Spravato® (esketamine) is an FDA-approved nasal spray medication for depression. It is specifically approved for:

• Treatment-resistant depression (TRD) – Recently, the FDA expanded its approval, meaning patients with TRD no longer need to be on another oral antidepressant to receive treatment.

• Major depressive disorder (MDD) with suicidal thoughts or actions – In these cases, Spravato® is still used alongside an oral antidepressant.

Spravato® has been clinically shown to improve depressive symptoms, often within just four weeks.

Unlike traditional antidepressants, which primarily target serotonin, norepinephrine, and dopamine, Spravato® works on the glutamate system, which plays a key role in brain plasticity and mood regulation. By enhancing communication between brain cells, Spravato® helps restore synaptic connections that may be impaired in individuals with depression.

Clinical studies have shown that Spravato® can significantly reduce depressive symptoms within just a few weeks, especially for those with treatment-resistant depression. Many patients begin experiencing improvement as early as 24 hours after the first dose.

Research suggests that untreated depression can cause long-term brain damage and may increase the risk of dementia. Studies indicate that individuals with depression experience up to 20% shrinkage of the hippocampus, a brain region responsible for memory and learning.

Esketamine appears to counteract these harmful effects of depression. Animal studies show that chronic stress weakens connections between brain cells, but esketamine reverses these changes and promotes the growth of new neural connections. This makes Spravato® unique among antidepressants—not only does it prevent depression-related brain damage, but it also has a growth-promoting effect on the brain, fostering resilience and recovery.

Treatment-resistant depression (TRD) occurs when a person’s depressive symptoms persist despite trying multiple antidepressant medications and therapies at adequate doses and durations. Essentially, it means that standard treatments have not effectively alleviated their depression.

• Up to 33% of people with depression do not respond to multiple conventional antidepressants.

• Esketamine (Spravato®) has been shown in clinical trials to reduce depression symptoms in a majority of these individuals.

• The only other FDA-approved drug therapy for TRD is a combination of olanzapine (an antipsychotic) and fluoxetine (a conventional antidepressant). However, this treatment is associated with significant long-term effects such as substantial weight gain, metabolic changes, diabetes, and high blood pressure.

Spravato® offers a new treatment option for TRD that is targeted, fast-acting, and effective for many patients who have not responded to traditional medications.

If you have tried two or more antidepressants without success, you may have treatment-resistant depression (TRD). In that case, Spravato® could be the treatment option you’ve been looking for. A consultation with our team can help determine whether Spravato® is the right fit for you.

Spravato® (esketamine) is a derivative of ketamine, but unlike ketamine infusions, it is FDA-approved for depression treatment. While ketamine is sometimes used off-label for depression, it has not received FDA approval. Both Spravato® and ketamine are Schedule III controlled substances.

Because Spravato® is FDA-approved, it is covered by most insurance plans, while ketamine infusions typically are not.

No — you cannot drive after a Spravato session. Because Spravato (esketamine) can cause dissociation, dizziness, and sedation, the FDA requires that all patients be monitored in-office for at least two hours after each dose and that you arrange for someone to drive you home. You should also avoid operating heavy machinery or making important decisions for the remainder of the day. Plan to have a trusted person available to pick you up after every session — this is a required part of the Spravato REMS (Risk Evaluation and Mitigation Strategy) program.

Spravato (esketamine), TMS, and ketamine are all advanced treatments for depression that NBCG offers, but they work in different ways and suit different patients. Spravato is an FDA-approved nasal spray administered in-office that works on glutamate receptors in the brain — it often produces faster results than TMS and is specifically indicated for treatment-resistant depression and suicidal ideation. TMS uses magnetic pulses to stimulate brain activity non-invasively with no sedation or driving restrictions. Ketamine works similarly to Spravato but is delivered as an infusion. NBCG is one of the few clinics in Utah that offers all three advanced depression treatments, and our providers can help you determine which option is the best fit based on your history, diagnosis, and treatment goals.