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We are very excited to offer Spravato at our offices.  Spravato is a nasally administered form of esketamine that is FDA approved for the treatment of treatment resistant depression in adults over the age of 18. It is to be used in conjunction with an oral antidepressant to help those who have failed to respond to at least 2 antidepressants. As it is FDA approved, many insurance companies will now cover the cost of this medication and the manufacturer, Janssen Pharmaceuticals, offers a generous copay assistance program. We will assist our patients with getting through the prior authorization process for the medication and the costs of administration.

Ketamine has been called the most important treatment advancement in the treatment of depression in the past 50 years. Until Spravato, Ketamine treatment required IV administration, these treatments were not covered by health insurance and the cost was significant to patients. Ketamine is active at the NMDA receptor sites in the brain and modulates the neurotransmitter glutamate rather than serotonin, dopamine and norepinephrine which our current antidepressants effect. The proposed mechanism of action for Spravato is that it restores the synaptic connections which have lost function in individuals suffering from severe depression. Ketamine works much faster than traditional antidepressants with improvement seen in days rather than weeks as with traditional antidepressant therapy. Studies also show a rapid reduction in suicidal ideation in those treated with Ketamine.

The treatment process involves an initial evaluation with Dr. Brown to determine if Spravato is appropriate for you and to discuss the medication’s use. If treatment is appropriate, you will receive Spravato twice weekly for four weeks then once per week for maintenance therapy. The long-term safety data with patients on Spravato has shown very good tolerability after use for 52 weeks and the patients showed good rates of continued response to Spravato. You will self-administer the nasal inhaler containing Spravato under our medical supervision and you will be monitored for at least 2 hours after administration. Your blood pressure will be checked at regular intervals as some individuals show an increase in blood pressure. As the medication can cause some alterations in alertness, you will be required to have someone drive you home after each treatment session.

For some patients, Spravato can also be used in conjunction with TMS. TMS can also be used to address anxiety associated with depression and the combination often leads to longer lasting effects. We strive to get our patients into full remission from depression.

Please visit to learn more about this life changing treatment option.

This Psychology Today article discusses both TMS and Esketamine for treating depression.

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