectious diseases, and has played a leading role in developing innovative mental health therapies, including Spravato and other psychiatric medications.
How Does Spravato Work?
Unlike traditional antidepressants that primarily target serotonin, norepinephrine, or dopamine, Spravato works through a different and more rapid mechanism. Its active ingredient, esketamine, is an NMDA (N-methyl-D-aspartate) receptor antagonist—which means it blocks certain glutamate receptors in the brain.
Glutamate is the brain’s most abundant excitatory neurotransmitter and plays a key role in mood regulation, learning, and memory. By modulating this system, Spravato helps rebalance brain activity in a way that traditional antidepressants don’t.
This action promotes rapid increases in synaptic plasticity—your brain’s ability to form new connections between neurons. In people with depression, this flexibility is often reduced. Spravato helps reverse that, essentially allowing the brain to “rewire” and respond to experiences and emotions in healthier ways.
Because of this, Spravato may offer relief within hours or days, which can be especially critical for individuals facing suicidal thoughts or severe depressive episodes. In contrast, conventional antidepressants often take several weeks to become effective.
Patients often describe the treatment experience as calming or mildly dissociative. While the sensation can be unfamiliar, it typically subsides within a few hours and is closely monitored by medical professionals. Over time, many patients report improved clarity, increased emotional resilience, and a renewed sense of possibility.
This novel mechanism makes Spravato an exciting option for those who haven’t responded to other treatments—and a sign of hope for those who may have felt like they were out of options.
How Long Does Spravato Last?
Spravato treatment is structured in two key phases:
- Induction Phase: Lasting about four weeks, this initial phase typically involves two treatments per week. This is when patients and providers assess how well Spravato is working and how it’s tolerated.
- Maintenance Phase: If treatment is effective, patients may continue with weekly or biweekly sessions based on their unique response and mental health goals.
Spravato is not a one-time treatment or quick fix. Ongoing treatment is often necessary, and Spravato can now be used either on its own or in combination with an oral antidepressant, depending on a patient’s unique treatment plan. Patients are regularly monitored to ensure safety and adjust the frequency of treatments over time.
Each session also includes a period of observation—typically about two hours after the dose—where healthcare professionals monitor for potential side effects like dissociation, sedation, or increased blood pressure.
Is Spravato Covered by Insurance?
Insurance coverage for Spravato varies depending on your plan, location, and clinical history. In many cases, insurance providers require prior authorization and documentation showing that other treatments have failed before approving Spravato.
Here are some important things to know:
- Prior authorizations may ask for your treatment history, including which antidepressants you’ve tried and how long you were on them.
- Patient assistance programs are available through Janssen and third-party organizations to help cover costs for eligible individuals.
- Coverage may be more likely if Spravato is being used for its FDA-approved indications (TRD or MDD with suicidal ideation).
Because the medication must be administered in a REMS-certified setting, costs can include both the drug itself and associated clinical services.
If you’re considering Spravato, we recommend reaching out to your insurance provider directly to understand your specific benefits and cost-sharing responsibilities. You can also contact Psyche Denver to speak with a care coordinator about next steps.
Final Thoughts
Spravato represents a major step forward in depression treatment, especially for individuals who haven’t found relief with standard medications. Its novel mechanism and fast-acting results make it a compelling option—but it also requires careful oversight, ongoing commitment, and sometimes navigating insurance hurdles.
If you or a loved one are exploring advanced depression treatment options, our team at Psyche Denver is here to help. We provide personalized evaluations and compassionate care in a safe, supportive environment.
Learn more about Spravato treatment or explore TMS therapy as another nontraditional approach. Ready to take the next step? Contact us today for a FREE Pre-Consultation to see if Spravato is the right fit for you.
References
- Janssen Pharmaceuticals. (n.d.). Spravato® (esketamine) Official Site
- National Institutes of Health. (2023). Esketamine for Treatment-Resistant Depression. NIH
- U.S. Food & Drug Administration. (2019). FDA Approves New Nasal Spray Medication for Depression. FDA
