Beyond Standard Antidepressants: A Comprehensive Guide to Spravato Treatment for Treatment-Resistant Depression

Written By Neurobehavioral Center for Growth

If you have tried two, three, or even four different antidepressants without relief, you know the exhaustion that comes with "Treatment-Resistant Depression" (TRD). You aren’t just fighting a mood disorder; you are fighting the discouragement of feeling like nothing works. 

For decades, the standard approach to depression has been the same: target serotonin levels (SSRIs). But for roughly 30% of patients, targeting serotonin isn't enough. 

Enter Spravato (esketamine). 

At NBCG, we are proud to be a Spravato REMS certified center. This guide will explain exactly what this treatment is, the science behind its rapid results, and how it compares to other ketamine therapies we offer. 

What is Spravato? 

Spravato is a prescription nasal spray containing esketamine. It is the first breakthrough in depression treatment in decades because it operates on a completely different system in the brain than pills like Prozac or Zoloft. 

It is currently FDA-approved for adults with: 

  1. Treatment-Resistant Depression (TRD): Depression that has not responded to at least two adequate trials of oral antidepressants. 

  1. Major Depressive Disorder with Suicidal Ideation (MDSI): For patients who need rapid symptom relief. 

The Science: Glutamate and Neuroplasticity 

Standard antidepressants take weeks to build up in your system. Spravato works differently. 

Instead of targeting serotonin, Spravato targets the NMDA receptors in the brain to increase the release of glutamate, the most abundant chemical messenger in the brain. Glutamate is responsible for building connections between neurons. 

Think of depression as a pruning process that causes the connections between your brain cells to wither. Spravato acts like fertilizer. It triggers neuroplasticity, helping your brain rapidly regrow synapses and restore neural pathways. This is why many patients feel relief in hours or days, rather than weeks.  

Why a Nasal Spray? 

You might wonder why such a powerful medication is administered via the nose. 

  • Rapid Absorption: The lining of the nose is rich in blood vessels and close to the brain, allowing the medication to bypass the digestive system and enter the bloodstream quickly. 

  • Non-Invasive: Unlike IV infusions, it does not require a needle stick, making it more approachable for many patients. 

Spravato versus IV/IM Ketamine: What is the Difference? 

At NBCG, we offer both Spravato and IV/IM Ketamine therapy. Patients often ask: "Which one is right for me?" 

Both treatments are derived from ketamine and work on the same brain receptors. However, there are distinct differences in how they are accessed and administered. 

1. FDA Approval & Insurance Coverage 

  • Spravato: FDA approved specifically for depression. This means it is covered by most major insurance plans, including Medicare. This significantly lowers the out-of-pocket cost for patients. 

  • IV/IM Ketamine: While highly effective, generic ketamine is used as an "off label" treatment for depression. Because of this, insurance rarely covers it, and patients must pay the full cost out-of-pocket. 

2. The Molecule 

  • Spravato (Esketamine): Contains only the "S" molecule of the ketamine compound. It is more potent by weight, allowing it to be effective as a nasal spray. 

  • IV Ketamine (Racemic): Contains both the "S" and "R" molecules. It is administered directly into the bloodstream (100% bioavailability). 

If you are looking for a treatment that uses your health insurance benefits, Spravato is the clear choice. If you prefer the precision of intravenous dosing and do not mind paying out-of-pocket, IV Ketamine may be an option we can discuss. 

The Treatment Experience: What to Expect 

Because Spravato is a powerful medication, it cannot be taken at home. It must be administered at a certified medical office under the REMS (Risk Evaluation and Mitigation Strategy) program. 

Here is what a typical session looks like at our clinic: 

  1. Self-Administration: You will comfortably seat yourself in our treatment room. Under our supervision, you will spray the device into your nose. 

  1. The Observation Window: You are required to stay in our clinic for two hours after administration. During this time, you can relax in a recliner, listen to music, or rest. 

  1. Monitoring: Our medical staff will periodically check your blood pressure and pulse oximetry to ensure they remain stable (as Spravato can temporarily increase blood pressure). 

  1. Going Home: You may feel sleepy or experience mild dissociation (a floaty feeling) during the session. Because of this, you cannot drive yourself home. You must have a friend, family member, or ride-service to pick you up. 

Capitalizing on Neuroplasticity: Why Therapy Matters 

While Spravato is a powerful tool to lift the heavy fog of depression, we believe medicine works best when paired with mindset. 

Because Spravato triggers neuroplasticity (the ability of the brain to reorganize itself), it creates a unique "window of opportunity." Think of Spravato as a snowplow clearing a path through a blizzard. It removes the obstacle, but it is up to you to walk down the path. 

To get the most out of this open window, we strongly encourage pairing your treatment with psychotherapy or specialized counseling. 

Why combine them? 

  • Cementing New Patterns: While the medication helps regrow neural connections, therapy (such as CBT or talk therapy) helps determine how those connections are formed. It helps you replace negative thought loops with healthier ones while your brain is in a more flexible state. 

  • Integration: The insights you gain during a Spravato session can be profound. Discussing them with a therapist helps you integrate those insights into your daily life. 

  • At-Home Mindfulness: We also recommend simple practices like journaling, meditation, or breathing exercises on the days between treatments. These small habits help keep stress low and support the healing process initiated by the medication. 

At NBCG, we view Spravato not just as a medication, but as a catalyst for the deeper work of healing.  

Frequently Asked Questions 

Does Insurance Cover Spravato? Yes. Because it is FDA-approved, most insurers cover the treatment for patients meeting the criteria. Furthermore, the Spravato withMe savings program can help eligible commercially insured patients pay as little as $10 per treatment for the medication cost. 

How long does treatment last? Spravato is an induction therapy. A typical schedule involves: 

  • Weeks 1-4: Twice a week. 

  • Weeks 5-8: Once a week. 

  • Maintenance: Every 1-2 weeks, individualized based on your response. 

How often will I need maintenance sessions? Once you complete the initial induction phase, your treatment becomes highly personalized based on your overall symptoms and clinical response. 

  • Maintenance Phase: While many patients begin maintenance every 1–2 weeks, this schedule is flexible. 

  • Variable Frequency: Depending on your stability, sessions may eventually be spaced out once every 3 weeks, or as infrequently as once every 6 months. 

  • Clinical Monitoring: Your provider will continually assess your progress to find the "lowest effective frequency" required to keep your depression in remission. 

What are the side effects? The most common side effects are temporary and occur during the 2-hour observation window. They include dissociation (feeling disconnected from your surroundings), dizziness, nausea, or sedation. Most patients find these manageable, and they usually resolve before you leave the clinic. 

____________________________________________________________________________________ 

Additional Resources & Further Reading 

We believe in empowering our patients with as much information as possible. If you would like to explore the science, safety data, and regulatory approvals of Spravato in more depth, we recommend visiting the following trusted sources: 

  • Official Patient Guide: What is Spravato? (Official Website) The manufacturer’s official guide for patients, offering a straightforward overview of the medication, safety information, and the REMS program. 

  • Scientific Research: NIH / PubMed Central Research Article For those interested in the clinical data, this article from the National Institutes of Health (NIH) database provides a deeper look into the efficacy and science of the treatment. 

____________________________________________________________________________________ 

Take the Next Step 

Depression tells you that nothing will get better. The science of Spravato proves that isn't true. By physically helping your brain build new connections, you can break the cycle of resistance. 

Whether you are interested in Spravato vs Ketamine infusion, or simply want to check your insurance benefits, we are here to guide you. 

NBCG Contact Information 

Find Relief from Treatment-Resistant Depression 

At Neurobehavioral Center for Growth, we specialize in advanced psychiatric treatments for those who haven't found relief with standard medication. 

  • Call us to check your insurance eligibility: (801) 806-4799 

Neurobehavioral Center for Growth
Next

Why Do I Feel "Tired but Wired"?