.avif)
What is Spravato (esketamine)?
Spravato (esketamine) is an FDA-approved nasal spray designed specifically for treatment-resistant depression (TRD): depression that hasn't improved after trying two or more antidepressants. It is also approved for people with Major Depressive Disorder who have suicidal ideation and need rapid intervention.
Unlike SSRIs, which affect serotonin activity in the brain and take four to six weeks, esketamine works on a different brain system (glutamate) and produces results faster. Clinical trials show treatment effects appeared at 24 hours and remained consistent through four weeks of treatment. It's one of the most studied rapid-acting treatments for depression.
At Salma Health clinics, esketamine is administered under medical supervision, in a calm and soothing room. Each session lasts about two hours with monitoring by trained staff. The standard treatment schedule is twice weekly for four weeks during the active phase, then less frequent sessions once a patient has transitioned to maintenance.
For important safety information about SPRAVATO®, see below.
How esketamine works
Esketamine works on NMDA receptors in the brain, increasing levels of glutamate, which boosts neural activity and strengthens communication between brain cells. This surge in connectivity is thought to “reset” brain circuits involved in mood and emotional regulation, helping patients who haven’t responded to standard antidepressants. Because esketamine can cause temporary dissociation or increase blood pressure, it is always given in a clinic setting with care monitoring.
Esketamine results
Spravato delivers meaningful relief for depression, with many patients experiencing improvement in days, even if traditional antidepressants haven’t worked for them.
Results are based on a randomized controlled trial evaluating Spravato plus an oral antidepressant against placebo, and a relapse-prevention study examining outcomes for patients who continued treatment after reaching remission.
Insurance & cost
Most insurance plans cover Spravato for treatment-resistant depression when eligibility criteria are met, and Salma Health works with Aetna, Anthem, Optum, Cigna, Blue Shield, Medicare and TRICARE, among others. Our team will help verify your benefits, coordinate prior authorization and explain any out-of-pocket costs before your first session. Self-pay patients are welcome.
Esketamine treatment process
Your journey with esketamine begins with a consultation with a Salma Health psychiatrist to determine whether this treatment is right for you.
Step 1: Initial evaluation
- Comprehensive psychiatric assessment, including your medical history, previous treatments and current medications
- Physical health screening to ensure esketamine is safe and appropriate for you
Step 2: First treatment session
- Esketamine nasal spray is self-administered under supervision in our clinic
- You remain in a comfortable observation area for approximately two hours while our team monitors your vital signs
Step 3: Ongoing treatment
- Induction phase: twice weekly for four weeks
- Maintenance phase: once weekly or every other week, depending on your response
- Each session includes monitoring and support from our care team
Step 4: Progress monitoring
- Regular check-ins with your psychiatrist to track your symptom improvement
- Adjustments may be made to your treatment plan as needed
Step 5: Long-term care
- Many patients continue maintenance sessions to sustain progress
- Esketamine can be combined with therapy, lifestyle interventions or medication management as part of your ongoing care
Safety & side effects
Esketamine is a well-tolerated, FDA-approved treatment when administered in a certified clinical setting under medical supervision.
Common side effects include:
- Dissociation, dizziness, nausea, headache and temporary increases in heart rate or blood pressure, typically peaking within the first hour and resolving before you leave.
- Sound sensitivity, which can be relieved by wearing headphones or earplugs during sessions.
- Mild drowsiness for two to three hours after treatment. (You should not drive or operate machinery for the rest of the day, so you'll need a caregiver to drive you home.)
While temporary dissociation is a common effect of esketamine, dissociation is different from hallucination. Dissociation is a temporary change in how you perceive your surroundings, such as feeling detached from your body or that things look or feel strange. Hallucination, seeing or hearing things that aren't there, does not happen with esketamine at clinical treatment doses. You remain fully conscious and aware throughout, with trained staff monitoring you.
In rare cases, esketamine can lead to respiratory depression or seizure.
See Important Safety Information about SPRAVATO®, including Boxed Warning by clicking the link here.
Is esketamine safe for long-term use?
Yes. Clinical trials tracking patients over months and years have not documented lasting adverse effects from esketamine. When used as prescribed and monitored by a qualified licensed clinician, esketamine is safe for ongoing treatment, and your provider will review your progress regularly and adjust your plan as needed.
.png)
