FDA-APPROVED TREATMENT FOR TREATMENT-RESISTANT DEPRESSION
Spravato® is a prescription nasal spray containing esketamine. For appropriately selected patients, it provides an important option for treatment-resistant depression.
At CNY Psychiatry, Spravato treatment involves more than administering medication and observing a patient afterward.
Every Spravato treatment includes psychiatric assessment.
Spravato is administered within psychiatric care, not in place of it.
PSYCHIATRIC CARE AT EVERY TREATMENT
The Spravato REMS program requires treatment in a certified healthcare setting under direct observation followed by monitoring for at least two hours.
At CNY Psychiatry, those requirements are the minimum safety framework, not the entirety of the treatment visit.
We assess symptoms, functioning, durability of improvement, side effects, medication changes, and new psychiatric or medical concerns. The objective is not simply to complete the observation period. It is to provide ongoing psychiatric treatment.
WHAT IS SPRAVATO?
Spravato contains esketamine, the S-enantiomer of ketamine. It is self-administered as a nasal spray under direct healthcare-provider observation and is not taken home.
WHAT DOES THE EVIDENCE SAY?
Spravato has been evaluated in randomized controlled trials and longer-term studies involving adults with treatment-resistant depression.
For treatment-resistant depression in adults, Spravato may be used as monotherapy or with an oral antidepressant. It also has an indication, in conjunction with an oral antidepressant, for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior.
WHO MAY BE A CANDIDATE?
Candidacy considers diagnosis, previous antidepressant treatment, psychotherapy, medical history, current medications, substance-use history, previous ketamine/Spravato/TMS treatment, safety, functional impairment, preferences, and goals.
WHAT DOES TREATMENT INVOLVE?
Patients self-administer Spravato under direct observation and remain under observation for at least two hours. Monitoring addresses sedation, dissociation, respiratory depression, vital signs, and other clinically important effects.
At CNY Psychiatry, the visit also includes psychiatric assessment of response, progress, and ongoing treatment needs.
Transportation
Patients cannot drive themselves home after a Spravato treatment. Arrange for a caregiver or family member to drive you home. Do not drive or operate machinery until the next day after a restful sleep.
WHAT DOES SPRAVATO FEEL LIKE?
Some patients experience relaxation, perceptual changes, dissociation, altered time perception, dizziness, sleepiness, nausea, or anxiety. These effects generally diminish during observation.
We do not consider a more intense subjective experience to mean that treatment is working better.
TREATMENT SCHEDULE
For treatment-resistant depression, treatment commonly begins twice weekly during the initial four-week induction phase, followed by less frequent treatment. During longer-term care, frequency is individualized to the least frequent dosing needed to maintain response or remission.
HOW DO WE DETERMINE WHETHER IT IS WORKING?
We use standardized symptom measurement together with psychiatric assessment. Improvement should ultimately be visible in the patient’s life: functioning, activities, relationships, motivation, and future planning.
WHAT HAPPENS AFTER IMPROVEMENT?
For some patients, continued Spravato maintenance is appropriate. Frequency can be adjusted according to durability of response and clinical circumstances.
Spravato should support recovery. It should not become the entirety of recovery.
INSURANCE AND PRIOR AUTHORIZATION
Spravato may be covered by health insurance when eligibility and medical-necessity requirements are met. Our staff works with patients to review benefits and obtain prior authorization when required.
Insurance authorization is not the same thing as clinical appropriateness. The first decision is whether Spravato makes sense medically.
OUR CLINICAL PERSPECTIVE
A two-hour observation period ensures appropriate safety monitoring. It does not, by itself, constitute psychiatric care.
At CNY Psychiatry, every treatment is an opportunity to assess whether symptoms are improving, function is returning, benefit is lasting, adverse effects are emerging, and the plan still makes sense. Procedures don’t replace psychiatric care. They are delivered within it.
