Spravato (Esketamine)

Spravato® (esketamine) is a prescription nasal spray for adults with treatment-resistant depression — depression that has not responded adequately to at least two antidepressant medications. It is also approved, together with an oral antidepressant, for depressive symptoms in adults with major depressive disorder who are experiencing acute suicidal thoughts or behavior. Spravato is not a take-home medication: it is given in our clinic, under medical supervision, as part of the FDA's REMS safety program.

How is Spravato different?

Esketamine works on the brain's glutamate system — a different pathway from standard antidepressants, which act mainly on serotonin and related chemicals. That difference is why Spravato can be an option when oral medications alone haven't been enough. It is always used alongside an oral antidepressant, not instead of one.

What does treatment look like?

You self-administer the nasal spray in our clinic while our team supervises. After each dose you stay with us for at least two hours of observation while we monitor how you feel and check your blood pressure. Most patients are treated twice a week for the first four weeks, then once a week, and then weekly or every two weeks based on response. You cannot drive after a treatment session — driving is off limits until the next day, after a restful night's sleep, so plan for someone to take you home.

Important safety information

The most common side effects are dissociation (feeling detached or unreal), sedation and sleepiness, dizziness, nausea, anxiety, and a temporary rise in blood pressure — which is why every session includes monitoring. Spravato carries FDA boxed warnings for sedation, dissociation, respiratory depression, misuse, and increased suicidal thoughts and behaviors in young people, and it is not appropriate for everyone — tell your provider about any history of aneurysm, bleeding in the brain, or high blood pressure. Your evaluation covers all of this carefully before treatment begins.

Does insurance cover it?

Many plans cover Spravato for patients who meet the treatment-resistant criteria, usually with prior authorization and documentation of the antidepressants already tried. Coverage is criteria-based, so our team verifies your benefits and handles the authorization before you start — call 863-261-8354 and we'll check.

Where is it offered?

Spravato is offered at our West Palm Beach and Okeechobee clinics only, because every session is supervised in person under the REMS program.

Common questions

Is Spravato the same as ketamine? Esketamine is closely related to ketamine — it is one of its two mirror-image molecules — but Spravato is its own FDA-approved medicine with its own dosing and safety program. Health Haven's esketamine treatment is Spravato; we do not offer IV ketamine infusions.

How soon might it help? Some patients notice a change within the first few weeks of treatment; for others it takes longer, and it doesn't work for everyone. We track your response closely and adjust the plan with you — no one can promise a result or a timeline.

Do I stop my antidepressant? No. Spravato is used together with an oral antidepressant, and your provider manages the full regimen.

Can I drive myself home? No. You must not drive until the next day, after a restful sleep. Please arrange a ride for every session.

If you've tried multiple antidepressants without relief, call (863) 261-8354 to schedule an evaluation and find out whether Spravato is a reasonable next step.