Spravato® (esketamine) is a nasal spray medication approved by the FDA for treatment-resistant depression and depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior. The steps in Spravato® treatment begin with a comprehensive evaluation by a healthcare provider to determine if a patient is an appropriate candidate.
Spravato® must be administered in a certified healthcare setting under medical supervision due to the risk of serious adverse outcomes, including sedation, dissociation, and potential for abuse. Patients self-administer the nasal spray under direct observation of a healthcare professional, and the dosing typically starts at 56 mg or 84 mg, which may be adjusted based on efficacy and tolerability.
Following ketamine therapy in Orange County, patients must remain at the healthcare facility for at least two hours of monitoring to ensure their safety and watch for potential side effects. During this observation period, healthcare providers assess blood pressure and monitor for dissociative symptoms or sedation. Patients should refrain from driving or operating heavy machinery for the remainder of the day after treatment.
What Steps Are Involved in Spravato® Treatment?
The steps in Spravato® treatment involve several carefully structured steps to ensure patient safety and treatment effectiveness:
- Initial Evaluation and Preparation: Before beginning Spravato® treatment, patients undergo a thorough psychiatric evaluation to confirm they have treatment-resistant depression, meaning they haven’t responded adequately to at least two different antidepressant medications or are experiencing acute suicidal thoughts with major depressive disorder.
- Treatment Day Protocol: On treatment days, patients are typically advised to refrain from eating for at least two hours before administration and to use a nasal decongestant, if necessary, approximately one hour beforehand. Upon arrival at the certified treatment facility, baseline vital signs, including blood pressure, are recorded. The patient then self-administers the nasal spray under the direct supervision of healthcare staff, with each device delivering one spray per nostril.
- Post-treatment: Patients rest comfortably in the clinic while being monitored for at least two hours after administration. During this time, staff regularly check blood pressure and assess for side effects, such as dizziness, dissociation, sedation, or nausea. Once cleared by the healthcare provider and feeling stable, patients can leave with their pre-arranged driver. The treatment schedule typically follows an induction phase of twice-weekly sessions for the first month, then transitions to weekly or every-other-week maintenance sessions based on individual response and physician recommendation.
How Long Does Each Spravato® Session Take?
Each Spravato® treatment session typically lasts approximately 2.5 to 3 hours, from arrival to departure, although the actual time may vary depending on individual response and facility protocols. The nasal spray administration itself is quite brief, usually taking only about 5 minutes for the patient to self-administer the medication under supervision, with a 5-minute rest period between sprays in each nostril.
However, the mandatory observation period is what extends the session length. Federal regulations and the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program require patients to remain at a certified healthcare facility for at least two hours after administration for the purpose of safety monitoring. During this time, healthcare providers check vital signs, particularly blood pressure, and assess for adverse effects such as sedation, dissociation, perceptual disturbances, or other concerning symptoms.
There’s also time needed before administration for check-in procedures and baseline vital signs, as well as time afterward for the final medical clearance before discharge. Patients should plan to block off at least half a day for each treatment session, particularly in the early weeks when appointments are held twice a week. Because patients cannot drive themselves home and may feel tired or mentally foggy after treatment, it’s important to have realistic expectations about the time commitment and to arrange for a responsible adult to provide transportation after each session.
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What Should You Expect During and After Treatment?
Spravato® treatment involves a structured clinical experience with specific protocols during administration and essential considerations for the hours and days that follow, along with particular insurance requirements that patients should understand before beginning therapy.
- During Administration: After checking in and having baseline vital signs recorded, you’ll self-administer the nasal spray under direct medical supervision in a comfortable, quiet setting. The medication may cause an unusual taste or sensation in your throat. Within minutes to an hour after administration, you may experience dissociative effects, such as feelings of detachment from your surroundings, an altered perception of time, or a dreamlike state.
- Immediately After Treatment: Once cleared to leave, you’ll need your pre-arranged driver to take you home, as you cannot operate a vehicle or heavy machinery for the rest of that day. Many patients experience fatigue, mental fog, or a slight sense of unease for several hours after leaving the clinic.
- In the Days and Weeks Following: Some patients notice mood improvements within hours to days after their first dose, though others may take several weeks to experience benefits. Side effects typically become less intense as your body adjusts to the medication over subsequent sessions.
- Insurance Requirements and Coverage Considerations: Spravato® is often costly, and insurance coverage varies significantly. Most insurance plans require prior authorization for Spravato® treatment, and many insurers mandate documentation that you’ve tried and failed at least two different antidepressant medications.
How Is Spravato® Monitored for Safety and Effectiveness?
Spravato® requires comprehensive safety monitoring and effectiveness tracking throughout the entire treatment course due to its unique mechanism of action, potential side effects, and the serious nature of treatment-resistant depression. It is only available through a restricted distribution program called the Spravato® REMS (Risk Evaluation and Mitigation Strategy), which ensures that the medication is administered safely in certified healthcare settings.
Effectiveness is monitored through regular psychiatric assessments using standardized depression rating scales and clinical interviews to track symptom improvement over time. Providers typically evaluate response after the initial induction phase to determine whether patients are experiencing meaningful benefit and whether dose adjustments are needed.
Key Takeaways on Steps in Spravato® Treatment
- This medication is specifically approved for adults with major depressive disorder who haven’t responded to at least two different antidepressants.
- Each session lasts approximately 2.5 to 3 hours, including a mandatory two-hour post-administration monitoring period in a certified healthcare facility.
- Spravato® commonly causes temporary dissociative symptoms, such as feeling detached from one’s body or surroundings, altered perception, and dreamlike states, along with potential dizziness, increased blood pressure, and sedation.
- Most insurance plans require prior authorization with documentation proving treatment-resistant depression, and the approval process can take days to weeks.
- Unlike traditional antidepressants that take weeks to work, some patients experience mood improvements within hours to days after starting Spravato®.
Spravato® treatment for anxiety and other mental health conditions is an innovative therapy that utilizes a nasal spray formulation of esketamine, aimed at those who have not found success with traditional antidepressant medications. The experienced professionals at Moment of Clarity in Southern California will guide you through the steps in Spravato® treatment, ensuring a safe and supportive environment.
If you’re seeking more information about how Spravato® could help you or to schedule a consultation, please reach out to us at 949-625-0564 today.
Resources
- National Library of Medicine – Spravato for Treatment-Resistant Depression: Efficacy and Sexual Side Effect Profile
- Johns Hopkins Medicine – Esketamine for Treatment-Resistant Depression
- Mayo Clinic – Esketamine (nasal route)
