A treatment we offer · For treatment-resistant depression
SPRAVATO® (Esketamine)
A nasal-spray treatment, FDA-approved for adults with Treatment-Resistant Depression — major depression that hasn't improved after trying at least two different oral antidepressants.. Unlike traditional antidepressants that work on serotonin or dopamine, SPRAVATO works on Glutamate — the brain's most common excitatory chemical messenger. SPRAVATO affects glutamate signaling, which is thought to help brain cells form new connections. signaling, and often reduces symptoms in days rather than weeks. Not everyone responds, though, and how much it helps — and how quickly — varies from person to person.
FDA Boxed Warning
Esketamine carries the FDA’s most serious warning category for four specific risks. We monitor for all of them at every visit, but you should know about each before deciding together whether SPRAVATO is right for you.
- Sedation — sleepiness or light-headedness during the session, which is part of why you can’t drive for the rest of the day.
- Dissociation — a feeling of being outside your body or that the room feels unreal. Most people experience some degree of this; it’s expected and it passes. It’s the reason for the two-hour observation window after each dose.
- Abuse and misuse — SPRAVATO is a Schedule III controlled substance. We follow strict REMS dispensing rules and never send doses home with you.
- Suicidal thoughts and behaviors — antidepressant medications can increase the risk of suicidal thoughts and behaviors in children and young adults. SPRAVATO is approved only for adults; if you ever have new or worsening thoughts of suicide or self-harm — between visits or during a session — please tell us right away, or call or text 988 any time, day or night.
You can read the full FDA-approved Prescribing Information at NIH DailyMed or talk through any of this together when you come in.
Manufacturer’s consumer site: spravato.com.
What SPRAVATO is
SPRAVATO (also called esketamine) is a prescription nasal spray derived from ketamine. The FDA first approved it in 2019 for adults with treatment-resistant depression when used alongside an oral antidepressant. In January 2025, it was approved on its own — clinically called Monotherapy — used on its own, without pairing with another medication..
It’s given under direct clinical supervision through a program called REMS (Risk Evaluation and Mitigation Strategy) — an FDA program for medications that need extra safety measures. You receive each dose at a certified clinic and stay on-site for monitoring., which is why you’ll receive each dose at our New Jersey office rather than take it home. The Utah office is working toward REMS certification; until then, SPRAVATO sessions are based out of our New Jersey office.
What a session looks like
Plan on about two and a half hours in the office each visit. Most of that time is quiet monitoring — you can bring headphones, a book, or just sit in the dimmed room.
- Before — eat lightly 2 hours ahead, skip caffeine the morning of, and arrange a ride home. You can’t drive for the rest of the day.
- During — you spray the dose yourself, with us in the room. Most people feel the medication within 20 minutes.
- After — you’ll stay for a 2-hour observation window where we check blood pressure and see how you’re feeling. Then your ride home picks you up.
The usual schedule is twice a week for the first four weeks, then slowly tapered. We adjust together based on how you’re responding.
Common effects & who it’s not for
In addition to the four boxed-warning risks above, SPRAVATO has more routine effects worth knowing about before deciding together if it’s the right fit.
Most common effects — usually during or shortly after the session, fading within a few hours:
- Dissociation — a feeling of being outside your body or that the room feels unreal. This is expected, and it passes.
- Sedation — sleepiness or light-headedness (part of why you can’t drive).
- Blood pressure elevation — a temporary rise, which is why we monitor during and after.
- Nausea, headache, or dizziness — less common, and usually mild.
Who qualifies
SPRAVATO is approved for adults (18+) with treatment-resistant depression — typically meaning you’ve tried at least two different oral antidepressants at the usual doses and didn’t get enough relief. If you’re not sure whether that describes your history, that’s exactly the kind of thing we’ll sort out together at the first visit.
About this page
This page describes a treatment we offer; it is not medical advice for any individual. Whether SPRAVATO is right for you depends on your medical history and current health, which we will review together at your visit.
Next step
Wondering if SPRAVATO fits?
Book a visit with Vanessa to walk through your history — what you've tried, what's worked, what hasn't — and whether SPRAVATO could be part of a plan that makes sense for you. No pressure. No upsell.