Depression can be difficult to treat, especially when symptoms persist despite trying multiple medications. For some individuals, traditional antidepressants may not provide enough relief, leading healthcare providers to consider additional treatment options.
One option that has received increasing attention in recent years is Spravato®. This FDA-approved treatment uses esketamine, a medication that works differently from conventional antidepressants and may help some people with treatment-resistant depression.
This Spravato overview explains what the treatment is, how it works, who may be a candidate, potential benefits and risks, and how it compares to other approaches such as Transcranial Magnetic Stimulation (TMS).
Spravato Overview: What Is Spravato?
Spravato is a prescription medication that contains esketamine, a compound derived from ketamine. It is administered as a nasal spray in a certified healthcare setting under medical supervision.
Unlike traditional antidepressants that are typically taken at home, Spravato must be given in an approved treatment center where patients can be monitored after each session.
Spravato received approval from the U.S. Food and Drug Administration (FDA) for specific depression-related conditions. Depending on the indication being treated, it may be prescribed either alongside an oral antidepressant or as part of a treatment plan determined by a healthcare provider.
For many individuals living with treatment-resistant depression, Spravato represents another evidence-based treatment option that may be considered when traditional approaches have not provided adequate relief.
Treatment-Resistant Depression
One of the primary FDA-approved indications for Spravato is treatment-resistant depression (TRD).
Treatment-resistant depression generally refers to major depressive disorder that has not improved sufficiently after trying at least two antidepressant medications at appropriate doses and durations.
For individuals living with treatment-resistant depression, exploring additional treatment options may be an important next step.
Major Depressive Disorder With Suicidal Thoughts or Behaviors
Spravato is also approved, in combination with an oral antidepressant, for adults with major depressive disorder who have acute suicidal thoughts or behaviors.
This approval reflects the need for additional treatment options when symptoms are severe and require prompt medical attention.
Because suicidal thoughts and behaviors require immediate evaluation, treatment decisions should always be made with qualified healthcare professionals who can assess each person’s specific circumstances.
How Spravato Works
Traditional antidepressants typically affect neurotransmitters such as serotonin, norepinephrine, or dopamine.
Spravato works differently than traditional antidepressants. Esketamine primarily affects a brain signaling system involving glutamate, which is the most abundant excitatory neurotransmitter in the brain. Specifically, esketamine acts on NMDA receptors, which are involved in learning, memory, and communication between brain cells.
Researchers believe these effects may help promote changes in neural connections that support mood regulation.
While scientists continue studying the exact mechanisms involved, Spravato’s unique approach offers an alternative pathway for people who have not experienced adequate improvement with conventional antidepressants.
What Happens During a Spravato Appointment?
Many people researching Spravato treatment want to know what the experience is actually like.
While treatment plans vary, a typical appointment includes several steps.
Before Treatment
A healthcare provider reviews symptoms, medical history, and treatment progress.
Blood pressure may be checked before treatment begins because Spravato can temporarily increase blood pressure.
During Treatment
The patient self-administers the nasal spray under supervision at the treatment center.
The medication is given according to a prescribed dosing schedule determined by the treating provider.
Observation Period
After receiving Spravato, patients remain at the treatment facility for monitoring.
This observation period is important because some individuals experience temporary side effects such as:
- Dizziness
- Drowsiness
- Dissociation
- Increased blood pressure
- Nausea
Patients typically cannot drive themselves home after treatment and should arrange transportation in advance.
Treatment Frequency
Spravato treatment usually begins with more frequent appointments and gradually transitions to a maintenance schedule if treatment continues.
The exact schedule depends on individual needs and clinical response.
Potential Benefits of Spravato
Like any depression treatment, benefits vary from person to person.
Potential advantages of Spravato treatment may include:
- An option for people with treatment-resistant depression
- A different mechanism than traditional antidepressants
- Potential symptom improvement for individuals who have not responded adequately to traditional treatment approaches
- Integration into a broader treatment plan that may include therapy and medication management
For patients who have struggled to find relief through conventional approaches, having additional evidence-based treatment options can be valuable.
Potential Side Effects and Risks
Every medical treatment carries potential risks, and Spravato is no exception.
Common side effects may include:
- Dizziness
- Drowsiness
- Nausea
- Headache
- Dissociation
- Temporary increases in blood pressure
- Anxiety
- Fatigue
Because of these effects, Spravato is available only through a Risk Evaluation and Mitigation Strategy (REMS) program that requires administration in certified healthcare settings.
Healthcare providers carefully evaluate whether Spravato is appropriate based on each patient’s medical history, current medications, and overall health.
Spravato vs TMS: What’s the Difference?
People researching advanced depression treatments often compare Spravato and TMS.
Both treatments are used for individuals who may not have achieved sufficient relief from traditional approaches, but they work very differently.
| Feature | Spravato | TMS |
| Treatment Type | Prescription medication (esketamine nasal spray) | Non-invasive brain stimulation |
| How It Works | Affects glutamate and NMDA receptors | Uses magnetic pulses to stimulate targeted brain regions |
| Medication Involved | Yes | No medication administered during treatment |
| Treatment Setting | Certified healthcare facility | Outpatient treatment center |
| Monitoring After Session | Required observation period | Typically no observation period required |
| Transportation Needs | Patients generally need transportation home | Patients can typically drive themselves |
| Common Side Effects | Dizziness, dissociation, nausea, increased blood pressure | Scalp discomfort, headache, temporary irritation at treatment site |
| Insurance Coverage | Varies by insurer and individual plan | Varies by insurer and individual plan |
Neither treatment is universally right for everyone.
The most appropriate option depends on factors such as:
- Diagnosis
- Treatment history
- Medical history
- Personal preferences
- Insurance coverage
- Provider recommendations
For individuals comparing treatments, understanding the differences can help support more informed discussions with healthcare professionals.
Who May Be a Candidate for Spravato?
Spravato may be considered for adults who:
- Have treatment-resistant depression
- Have not experienced adequate improvement with multiple antidepressants
- Meet FDA-approved treatment criteria
- Can attend regular in-office appointments
- Are medically appropriate candidates based on provider evaluation
Not everyone with depression will qualify for Spravato treatment.
A comprehensive assessment helps determine whether it may be appropriate as part of a personalized treatment plan.
Understanding Your Options for Treatment-Resistant Depression
Recovery looks different for every person, and treatment decisions should always be based on an individual’s symptoms, treatment history, and goals. Some individuals respond well to traditional antidepressants. Others benefit from psychotherapy, lifestyle changes, TMS, Spravato, or a combination of approaches.
The most important step is working with qualified healthcare professionals who can evaluate your symptoms, treatment history, and goals to help identify appropriate options.
If traditional treatments haven’t provided relief, our team can help you understand whether TMS or another treatment option may be appropriate for your situation. We are here to answer your questions, provide clear information, and help you explore evidence-based approaches to depression treatment.
Contact Pulse TMS to discuss your treatment options and learn whether TMS may be appropriate for your situation.
Frequently Asked Questions
Is Spravato the same as ketamine?
No. Spravato contains esketamine, which is derived from ketamine but is a distinct FDA-approved prescription medication administered under specific medical guidelines.
How quickly does Spravato work?
Response times vary. Some individuals report symptom improvement relatively quickly, while others may require additional treatments before noticing meaningful changes.
Does insurance cover Spravato?
Insurance coverage varies by insurer, plan, diagnosis, and eligibility requirements. Coverage should always be verified directly with the insurance provider and treatment center.
Can Spravato and TMS be used together?
In some cases, healthcare providers may consider multiple treatment approaches as part of an individualized care plan. Treatment decisions should always be based on a thorough clinical evaluation and discussion with qualified healthcare professionals.
Who qualifies for Spravato treatment?
Eligibility depends on factors such as diagnosis, treatment history, medical history, and FDA-approved criteria. A healthcare provider can determine whether Spravato may be appropriate for a specific individual.
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