If therapy, medication trials, and lifestyle adjustments haven’t moved the needle on your depression, you’re not out of options. Spravato® is among the more promising treatments for difficult-to-treat depression, often producing noticeable improvement within hours or days rather than the weeks that typical antidepressants can take.¹
At New Directions, our providers will help you weigh the risks and benefits to determine whether it’s the right fit for your care.
What Is Spravato®?
Spravato® is a prescription nasal spray containing esketamine, and it has FDA approval for treating depression that hasn’t responded to traditional treatments. Unlike conventional antidepressants, which primarily work on serotonin, Spravato® targets glutamate, a brain chemical believed to play a central role in depressive symptoms. This is what allows Spravato® to help people who haven’t seen results from typical antidepressant medications.
Is Spravato® the Same as Ketamine?
Spravato® is derived from ketamine, separating out the specific molecule esketamine. Ketamine and esketamine are enantiomers, meaning they share an identical chemical formula but differ in molecular arrangement. That structural difference gives esketamine a more targeted effect on NMDA receptors in the brain, which is thought to make it a stronger antidepressant with fewer side effects for most people.
They also differ in delivery methods, as ketamine is usually administered intravenously (IV), while Spravato® comes as a self-administered nasal spray.
Why Some Depression Is Harder to Treat
Depression is a complex condition, and someone’s genetics, brain chemistry, and lifestyle can all influence how well treatment can work. Roughly one in three adults with depression don’t find relief from standard antidepressants. These medications work by gradually shifting how the brain produces and processes neurotransmitters like serotonin and norepinephrine over time.²
Some people also struggle to stay on these medications long-term because of side effects that they can’t tolerate. If someone has tried two or more typical antidepressants at proper doses without success, this is classified as difficult-to-treat depression.²
How Does Spravato® Work for Depression?
Rather than working on serotonin or norepinephrine, Spravato® acts on NMDA (N-methyl-D-aspartate) receptors, quickly raising glutamate levels in the brain. This sets off a chain reaction that supports the formation of new neural pathways, improving mood and overall cognitive function.³
The Role of Glutamate in the Brain
Glutamate functions like a messenger, keeping different brain regions, especially those tied to mood, memory, and drive, in touch with each other. When that signaling slows down, depression can leave the brain feeling like it’s operating in slow motion. This slowing can make it difficult to integrate lifestyle changes or engage in therapy, keeping you feeling stuck in depression.
Spravato® helps restart that communication. People often describe the effect as their brain “waking back up” after being stuck for a long time.
How Spravato® Helps the Brain Reconnect
Standard antidepressants usually take a month or more to show results because they work by slowly recalibrating brain chemistry. Spravato® moves faster by acting directly on glutamate pathways, which speeds up the brain’s ability to reconnect. Many clients notice early, tangible changes, such as more energy, sharper thinking, or a renewed sense of interest in life, after only a handful of sessions.³
Spravato® works by:
- Boosting glutamate activity, reactivating brain regions that depression has left dormant
- Promoting new neural connections, which supports emotional flexibility and responsiveness
- Strengthening long-term communication between brain regions responsible for mood regulation
The Benefits of Spravato® for Hard-to-Treat Depression
For anyone who’s tried other medications without success, Spravato® offers several distinct advantages, with speed being one of the biggest. Many people notice symptom improvement within a day or so of starting treatment. Even people who’ve been in treatment for years sometimes find themselves gaining new insights and applying coping strategies more effectively, a shift often credited to the neuroplasticity that Spravato® encourages.
Key benefits include:
- Fast-acting relief: Many clients notice significant changes after just one or two sessions.
- Better daily functioning: Ongoing treatment often brings improvements in overall well-being and the ability to manage day-to-day responsibilities.
- Stronger results alongside other antidepressants: Spravato® is frequently paired with an oral antidepressant, amplifying the effectiveness of both.
- Deeper progress in therapy: The neuroplasticity boost from Spravato® often helps people apply coping tools more effectively, process emotions more fully, and gain more insights in therapy.
- Easier, less invasive treatment: Compared to IV ketamine, many people find the self-administered nasal spray more comfortable and convenient.
What to Expect During Spravato® Treatment
Because Spravato® falls under the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program, it can only be administered in certified healthcare settings, ensuring safety for every client. At New Directions Mental Health, treatment happens in a calm, supportive space built to help clients feel at ease throughout the process.
A typical Spravato® appointment includes:
- Self-administering the nasal spray under a provider’s guidance
- A minimum two-hour observation period with routine check-ins and blood pressure monitoring
- A quiet recovery space for resting, listening to music, or reading
- Post-treatment guidance, since clients can’t drive or operate machinery until the following day after a full night’s sleep
We also recommend pairing Spravato® with talk therapy. Combining medication and therapy tends to produce stronger outcomes for depression overall.
Typical Spravato® Treatment Schedule
While every person’s care will be uniquely designed to fit their needs and schedule, here’s the general timeline:
- Weeks 1–4: Two sessions weekly during the induction phase
- Weeks 5–8: One session weekly
- Ongoing: Weekly or biweekly, adjusted based on how you’re responding but often long-term
How Long Will It Take to Feel Better After Starting Spravato® Treatments?
Some people notice a mood shift within a day of their first dose. For others, improvement builds gradually across the first few weeks. Clients who stick with regular treatment tend to see more stable, longer-lasting symptom relief.³ There’s no universal timeline, and everyone’s experience will be different. However, many describe finally feeling lighter after what’s felt like years of carrying extra weight.
Possible Side Effects of Spravato®
Spravato® can bring on some short-term side effects, such as dizziness, nausea, a sense of detachment from your surroundings (dissociation), or drowsiness. These tend to surface shortly after administration and clear up by the end of the day.³ Side effects are typically strongest at the first appointment, when nerves are running high, and tend to ease with each subsequent visit.⁴
Less frequent side effects can include:³
- A modest rise in blood pressure
- Temporary shifts in perception or sensation
- Post-treatment headache or fatigue
Given these possibilities, everyone stays in the treatment space for at least two hours after dosing, monitored the whole time by experienced clinical staff focused on your comfort and safety.
How Much Does Spravato® Cost?
At our clinics across Pennsylvania, we work directly with your insurance provider to bring down the cost of Spravato® as much as possible. Since qualifying for Spravato® means you’ve already received a depression diagnosis and tried other medications without success, insurers generally recognize the value of covering it as part of your treatment plan.
New Directions Mental Health is in-network with most major insurers, including Medicare and Medicaid at many of our clinics. Our intake team handles the insurance directly and can help you sort through your payment options.
Get Started With Spravato® at New Directions Mental Health
Every person’s experience with depression looks different, which is why New Directions Mental Health builds individualized treatment plans designed around your specific needs. Call 724.374.7414 or fill out a quick intake form to connect with our team and begin your path to feeling better.
Frequently Asked Questions
What is the success rate of Spravato® treatment?
Research shows that Spravato® is effective for hard-to-treat depression, with roughly 70% of patients seeing a reduction in symptoms.⁵ Full remission rates run somewhere between 30% and 58%.⁴
What should I avoid while using Spravato®?
Some medications, including certain depressants, stimulants, and MAOIs, can interact with Spravato®. Make sure your provider knows about every medication and supplement you take before starting treatment. Because nausea is a possible side effect, it’s best to avoid eating for two hours and drinking for 30 minutes beforehand.⁶
How long do most people stay on Spravato®?
Most people start with two sessions weekly for roughly the first month, taper to weekly visits the following month, then move to ongoing weekly or biweekly care after that. You and your provider will decide together how long you should remain on Spravato®.⁷
Can Spravato® be covered by insurance?
Yes. If your plan includes behavioral health coverage, Spravato® is often covered for people who have tried at least two other traditional antidepressants without success. Check with our intake team by calling 724.374.7414 to confirm they’re in-network with your specific insurance plan.
Sources:
- https://www.spravato.com/files/patient-discussion-guide.pdf
- https://www.spravato.com/spravato-right-me/
- https://www.spravato.com/files/SPRAVATO-Patient-Brochure.pdf
- Maxwell Z. Price, Richard L. Price. (2024). Benefits and risks of esketamine nasal spray continuation in treatment-resistant depression. Biomarkers in Neuropsychiatry, 11. https://doi.org/10.1016/j.bionps.2024.100104
- Wang, K., Eftang, C. N., Jakobsen, R. B., & Årøen, A. (2020). Review of response rates over time in registry-based studies using patient-reported outcome measures. BMJ open, 10(8). https://doi.org/10.1136/bmjopen-2019-030808
- https://www.spravato.com/patient-education/
- https://www.spravato.com/taking-spravato/
