Spravato for treatment-resistant depression: what a treatment day looks like

If you have tried two or more antidepressants without enough relief, you may have heard about Spravato (esketamine). It works differently from traditional antidepressants and is given under supervision in a certified healthcare setting. Here is what a treatment day actually looks like.

Who Spravato is for

Spravato is FDA-approved for adults with treatment-resistant depression, generally meaning depression that has not improved after at least two antidepressant trials. It is also approved, alongside an oral antidepressant, for adults with major depressive disorder with acute suicidal thoughts or behavior. A full evaluation determines whether it is a good fit for you.

Before your first session

• Evaluation: a review of your history, past treatments, and health, including blood pressure.
• Insurance: most plans require prior authorization, which the clinic handles.
• Ride home: you will need someone to drive you home after each session.

During the session

• You arrive, check in, and have your blood pressure checked.
• You use the nasal spray yourself, under direct supervision.
• You rest in a comfortable chair while staff monitor you for at least 2 hours, as required by the Spravato REMS safety program.
• Many people feel relaxed, sleepy, or a bit detached or floaty for a while. These effects usually ease within the monitoring period.
• Your blood pressure is checked again before you leave.

After the session

You should not drive, operate machinery, or do anything that requires full alertness until the next day after a restful night of sleep. Most people go home and rest for the remainder of the day.

How often are sessions?

Treatment typically starts twice a week for the first four weeks, then once a week, then weekly or every other week depending on how you respond. Your schedule is personalized.

Is it safe?

Spravato has important risks, including sedation, dissociation, increased blood pressure, and potential for misuse, which is why it is only available through the restricted REMS program with in-clinic monitoring. Your provider will review the risks and benefits for your situation.

Learn more about Spravato treatment at Peak, or take our free depression screening test.

SPRAVATO® is a registered trademark of Johnson and Johnson.