A Breakthrough for Treatment-Resistant Depression
Spravato (esketamine) is an FDA-approved nasal spray for treatment-resistant depression (TRD) and major depressive disorder with suicidal ideation. It works through a different mechanism than traditional antidepressants — targeting glutamate receptors rather than serotonin — and often produces results within hours or days rather than weeks.
For patients who have tried multiple antidepressants without adequate response, Spravato represents a genuinely different treatment pathway with strong clinical evidence behind it.
Spravato vs. Ketamine: What's the Difference?
Spravato (Esketamine)
- • FDA-approved for TRD and MDD with suicidal ideation
- • Nasal spray administered in a certified healthcare setting
- • REMS program requires monitoring post-administration
- • May be covered by insurance with prior authorization
- • Twice-weekly for 4 weeks, then weekly, then biweekly
Ketamine (IV/IM)
- • Off-label use for TRD and PTSD
- • Administered intravenously or intramuscularly
- • Typically 6 infusions over 2–3 weeks
- • Generally not covered by insurance
- • Rapid onset — often within first session
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Book AppointmentFrequently Asked Questions
Patients with treatment-resistant depression (failed 2+ adequate antidepressant trials), or major depressive disorder with active suicidal ideation. Dr. Agresti will evaluate your history to determine if you are an appropriate candidate.
Spravato is sometimes covered with prior authorization from insurance plans. The coverage requirements vary significantly by plan. Dr. Agresti can help evaluate your coverage and navigate prior authorization.
Some patients notice improvement after the first session. Most see meaningful response within the first 2–3 weeks. This is dramatically faster than traditional antidepressants, which typically require 4–6 weeks.
Common side effects include dissociation, dizziness, nausea, and elevated blood pressure — typically occurring during and shortly after administration and resolving within 2 hours. This is why the REMS program requires monitoring for at least 2 hours post-dose.
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