SPRAVATO® for Treatment-Resistant DepressionYou’re not out of options.
FDA-approved esketamine nasal spray in Bellevue, WA
SPRAVATO® is for adults whose depression hasn’t improved with at least two antidepressants. It targets a different brain pathway, and every treatment takes place in our clinic with our team.
- FDA-approved since 2019
- Covered by most insurance
- Certified SPRAVATO® REMS center
- Free insurance verification
What is SPRAVATO®?
SPRAVATO® (esketamine) is an FDA-approved prescription nasal spray for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder who have suicidal thoughts or actions.
First approved in 2019, it offers a different option when other antidepressants have not helped. It is self-administered under medical supervision at our Certified SPRAVATO® REMS center in Bellevue, followed by at least two hours of in-office monitoring.
Read what the video says
“Spravato is the only FDA-approved nasal spray taken with or without an oral antidepressant for adults with treatment-resistant depression. While the exact way that Spravato works in depression is unknown, it acts on glutamate, a chemical messenger in the brain thought to regulate depression.”
A video from Janssen, the maker of SPRAVATO®.
See the Important Safety Information.
How it works
How does SPRAVATO® work differently than an antidepressant?
Most antidepressants adjust serotonin or norepinephrine and can take 4 to 8 weeks to help. SPRAVATO® is thought to work through glutamate, the brain’s most common chemical messenger, by acting on the NMDA receptor. Researchers believe this helps restore connections between brain cells that depression can weaken, which may be why some people notice changes quickly.
That may be why it can help when other antidepressants haven’t, used on its own or alongside an oral antidepressant.
A different target
Esketamine is thought to block NMDA receptors, setting off a glutamate surge instead of slowly adjusting serotonin.
Brain connections rebuild
That signal is thought to encourage new connections (synapses) in mood circuits, supporting neuroplasticity.
Mood can lift sooner
In studies, some adults improved within 24 hours. Regular sessions help hold those gains over time.1
3× more likely to reach remission at week 4 than placebo when used on its own (22.5% vs 7.6%)1, from the clinical trial that led to SPRAVATO®’s 2025 FDA approval as a standalone treatment for adults with treatment-resistant depression. Remission was defined as a MADRS score of 12 or lower. Individual results vary.
Cost & coverage
Is SPRAVATO® covered by insurance? For most people, yes.
Most major plans cover SPRAVATO® for treatment-resistant depression. Plans usually ask for a depression diagnosis and at least two antidepressant trials that didn’t help enough.
We handle the insurance work for you: verifying benefits, submitting prior authorization and coordinating the medication, so you know what’s covered before your first visit. Commercially insured patients may also qualify for the manufacturer’s savings program.
Eligible patients pay as little as$10per treatment*
SPRAVATO® withMeSavings Program
Have commercial insurance? Ask about the savings card.
*For eligible patients with commercial insurance, toward the cost of the SPRAVATO® medication. Not for Medicare, Medicaid or other government insurance. Does not cover the cost of treatment observation. Yearly limits apply, and the offer may change or end. Program details
Plans we work with include
Coverage depends on your plan. We’ll confirm your benefits before you start.
And many other plans. See insurance & billing →
What to expect
What happens during a SPRAVATO® session?
Each visit takes about two to two and a half hours. After a quick blood pressure check, you administer the nasal spray under our team’s supervision. You then relax in a private, comfortable room for at least two hours while a team member checks on you and monitors your blood pressure. Many people listen to music or simply rest.
Arrival
Check in and settle in
Relax in a reclining chair in a private room. We take your blood pressure first.
Start treatment
Administer the spray
A team member guides you through two or three devices, five minutes apart.
First 40 minutes
Rest while it takes effect
Effects like dreaminess or dizziness usually peak now. We recheck your blood pressure.
Up to 2 hours
Relax under supervision
Listen to music, close your eyes or rest. Someone checks on you the whole time.
Discharge
Cleared to go home
A clinician confirms you’re stable and ready to leave. You can’t drive yourself, so plan your ride home ahead of time.
Next morning
Back to your day
After a good night’s sleep, most people resume normal activities, including driving.
Safety
What does SPRAVATO® feel like, and what are the side effects?
Many people feel dreamy, detached or a little floaty for part of the visit. This is called dissociation. It’s expected, it usually peaks in the first 40 minutes and fades well before you leave, and it tends to lessen as treatment goes on.
That’s exactly why SPRAVATO® is only given in certified clinics. We check your blood pressure before and after your dose, and someone is always nearby.
Most common
- Feeling disconnected (dissociation)
- Dizziness or spinning
- Nausea or vomiting
- Sleepiness
- Higher blood pressure
- Numbness, anxiety, feeling drunk
How we keep you safe
- Blood pressure checks before and after
- Private, quiet treatment room
- Trained staff observe the full 2 hours
- You leave only when cleared
- Progress tracked with depression scales
See the full Important Safety Information, including the boxed warning.
Compare your options
SPRAVATO® (esketamine) vs. NeuroStar® Advanced TMS Therapy
Both can help when antidepressants haven’t. We offer SPRAVATO® (esketamine) and NeuroStar® Advanced TMS Therapy, and we’ll help you weigh which fits your life, history and insurance.
| Feature | SPRAVATO® (esketamine) | NeuroStar® Advanced TMS Therapy |
|---|---|---|
| FDA status for depression | Approved (2019) | Cleared (2008) |
| Usually covered by insurance | Yes, most plans | Yes, most plans |
| How it’s given | Self-administered nasal spray in clinic | Magnetic pulses to the scalp |
| Time per visit | About 2 hours, monitored | Under 20 minutes |
| Can drive after | Next day | Yes, right away |
| Visit schedule | 2× a week, tapering to every 1–2 weeks | 3–5× a week for about 7 weeks |
Why Modern Mind & Wellness
Two advanced depression treatments, one care team
We offer both SPRAVATO® and NeuroStar® Advanced TMS Therapy, along with psychiatric evaluation and medication management, all in one place. Your provider will take the time to understand your history and help you choose the treatment that fits you best. Both options are provided by the same team, so your care stays consistent and personal. When appropriate, SPRAVATO® and TMS can also be used safely together, giving you and your provider flexibility to shape a plan that works for you.
Is SPRAVATO® right for me?
Who is a good candidate for SPRAVATO®?
SPRAVATO® is for adults 18 and older. You may be a candidate if:
- You’ve tried at least two antidepressants and still don’t feel well enough
- Side effects made earlier medications hard to stay on
- You want a treatment that works on a different pathway
SPRAVATO® may not be right for you if you have a blood vessel condition such as an aneurysm or arteriovenous malformation, a history of bleeding in the brain, or an allergy to esketamine or ketamine. Uncontrolled high blood pressure, pregnancy and a history of substance use or psychosis also need a careful conversation. Your evaluation covers all of this.
See if SPRAVATO® may be right for you
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Free SPRAVATO® consultation
Request your free consultation
Tell us how to reach you, and our care team will contact you to schedule a free, no-obligation conversation about SPRAVATO®.
- No cost and no commitment
- We verify your insurance for you
- A short conversation by phone or in person
Prefer to talk now? Call (425) 300-9555.
Questions
SPRAVATO® (esketamine) FAQs
Have a question that isn’t here? Call or text us. There’s no wrong question.
Call or text (425) 300-9555SPRAVATO® (esketamine) is an FDA-approved prescription nasal spray for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder who have suicidal thoughts or actions. Unlike most antidepressants, it is thought to act on the brain’s glutamate system, which may help restore brain connections that affect mood and thinking.
SPRAVATO® is usually considered for adults whose depression has not improved after trying at least two oral antidepressants. It is approved for adults with major depressive disorder who had an inadequate response to at least two oral antidepressants. Our psychiatric providers will review your history to see whether it’s a good fit for you.
No. Esketamine is chemically related to ketamine, but it was specifically developed, tested and FDA-approved to treat depression. Unlike ketamine infusion therapy, SPRAVATO® is a nasal spray given only at certified treatment centers under the FDA’s REMS safety program.
Results vary from person to person. In a clinical trial, SPRAVATO® produced a measurable change in depression scores as early as 24 hours after the first dose, and the improvement held through at least four weeks of treatment. Some people respond faster than others.
You give yourself the nasal spray in our private treatment suite while our team supervises, then you rest for at least two hours while we monitor you. Blood pressure is checked before each dose and again about 40 minutes afterward. Because some people feel nauseated, you should avoid eating for at least 2 hours and drinking liquids for 30 minutes before treatment.
Most people start with twice-weekly sessions. The usual schedule is twice weekly for weeks 1 to 4, once weekly for weeks 5 to 8, and then once weekly or every two weeks after that. Frequency is adjusted to the least often needed to maintain your response.
Common side effects include dizziness, nausea, sleepiness and temporary changes in perception. These effects usually ease before you leave the clinic. Our team monitors you for the full observation period to keep you safe and comfortable.
No. Because SPRAVATO® can cause drowsiness, dissociation or dizziness, you cannot drive until the day after treatment. Plan for a friend, family member or rideshare to take you home after each session.
Many commercial plans and Medicare cover SPRAVATO®, usually with prior authorization. Our team verifies benefits and submits the authorization for you. Eligible commercially insured patients may also qualify for the manufacturer’s savings program, which can lower out-of-pocket costs significantly.
Not necessarily. In January 2025, the FDA approved SPRAVATO® as a monotherapy for adults with treatment-resistant depression. Your provider may recommend using it alone or together with an oral antidepressant, depending on your needs.
Free patient guide
Download our free SPRAVATO® patient guide
Our short guide explains SPRAVATO® in plain language, so you can read it at your own pace and share it with someone you trust.
- How SPRAVATO® works and what a visit feels like
- What the first weeks of treatment look like
- How insurance and savings programs work
- Questions to bring to your consultation
Indications & Important Safety Information
WARNING: SEDATION, DISSOCIATION, RESPIRATORY DEPRESSION, ABUSE AND MISUSE; and SUICIDAL THOUGHTS AND BEHAVIORS
SPRAVATO® can cause sedation, dissociation and respiratory depression, so patients are monitored for at least 2 hours after each dose in a certified healthcare setting. It carries a risk of abuse and misuse. Antidepressants may increase suicidal thoughts and behaviors in children, adolescents and young adults; all patients should be monitored for worsening and emergence of suicidal thoughts. SPRAVATO® is available only through a restricted program, the SPRAVATO® REMS.
Read the full Boxed Warning in the Prescribing Information, and the complete Important Safety Information on spravato.com.
Indications. SPRAVATO® is indicated in adults for treatment-resistant depression, as monotherapy or with an oral antidepressant, and for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior, with an oral antidepressant. It is not approved as an anesthetic, and its use for preventing suicide has not been demonstrated.
Do not use if you have an aneurysmal vascular disease or arteriovenous malformation, a history of intracerebral hemorrhage, or hypersensitivity to esketamine, ketamine or any ingredient. Full Prescribing Information and Medication Guide
References
- Johnson & Johnson. SPRAVATO® approved in the U.S. as the first and only monotherapy for adults with treatment-resistant depression. January 21, 2025.
- SPRAVATO® (esketamine) nasal spray Prescribing Information. Janssen Pharmaceuticals.
Medically reviewed by Melissa Mason, PMHNP-BC · Last reviewed October 22, 2026
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