What Is Spravato (Esketamine) Therapy? A Guide for Treatment-Resistant Depression

When depression does not respond to standard antidepressants, it can feel like you have run out of options. For adults living with treatment-resistant depression, Spravato (esketamine) offers an FDA-approved path forward — one that works differently from traditional medications and is available right here at Health Haven.

What Is Spravato?

Spravato is the brand name for esketamine, a prescription nasal spray approved by the FDA for adults with treatment-resistant depression — generally defined as depression that has not improved after trying at least two antidepressant medications. It is also approved for depressive symptoms in adults with major depressive disorder who are experiencing acute suicidal thoughts or behavior.

You may have heard Spravato described alongside ketamine. Esketamine is derived from ketamine, but Spravato is its own FDA-approved medication with its own dosing, safety program, and clinical evidence. At Health Haven, Spravato nasal spray is the only esketamine/ketamine-based treatment we offer — we do not provide IV infusions, injections, or compounded formulations.

How Does Spravato Work?

Most antidepressants target serotonin or norepinephrine and can take four to six weeks to show an effect. Esketamine works on the glutamate system — the brain's most abundant neurotransmitter pathway — which is thought to support neuroplasticity, the brain's ability to form new connections. Because of this different mechanism, some people notice improvement in depressive symptoms within hours or days rather than weeks.

Spravato is not a standalone cure. It is prescribed alongside an oral antidepressant and works best as part of a comprehensive treatment plan that may include therapy and ongoing psychiatric care.

Who May Benefit?

Spravato may be an option if you are an adult who:

• Has been diagnosed with major depressive disorder that has not responded to at least two antidepressant trials
• Is currently taking, or willing to take, an oral antidepressant alongside treatment
• Can attend in-clinic appointments for supervised administration

It is not appropriate for everyone. A Health Haven psychiatrist will complete a full psychiatric evaluation — including your medical history, current medications, and prior treatment attempts — before determining whether Spravato is a safe fit for you.

What to Expect During Treatment

Because of its safety requirements, Spravato is only administered in a certified healthcare setting — never at home. Here is what a typical course looks like:

• Supervised dosing: You self-administer the nasal spray under the direct observation of a healthcare professional at our clinic.
• Monitoring: After each dose, you are monitored on-site for at least two hours so our team can watch for side effects such as dizziness, nausea, or dissociation, and confirm you are safe to leave.
• Treatment schedule: Treatment often begins with twice-weekly sessions for the first month, then tapers to weekly or every-other-week sessions depending on your response.
• No driving: You will need a ride home after each session — patients cannot drive until after a full night's rest.

Where Is Spravato Available at Health Haven?

Spravato treatment is currently offered at our West Palm Beach and Okeechobee offices only, where our certified clinical teams and monitoring facilities are in place.

Is Spravato Right for You?

If you have tried multiple antidepressants without meaningful relief, you do not have to accept that as the final answer. The first step is a psychiatric evaluation with one of our providers, who will review your history and discuss whether Spravato — or another advanced option such as TMS therapy — fits your situation.

Call 863-261-8354 or reach us at info@healthhavenllc.org to schedule an evaluation at our West Palm Beach or Okeechobee office. If you or someone you love is in crisis, call or text 988 for immediate support.