What Is Spravato (Esketamine)?

Spravato (esketamine) is the first FDA-approved intranasal treatment for treatment-resistant depression — and as of 2025, the first and only FDA-approved therapy that can be used without a daily oral antidepressant. If you have tried two or more antidepressants without lasting relief, Spravato is a nasal spray administered at our San Francisco clinic under clinical supervision that can produce measurable improvement within hours of the first session.

Esketamine is the more potent form of ketamine — a molecule with over 50 years of medical safety data. Unlike traditional antidepressants that target serotonin and can take weeks to work, Spravato targets glutamate, the brain's primary excitatory neurotransmitter, and triggers rapid neuroplasticity — the brain's ability to form new connections and break entrenched patterns. Because Spravato is FDA-approved, it is covered by most major insurance plans for treatment-resistant depression, making it significantly more accessible than IV ketamine, which is used off-label.

At Clarus Health, we offer both Spravato and IV ketamine and will recommend the right fit based on your clinical picture, insurance coverage, and goals.

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How Spravato Works: A New Pathway for Depression

Most antidepressants target the serotonin system and take four to six weeks to work — with no effect at all for a significant portion of patients. Spravato works differently. It blocks NMDA receptors in the brain, triggering neuroplasticity — the formation of new synaptic connections that allow the brain to break out of the rigid patterns that drive treatment-resistant depression. Relief can begin within hours of the first session.

The neuroplastic window Spravato opens is also the optimal time for therapeutic support. Working with a clinician in the 24–48 hours after each session can deepen and extend the gains from treatment, which is why integration therapy is part of how we deliver Spravato care at Clarus Health.

Spravato has been administered to more than 140,000 patients across 77 countries, with nearly six years of real-world safety data.

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Is Spravato FDA-Approved? What the Research Shows

Spravato has received three separate FDA approvals:

• 2019 — Treatment-resistant depression, for adults who have not responded adequately to at least two antidepressants. This was the first new mechanism for depression approved by the FDA since Prozac in 1987.
• 2020 — Major depressive disorder with suicidal ideation, based on evidence showing significant improvement in depressive symptoms within 24 hours of the first dose.
• 2025 — Standalone monotherapy, making Spravato the first and only monotherapy for treatment-resistant depression. Eligible patients no longer need a daily oral antidepressant alongside it.

Across multiple large randomized controlled trials, Spravato has demonstrated rapid and clinically meaningful reductions in depression symptoms within hours of the first dose, maintained over time. Patients who achieve remission and continue treatment experience a 51–70% reduction in relapse risk compared to those who discontinue. In a direct head-to-head comparison against one of the most common alternatives for treatment-resistant depression, Spravato produced significantly higher remission rates at 8 weeks and superior outcomes sustained through 32 weeks.

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What to Expect: Spravato at Our San Francisco Clinic

Because Spravato can cause transient sedation and dissociation, the FDA requires it to be administered and monitored at a certified clinic. Every Spravato session at Clarus Health is supervised by a licensed clinical provider.

1. Holistic intake & insurance verification Your treatment begins with a comprehensive psychiatric evaluation — reviewing mental health history, medications, genetics, and hormones — to confirm eligibility and build your personalized protocol. We verify your insurance coverage before your first session.
2. The Spravato session You self-administer the nasal spray in a private room. Sessions last approximately two hours, during which a licensed clinical provider monitors your blood pressure and wellbeing. Most patients notice a shift within the first one to four sessions — many within 24 hours.
3. Integration support The hours after each session are when the brain is most neuroplastic and receptive to change. Our holistic psychiatry team provides integration therapy during this window to help anchor new insights into lasting change. Medication management is available as needed throughout your treatment.
4. Ongoing monitoring & maintenance Your licensed clinical provider monitors your response throughout the full treatment course — from the twice-weekly induction phase through the weekly and then biweekly maintenance phase — with dosing adjusted based on your response and tolerability.

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What Does Spravato Feel Like? What to Expect at Your First Session

Spravato produces a temporary dissociative state for most patients: a sense of floating, detachment from your surroundings, altered perception of time, or dreamlike thinking. This typically begins within minutes of administration and resolves within the two-hour monitoring period. The intensity varies by patient and session.

This altered state is part of how Spravato works. The neuroplastic shift the medication produces appears connected to this temporary change in perception — the brain becomes more open to forming new patterns. Most patients find the experience manageable, particularly after the first session.

You will not be able to drive after your session and should arrange a ride home. Many patients use the post-session time for journaling or quiet reflection — practices our integration therapy team can guide you through to deepen the therapeutic benefit.

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Spravato Side Effects: What You Should Know

Spravato carries a boxed warning for sedation, dissociation, and abuse potential — which is why it must be administered in a certified clinical setting with clinical oversight, not at home. The most common Spravato side effects are:

• Dissociation — a sense of detachment or unreality, typically resolving within the two-hour monitoring window
• Dizziness and nausea — common during and shortly after the session, managed in real time by your clinical supervisor
• Elevated blood pressure — monitored before and after each session; patients with uncontrolled hypertension may not be eligible
• Sedation and fatigue — most patients feel tired for the remainder of the day after a session
• Headache — reported by some patients, typically mild and short-lived

Across nearly six years of real-world use in over 140,000 patients worldwide, Spravato's safety profile has remained consistent with what was observed in clinical trials — no unexpected long-term safety signals have emerged. One practical advantage over traditional antidepressants: Spravato has a significantly lower incidence of sexual dysfunction — less than 1% of patients, compared to 30–40% with SSRIs.

Spravato is not appropriate for patients with uncontrolled hypertension, aneurysmal vascular disease, a history of psychosis, or active substance use disorder. Our intake evaluation identifies any contraindications before treatment begins.

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How Much Does Spravato Cost? Insurance Coverage in California

Because Spravato is FDA-approved for treatment-resistant depression and major depressive disorder with suicidal ideation, it is covered by most major insurance plans — including Medicare, Medi-Cal, and commercial insurers — for eligible patients. Many patients pay only their standard copay per session once coverage is confirmed.

Without insurance, the per-session cost is significant, which is why we verify your benefits before your first appointment and handle the prior authorization process. You receive a clear out-of-pocket estimate before committing to treatment.

Coverage applies to treatment-resistant depression and MDD with suicidal ideation. For other conditions such as anxiety, PTSD, or ME/CFS, IV ketamine is typically the more appropriate clinical and financial choice. Contact us and we will help you navigate both options.

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Spravato vs IV Ketamine: Which Is Right for You?

Both Spravato and IV ketamine work on the same pathway and produce rapid relief. The right choice depends on your diagnosis, insurance, and goals. At Clarus Health, we offer both and make a personalized recommendation based on your full clinical picture.

• Spravato may be the better fit if you have a primary diagnosis of treatment-resistant depression or MDD with suicidal ideation, your insurance covers it, you prefer to avoid needles, or you want the additional reassurance of an FDA-approved treatment with years of real-world data
• IV ketamine may be the better fit if your condition extends beyond depression — including anxiety, PTSD, chronic pain, or addiction; you want the fastest onset and highest bioavailability; or insurance coverage is not the deciding factor. Research shows IV ketamine produces approximately 10% better depression outcomes and faster time to relief
• Many patients use both — Spravato for insurance-covered maintenance with IV ketamine boosters as needed. Spravato patients at Clarus Health receive discounts on IV treatments

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Spravato Clinic in San Francisco — Begin Your Treatment Today

If you have tried two or more antidepressants without adequate relief — or if you are living with major depressive disorder with suicidal ideation — Spravato at Clarus Health's San Francisco clinic offers a rigorously studied, insurance-covered path forward. We serve patients throughout the San Francisco Bay Area. Contact us to verify your insurance, review your history, and determine whether Spravato or IV ketamine is the right first step.

*Spravato® (esketamine) is FDA-approved for treatment-resistant depression and major depressive disorder with acute suicidal ideation or behavior in adults. As with all medical treatments, Spravato carries risks and benefits that must be discussed with a licensed clinical provider. Spravato is only available through a certified REMS program at approved healthcare settings. Speak with a member of the Clarus Health clinical team to determine if this therapy is right for you. Insurance coverage varies by plan and requires prior authorization; contact us for a benefits verification before your first session.