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Spravato for Depression Treatment

Spravato for Depression

Spravato for depression treatment has become a more common way to access the benefits of ketamine for mental health. The esketamine nasal spray is a brand-name prescription medication that is prescribed for adults with the following conditions: 

  • Treatment-resistant depression (TRD): TRD is depression that hasn’t improved even after a patient has tried two or more antidepressant medications. TRD is diagnosed only when treatment includes different classes of medication used for a reasonable amount of time without showing any improvements in moods or experiencing unsatisfactory results (such as intolerable side effects).
  • Major depressive disorder (MDD): MDD is defined by persistent sadness or irritability. It is also commonly referred to as clinical depression. MDD is the most common mental health condition in the United States. 

Spravato is used together with another antidepressant medication that is taken orally to treat TRD and MDD.

Spravato for Depression Treatment at Axis Integrated Health

At Axis Integrated Health, we have an established process for using Spravato for depression treatment.

  • Scheduled 60-minute intake appointments with one of our psychiatrists to learn more about your needs and situations.
  • If we determine Spravato for depression is appropriate for you, we will discuss its benefits and also get insurance authorization on your behalf.
  • Once approved for treatment, we will schedule your appointment. The first treatment will begin as soon as possible after approval. 
  • You will be scheduled for two treatment sessions each week for the first four weeks.
  • For the second four weeks, you will come in for one treatment session per week. 
  • After the first eight weeks, you will come in for one treatment with as much time in-between sessions as is tolerable for your situation and based on your response to the treatment. 

Each visit occurs in a private room. You will have access to noise-canceling headphones, a curated ketamine music playlist, warm blankets, eye masks, and comfortable chairs to relax while receiving Spravato. You are also welcome to bring whatever you need to feel comfortable, including one other support person.

You will stay in the clinic under observation until potential side effects have passed. You will always receive a debrief before and after each treatment session with one of our team members. During the debrief session, our team members will chat with you about the experience and help you make the most of each Spravato nasal spray treatment.

Spravato is a ketamine nasal spray that takes about 10 minutes to take effect. You may experience some dissociative effects. The experience can be a strong catalyst for change.

Call us at (720) 400-7025  to schedule your intake session to see if Spravato for depression treatment is right for you.

Preparing for Spravato Treatment

When taking Spravato for depression, there are a few things you need to do in order to prepare for the ketamine experience:

  • Plan your ride: Be sure to find someone to give you a ride or schedule a ride with a ride-sharing app, as you can not drive until the day after your treatment session and after a good night’s sleep.
  • Time your food: You shouldn’t eat four hours before your treatment session, and you shouldn’t drink liquids 30 minutes before your treatment session. On the day of treatment, you should limit meals to light foods and avoid anything greasy or heavy. Failure to follow this recommendation may cause you to experience nausea or vomiting during or after your treatment.
  • Medication management: If you are taking a nasal decongestant medicine or nasal corticosteroid, you need to take those medications an hour before your Spravato for depression treatment. 
  • Avoid these: Do not drink alcohol within 24 hours of Spravato treatment as it decreases the effect of your treatment. If you take Lamictal or benzodiazepines, skip them within 6 hours of treatment.
  • Relax and rest: The night before a treatment session, you should take it easy and do things you enjoy. Avoid any stressful media, movies, or music.

What To Do After Spravato

For more information about what to do after Spravato treatment, please read our blog. Here are a few tips:


  • Schedule a therapy session: Sharing experiences with Spravato treatment during therapy sessions facilitates integration and processing of insights gained. Therapists can assist individuals in making meaning of their experiences and translating them into actionable steps for growth. Scheduling time with a therapist a day or two after treatment can help you build better emotional processing skills, and counteract maladaptive patterns from the past. 
  • Prioritize Self-Care: Knowing what to do after Spravato includes making lifestyle changes that support mental health and overall well-being. After completing ketamine treatment, individuals should prioritize self-care activities that support mental and emotional well-being. This includes adequate rest, hydration, and engagement in activities promoting relaxation.
  • Consider TMSPatients should consider transcranial magnetic stimulation (TMS) after ketamine treatment to sustain and enhance the therapeutic benefits achieved. While Spravato can provide rapid relief from depressive symptoms, its effects may not always be long-lasting. TMS offers a non-invasive and well-tolerated option for individuals seeking sustained improvement in mood and functioning. Integrating TMS into post-ketamine care can optimize treatment outcomes and support individuals in their journey towards long-term recovery and well-being.
  • Meditate: Meditation is shown to increase synaptic growth, and combined with the effects of ketamine, you can boost your ability to shape new synapses into more positive thought patterns that can help you recover faster.
  • Embrace Mindfulness: Incorporating mindfulness practices into daily routines can aid in processing emotions and reducing stress levels. Practicing mindfulness fosters present-moment awareness, facilitating resilience in the post-ketamine period.
  • Maintain Physical Activity: Knowing what to do after Spravato treatment includes making lifestyle changes that support mental health and overall well-being. Engaging in regular physical activity complements the effects of ketamine treatment by releasing endorphins and enhancing mood. Individuals are encouraged to incorporate exercise routines suited to their preferences and abilities.
  • Seek Social Support: Building a strong support network is crucial after Spravato treatment. Connecting with supportive friends, family, or peers can provide emotional validation and encouragement throughout the recovery process. Ask your provider if they have a social prescribing program.
  • Schedule Follow-Up Care With Your Provider: After completing ketamine treatment, individuals may require follow-up care to monitor progress and adjust treatment plans as needed. We recommend seeing your psychiatric provider at least once a month while in Spravato treatment. 


  • DO NOT DRIVE: No matter how confident you are in your faculties after Spravato, do not take the risk of driving yourself home. Not only can you cause harm to others, but you may also get discharged from your provider if caught driving after treatment.
  • Eat a heavy meal: To avoid nausea and vomiting, patients are instructed not to eat 2 hours prior to treatment. After treatment, you may be hungry, and we recommend avoiding heavy meals as your stomach may still need some time to adjust.
  • Watch the news: Spravato treatment often induces a state of heightened sensitivity and vulnerability, making individuals more susceptible to negative stimuli. The constant barrage of distressing news stories, sensationalized headlines, and negative imagery prevalent in the media can exacerbate feelings of anxiety, sadness, or despair, undermining the therapeutic effects of ketamine.
  • Consider avoiding social media: Social media platforms are saturated with curated content, comparison triggers, and sensationalized news, which can exacerbate feelings of anxiety, self-doubt, and discontent. Moreover, the constant stream of information and social interactions can overwhelm the senses and disrupt the delicate balance achieved during Spravato therapy. By limiting exposure to social media, patients can create a conducive environment for healing, reduce stress, and foster a sense of inner peace and stability. Prioritizing real-world connections, engaging in mindfulness practices, and pursuing activities that promote relaxation and self-care are recommended alternatives to mitigate the potential negative impact of social media on post-ketamine recovery.



Spravato Medication Details

The non-brand name of the drug used in Spravato is Esketamine, which is made from a drug called ketamine. Esketamine is a more potent version of ketamine, which the FDA approved specifically for use as a nasal spray for individuals with TRD and MDD. 

Esketamine is derived from part of the ketamine molecule. It is more potent than ketamine, which allows it to be delivered at a lower dosage level and with fewer side effects. 

Spravato nasal spray is FDA-approved; therefore, most insurance companies will cover this treatment!

How Spravato (Esketamine) Treats Depression

Esketamine works differently than other antidepressants drugs

Conventional antidepressants increase naturally occurring chemicals in the brain, such as serotonin, norepinephrine, and dopamine. Increasing the amount of these chemicals in the brain allows for more effective communication between brain cells, positively impacting one’s mood. 

Esketamine works in a whole new way. Instead of increasing serotonin, norepinephrine, or dopamine in the brain, like other antidepressants, Esketamine increases the levels of glutamate by working at a different receptor called the NMDA receptor. Glutamate is the most abundant excitatory neurotransmitter in your body. It is important for proper brain function.

By increasing the levels of glutamate, your brain is able to grow new and stronger communication paths that help balance out the communication between different areas of the brain. In depression, we now know that the brain does not communicate between different areas as it should. This causes commonly reported symptoms of depression, such as recurring negative thoughts, brain fog, and hopelessness. 

Esketamine does this rapidly, and many patients feel improvement after a few treatments.

Spravato (Esketamine) Side Effects

The most common side effects of receiving esketamine are dizziness and a temporary increase in blood pressure. Esketamine can also cause an out-of-body experience or sedation. 

That is why the drug is administered in a clinical setting under observation. You don’t leave until these side effects have subsided. Side effects are usually the most intense during your first two treatments and become less intense during later treatments. 

Other side effects can include 

  • Nausea
  • Drowsiness
  • Headache
  • A feeling similar to feeling drunk
  • Feeling anxious
  • Feeling very happy or excited

Who Should Take Spravato

You can take Spravato for depression if you have TRD or MDD and other treatment methods have not worked for you. This form of treatment is best for individuals without a history of alcohol or substance abuse disorders or other major medical conditions. 

You should not take Spravato if you have the following conditions: 

  • Blood vessel disease
  • History of bleeding in the brain
  • Abnormal connection between your veins and arteries
  • Allergies caused by esketamine, ketamine, or any other ingredient contained in Spravato

Before taking Spravato fore depression, please let us know about any medications and supplements you are taking, as well as any health conditions you have. This will help us determine if Spravato is the right treatment for you when considering your whole-health picture.

4 Benefits of Spravato (Esketamine)

Spravato is an innovative new treatment for individuals with depression. It offers unique treatment benefits.

Rapid Relief

Most traditional antidepressant medications are designed to be slow-acting, which means that it can take many weeks for you to notice a difference in how you feel. Esketamine is different, though. It rapidly impacts your brain’s cells, bringing immediate relief from your depression symptoms within hours of treatment.

Decreases Suicidal Thoughts

Many traditional antidepressant medications may increase suicidal thoughts, especially at the start of treatment. Eskatamine is one of the only drugs proven to decrease suicidal thoughts. The only exception is lithium, which is commonly used to treat bipolar disorder.

Effective for Treatment-Resistant Depression

TRD is tricky to treat. Esketamine has been approved by the U.S. F.D.A. since 2019 for TRD. Multiple studies have shown that it is an effective TRD treatment option.

Create New Brain Connections

Research has shown that taking Spravato for depression helps you build new brain connections. A newer understanding of depression has shown us that depression may be caused due to irregular communication paths in the brain. 

As your brain continues to follow the negative thought pattern paths, it starts to shut down other pathways. This changes the brain's communication, worsening depression. 

Clinical studies have shown that taking Spravato for depression helps the brain make new connections and helps the brain heal from the damage resulting from long-term depression.

Difference Between Esketamine and Ketamine

Esketamine (the active drug in Spravato) and ketamine are not the same thing. 

Ketamine is comprised of two mirror-image molecules: R-ketamine and 5-ketamine (which is known as esketamine). Therefore, Esketamine is one-half of the molecular compound within ketamine. 

When the molecule is split in two, each molecule is now called an enantiomer. Each one interacts differently with the receptors in your brain.  

Spravato, when used in combination with another antidepressant medication, is approved for use by the U.S. F.D.A. for treating adults with TRD and MDD. 

Ketamine isn’t FDA-approved to treat depression due to the fact that it is already FDA-approved and has been around so long it's now considered a generic drug. However, it is legal to prescribe for off-label uses and hundreds of studies have shown amazing results when appropriately trained medical providers offer ketamine as a treatment for depression.

Read more about the differences between IV Ketamine infusions vs. Spravato in our blog.

How Do I Qualify for Spravato Treatment?

If you suffer from treatment-resistant depression or major depressive disorder, Spravato may be the treatment you need. Qualifying for Spravato treatment is relatively simple. If you have tried two or more antidepressants in the past and you haven't gotten results, it's likely that your insurance will cover Spravato treatment. 

Press the "schedule now" button above to book your initial intake. After you discuss with your medical history with your provider and are deemed eligible for treatment, we will manage the entire prior-authorization process for you, which can happen as quickly as within the week to as long as a year (this is a true story. We do not give up on our patients and will advocate on their behalf for this long if necessary). Most prior-authorizations are usually approved within 2 weeks. 

Spravato FAQs

What is Spravato (Esketamine)?

Spravato is an intranasal spray that contains the active ingredient esketamine hydrochloride. It is an FDA-approved treatment for individuals with treatment-resistant depression (TRD).

Who is Spravato for?

Spravato is for individuals with treatment-resistant depression (TRD) who also take an oral antidepressant.

What oral antidepressants can be used with Spravato?

Spravato must be taken alongside an oral antidepressant. 

Common oral antidepressants that can be used with Spravato include: 

  • Wellbutrin
  • SNRIs such as Cymbalta and Effexor
  • SSRIs such as Zoloft, Prozac, and Paxil

Is Spravato safe for use in children?

No, Spravato is currently not approved for use in children. It is intended to be used by adults.

Can I get Spravato at my local pharmacy?

No, you cannot get Spravato at your local pharmacy. The medication must be administered at your doctor’s office under the direct supervision of a healthcare provider who is certified to dispense and prescribe Spravato.

How long does Spravato take to work for depression?

In FDA studies, effects were noted from Spravato within two days, although you may feel relief within hours of your treatment.

Is Spravato for depression treatment safe?

Yes, Spravato is an FDA-approved drug for treatment-resistant depression and is safe to use. However, the way it works on your body during a treatment session needs to be monitored closely, which is why Spravato is administered at the doctor’s office. You will continue to be monitored for at least two hours after each treatment session.

Does Spravato for depression treatment interact with other drugs?

Yes, there are several drug interactions with Spravato that one should be aware of, which is why it is always important to discuss all drugs you are taking with your medical provider before combining them with Spravato. 

Spravato may increase sedation when mixed with CNS depressants such as benzodiazepines, opioids, and alcohol. It interacts with stimulants such as amphetamines and other drugs that may increase blood pressure. It also is known to interact with Monoamine Oxidase Inhibitors (MAOIs)

Spravato is an FDA-approved drug for treatment-resistant depression and is safe to use. However, the way it works on your body during a treatment session needs to be monitored closely, which is why Spravato is administered at the doctor’s office. You will continue to be monitored for at least two hours after each treatment session.

Can I drive after Spravato for depression treatment?

No. You should not drive until a day after your treatment session after you have had a good night’s sleep. Please remember to arrange a ride to and from your Spravato treatment session.

How can I prepare for a Spravato treatment?

Don’t eat four hours before your treatment session. Don’t drink liquids 30 minutes before your treatment session. Avoid greasy or heavy foods on the day of treatment. Be sure to arrange a ride to and from treatment. 

How long do you stay on Spravato?

The first 2 months of Spravato start with 2 treatments per week in the first month, and 1 treatment per week for the second month. As individual responses vary, patients will need to talk to their provider about the appropriate cadence and duration of treatment for the patient. Depending on the severity of the depression, some patients may continue to come once a week for several months, while others will titrate down to once a month. Individual response may vary and we monitor patients for results to ensure that the treatment is appropriate for the patient and their mental health goals. 

Does Spravato get you high?

Disassociative effects have been observed in most of our patients. However, this is considered a negative side-effect and not the mechanism by which the brain heals from depression and anxiety. Many patients feel that as they build tolerance for the medication, it is no longer working because they are no longer "disassociating." However, this would be akin to feeling as though the medication is no longer working because the patient is no longer vomiting. The disassociation, while pleasant for many, is not proof of the medication's efficacy.

How much does Spravato for depression treatment cost?

Spravato costs between $700-$1200 per dose, however, this cost is normally covered by insurance.
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