SPRAVATO®, and what the first month of treatment looks like.

We offer SPRAVATO® for a specific reason. It is the only rapid-acting treatment for depression that carries FDA approval.

That distinction matters more than it may sound. Ketamine therapy, which we also offer, is an off-label use of an FDA-approved anesthetic. Esketamine, the medication in SPRAVATO®, went through the approval process specifically for treatment-resistant depression, which means the evidence, the dosing, and the safety requirements are defined and standardized.

Why we offer it

SPRAVATO® is FDA-approved for adults with treatment-resistant depression, used together with an ongoing oral antidepressant, in people who have not responded adequately to at least two antidepressants.

That description covers a great many of the people who reach us. They have taken medication after medication at adequate doses, for long enough to know it. They are not new to treatment. They are tired of waiting for something to work.

We offer it, too, because of how the treatment is structured. Every dose is given in a certified setting under the REMS program, with observation and vital sign checks built into the visit. Those two hours in the office are not incidental. They are the reason a treatment this fast can be offered safely.

And while IV ketamine is generally paid for out of pocket, SPRAVATO® is often covered by insurance with prior authorization, which we help patients pursue.

How it helps

Esketamine acts on the glutamate system rather than primarily on serotonin or norepinephrine. The downstream effects are thought to involve pathways related to mood regulation and neuroplasticity, the brain's capacity to adapt and form new connections.

In practice, that means a treatment that can begin working within a day or two for some people, rather than the several weeks a standard antidepressant may take. In the studies behind its approval, improvements in depressive symptoms appeared early, often within the first week, and reductions in suicidal thinking showed up within the first day for some patients.

Three honest notes.

It is given alongside an oral antidepressant, not instead of one. The combination is what was studied and approved.

It does not work for everyone. A portion of people complete an induction course with little benefit, which is why the end of induction is a real decision point rather than a formality.

And it treats depression rather than curing it. Stopping treatment entirely tends to lead back to where you started, so the plan has to include what comes after.

What a treatment appointment involves

Plan on being with us for roughly two and a half hours. We check in and take your blood pressure, you self-administer the nasal spray under clinical supervision, and then you rest in a private, calm space while we monitor you for at least two hours, as prescribing information requires.

The temporary effects are worth describing plainly. Many people feel drowsy, floaty, or detached from their surroundings for a while, and some notice changes in perception. Blood pressure can rise, and the spray can irritate the nose. Most of this settles within about ninety minutes, and our team stays close throughout.

You must have a responsible adult drive you home. You should not drive or operate machinery until the next day, after a full night's sleep.

The shape of the first month

Weeks one through four: induction

Treatment is given twice weekly for four weeks, for up to eight sessions, while your oral antidepressant continues. This phase exists to establish whether SPRAVATO® helps you and how well you tolerate it.

Weeks five through eight: the transition

If you have responded, treatment usually moves to once weekly for the next four weeks. This is when gains are consolidated and we learn how long the effect holds for you.

Beyond two months: maintenance

After that, spacing becomes individual. Some people come every one to two weeks, some every three or four, and some eventually less often. The schedule is adjusted based on your response and tolerability rather than fixed in advance.

What the timeline of results tends to look like

The first day or two

Some people notice a change quickly, including a lessening of hopelessness or of suicidal thinking. Others notice nothing yet, which is common and not a reason to stop.

The first two weeks

This is where most of the people who respond begin to see something clear. Sleep and energy often move before mood does, and families sometimes notice before patients do.

The end of induction

At four weeks we have an answer. If there has been meaningful improvement, we move to maintenance. If there has not, we stop, and we say so plainly rather than continuing a treatment that is not working.

Months two and beyond

Maintenance is what protects the improvement. Spacing it too far out, or stopping it, usually means the depression returns. We would rather plan for that openly at the start than discover it later.

Considering SPRAVATO®

SPRAVATO® raises blood pressure, can cause temporary dissociation, and is not appropriate for everyone. Screening covers your cardiovascular history, current medications, psychiatric history, and other individual factors, and it happens before any treatment is scheduled.

If you have tried two or more antidepressants without enough relief, this is a reasonable treatment to ask about. A comprehensive evaluation is where that conversation starts.

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This journal is intended for educational purposes and does not replace individualized medical or psychiatric care. If you or someone you know is experiencing a mental health crisis or thoughts of suicide, call or text 988 in the United States for immediate support.