Spravato (Esketamine) Therapy

Spravato (esketamine) is a prescription nasal spray that is derived from ketamine. It received FDA approval in 2019 for the treatment of treatment-resistant depression (TRD) and major depressive disorder with acute suicidal ideation.

Because it is FDA-approved for these specific psychiatric conditions, it offers a unique pathway for patients seeking alternative depression treatments with the support of commercial health insurance.

Spravato must be taken in a certified medical office under the Risk Evaluation and Mitigation Strategy (REMS) program:

1. Administration: You self-administer the nasal spray device under the direct supervision of a healthcare provider.
2. Observation: You must remain in the clinic for at least two hours after taking the dose to be monitored for side effects like sedation and dissociation.
3. Discharge: After two hours, assuming side effects have cleared, you will be discharged to a trusted driver.

The primary advantage of Spravato over IV ketamine is that it is frequently covered by Medicare and most major commercial insurance providers. Out-of-pocket costs will depend heavily on your specific pharmacy benefits, deductible, and copay requirements. Without insurance, Spravato is significantly more expensive than generic ketamine.

Common side effects include dissociation, dizziness, nausea, sedation, spinning sensation (vertigo), decreased feeling or sensitivity, and increased blood pressure. Because of the risk for sedation and dissociation, it is only available through a restricted distribution system (REMS).