Spravato® Treatment Services

Frequently Asked Questions About SPRAVATO® (Esketamine)

What is SPRAVATO®?

SPRAVATO® is the brand name for esketamine, an FDA-approved nasal spray used to treat certain adults with depression. Unlike traditional antidepressants that primarily affect serotonin, norepinephrine, or dopamine, esketamine acts mainly through the brain’s glutamate system and NMDA receptors.

SPRAVATO® is given only in a certified healthcare setting under medical supervision.

Who may be a candidate for SPRAVATO®?

SPRAVATO® may be considered for adults with treatment-resistant depression (TRD), generally meaning depression that has not adequately improved despite appropriate trials of antidepressant medications.

SPRAVATO® is FDA approved for treatment-resistant depression in adults either by itself or together with an oral antidepressant. It is also approved, together with an oral antidepressant, for depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior.

A psychiatric evaluation is needed to determine whether SPRAVATO® is appropriate for you.

Is SPRAVATO® the same as ketamine?

Not exactly.

Esketamine, the medication in SPRAVATO®, is one component of the ketamine molecule. SPRAVATO® is an FDA-approved nasal spray with standardized dosing and specific safety-monitoring requirements.

Intravenous or compounded ketamine is different and is not the same treatment as SPRAVATO®.

How is SPRAVATO® administered?

SPRAVATO® is a nasal spray that you administer yourself while being directly observed by a healthcare professional.

Each nasal spray device contains 28 mg of esketamine. Depending on the prescribed dose, multiple devices are used during the treatment session.

SPRAVATO® cannot be taken home for self-administration.

How long does a SPRAVATO® appointment take?

Patients must remain at the treatment center for at least two hours after receiving SPRAVATO®.

During this period, our clinical team monitors you for possible effects such as sedation, dissociation, blood-pressure changes, and respiratory changes.

Plan for the overall appointment to take somewhat longer than two hours to allow for check-in, medication administration, monitoring, and discharge assessment.

How often is SPRAVATO® given?

For treatment-resistant depression, treatment usually begins more frequently and then gradually becomes less frequent.

A commonly used FDA-approved schedule includes:

• Weeks 1–4: twice weekly

• Weeks 5–8: once weekly

• Week 9 and beyond: usually once weekly or every other week, depending on response

The treatment schedule is individualized by your psychiatrist based on symptoms, response, tolerability, and insurance requirements.

How quickly does SPRAVATO® work?

Some patients experience improvement relatively early in treatment, while others require several treatments before noticing a meaningful difference.

Response varies from person to person, and improvement cannot be guaranteed. SPRAVATO® treatment is generally evaluated over a series of sessions rather than based on how a patient feels after one treatment.

What does SPRAVATO® feel like?

Experiences vary considerably.

During or shortly after treatment, some patients may experience:

• A floating or detached sensation

• Changes in perception

• Dizziness

• Sleepiness

• Nausea

• Feeling temporarily “different” or disconnected

• Mild anxiety

• Increased blood pressure

These effects commonly lessen during the monitoring period.

What is dissociation?

Dissociation is a temporary change in how you perceive yourself or your surroundings. Some patients describe feeling detached, dreamlike, unusually relaxed, or as though time or space feels different.

Because SPRAVATO® may cause dissociation and sedation, every treatment takes place in a monitored medical setting.

Is SPRAVATO® addictive?

SPRAVATO® contains esketamine, which is a Schedule III controlled substance and has potential for abuse and misuse.

Patients are therefore screened appropriately and monitored throughout treatment. SPRAVATO® is available only through a restricted safety program known as the SPRAVATO® REMS Program.

Can I drive myself home after SPRAVATO®?

No.

You must arrange for someone to safely transport you home after every SPRAVATO® treatment.

Patients should not drive, operate machinery, or perform potentially hazardous activities for the remainder of the treatment day. Driving should resume only after a restful night's sleep, consistent with your clinician's instructions.

Will my blood pressure be monitored?

Yes.

SPRAVATO® can temporarily increase blood pressure. Your blood pressure is checked before treatment, approximately 40 minutes after administration, and again as clinically appropriate before discharge.

Patients with certain cardiovascular or cerebrovascular conditions may require additional evaluation before treatment.

Who should not receive SPRAVATO®?

SPRAVATO® is contraindicated in certain patients, including people with:

• Certain aneurysmal vascular diseases

• Arteriovenous malformations

• A history of intracerebral hemorrhage

• Known hypersensitivity to esketamine, ketamine, or ingredients in SPRAVATO®

Other medical conditions may also require additional consideration. Your psychiatrist will review your medical history, medications, blood pressure, substance-use history, and other relevant factors before treatment.

Can I eat or drink before SPRAVATO®?

Because SPRAVATO® may cause nausea or vomiting, patients are generally instructed to avoid food for at least 2 hours before treatment and liquids for at least 30 minutes beforehand.

Our team will provide specific preparation instructions before your first treatment.

Can I use a nasal spray before treatment?

Some nasal medications may be permitted, but timing can matter.

If you routinely use a nasal decongestant or nasal corticosteroid, let our team know. We will provide instructions about when it can be taken relative to your SPRAVATO® treatment.

Do I need to continue my antidepressant?

Not necessarily in every case.

SPRAVATO® is currently FDA approved for treatment-resistant depression either as monotherapy or together with an oral antidepressant. For the treatment of depressive symptoms associated with major depressive disorder with acute suicidal ideation or behavior, it is used together with an oral antidepressant.

Your psychiatrist will determine whether your existing medications should be continued, adjusted, or changed.

Is SPRAVATO® used for suicidal thoughts?

SPRAVATO® is FDA approved, together with an oral antidepressant, for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior.

However, SPRAVATO® has not been demonstrated to prevent suicide or independently reduce suicidal thoughts or behavior, and it does not replace hospitalization or emergency psychiatric care when those are clinically necessary.

If you are experiencing an immediate psychiatric emergency or are at risk of harming yourself or someone else, call 911 or go to the nearest emergency department.

Is SPRAVATO® covered by insurance?

Many commercial insurance plans, Medicare Advantage plans, and other insurers provide coverage for SPRAVATO® when their medical-necessity requirements are met.

Coverage varies by insurance company and individual plan. Prior authorization is commonly required, and insurers may require documentation of previous antidepressant treatment.

The AiMM team can help determine your benefits and work through the prior-authorization process when appropriate.

How long will I need SPRAVATO® treatment?

There is no single treatment duration that is right for everyone.

After the initial treatment phase, some patients benefit from ongoing maintenance treatment once weekly or every other week. Your psychiatrist will periodically evaluate whether continued treatment remains beneficial and medically appropriate.

What happens during a SPRAVATO® treatment at AiMM?

Before treatment, our team will review how you are feeling and check your vital signs, including blood pressure.

You will then administer SPRAVATO® nasal spray under direct supervision. During the monitoring period, you can rest comfortably while our clinical team monitors your blood pressure, oxygen level, alertness, and overall response.

You will remain in the clinic for at least two hours after administration and will be discharged only after the clinical team determines that you are medically ready to leave.

Does AiMM offer SPRAVATO® treatment in Huntsville, Alabama?

Yes. Alabama Institute of Mood and Memory (AiMM) offers SPRAVATO® evaluation and treatment in Huntsville, Alabama for appropriate adult patients with treatment-resistant depression and other FDA-approved indications.

Treatment is provided in a supervised clinical environment with appropriate monitoring before, during, and after each session.

How do I know whether SPRAVATO® is right for me?

The first step is a psychiatric evaluation.

Your psychiatrist will review your diagnosis, previous antidepressant treatments, current medications, medical history, blood pressure, previous treatment response, and treatment goals.

Depending on your individual situation, options may include medication management, psychotherapy, TMS, SPRAVATO®, ECT, or a combination of treatments.

How can I schedule a SPRAVATO® consultation at AiMM?

Contact Alabama Institute of Mood and Memory (AiMM) to request a consultation for SPRAVATO® treatment in Huntsville.

Our team can review your clinical history, discuss whether SPRAVATO® may be appropriate, and help determine your insurance coverage and prior-authorization requirements.

Alabama Institute of Mood and Memory (AiMM)
Because Every Mind Matters.