Important: Spravato is always prescribed in conjunction with an oral antidepressant. It is not used as a standalone treatment and must be part of a comprehensive psychiatric care plan under medical supervision.
SPRAVATO® (ESKETAMINE) IN SAN DIEGO, CA
Spravato® (esketamine) is an FDA-approved nasal spray for treatment- resistant depression and major depressive disorder with suicidal ideation. As a REMS-certified provider, Seaside Ketamine in Cardiff-by-the-Sea offers Spravato with full medical supervision, integration support, and the metabolic psychiatry approach that makes lasting change possible.
UNDERSTANDING SPRAVATO
Spravato® is the brand name for esketamine — a purified form of one of ketamine’s two mirror-image molecules (the “S” enantiomer).
The key difference between Spravato and traditional ketamine therapy is regulatory status and formulation: Spravato is the only FDA-approved esketamine product specifically indicated for treatment-resistant depression and major depressive disorder with suicidal ideation.
Spravato is administered as a nasal spray under medical supervision in a REMS-certified clinic, with a required post-administration monitoring period to ensure safety and tolerability.
Spravato is FDA-approved for two specific indications:
You're experiencing major depression with active suicidal thoughts or behaviors. Spravato can be used for rapid reduction of depressive symptoms in this acute situation.
You're experiencing major depression with active suicidal thoughts or behaviors. Spravato can be used for rapid reduction of depressive symptoms in this acute situation.
Important: Spravato is always prescribed in conjunction with an oral antidepressant. It is not used as a standalone treatment and must be part of a comprehensive psychiatric care plan under medical supervision.
One of the most significant advantages of Spravato is insurance coverage. Because it’s FDA-approved for specific psychiatric indications, many commercial insurance plans and Medicare provide coverage for eligible patients. Our team will verify your benefits in advance and review any prior authorization requirements so you understand costs and coverage before starting treatment.
Most major commercial plans cover Spravato after prior authorization. Our team handles the authorization process for you and verifies your benefits before treatment begins.
Medicare Part B covers Spravato treatment. We work with Medicare to ensure coverage and minimize your out-of-pocket costs.
Insurance companies typically require documentation that you've tried two or more antidepressants without adequate response. We manage this entire process on your behalf.
If insurance doesn't cover Spravato, or if you prefer not to use insurance, self-pay options are available. We'll discuss all options during your consultation.
Not sure if your insurance covers Spravato? Call us at (858) 215-2618 and our team will verify your benefits, explain your coverage, and walk you through the next steps.
Twice-weekly sessions. You self-administer the nasal spray under medical guidance, then remain under observation for a minimum of 2 hours. Blood pressure is monitored before treatment, at 40 minutes, and at 2 hours. You cannot drive until the following day.
Sessions reduce to once weekly. Response is evaluated, and the dose may be adjusted (56mg or 84mg) based on your progress and tolerability.
Sessions move to once weekly or once every two weeks based on clinical response. Many patients find a stable maintenance schedule that sustains improvement long-term.
| Feature | Spravato® | IV Ketamine | IM Ketamine |
|---|---|---|---|
| FDA Approval | Yes (TRD, MDSI) | Off-label | Off-label |
| Insurance Coverage | Often covered | Typically self-pay | Typically self-pay |
| Administration | Nasal spray (self-administered) | Intravenous infusion | Intramuscular injection |
| Dose Control | Fixed (56mg or 84mg) | Real-time adjustable | Set per injection |
| Session Time | 2+ hours (required observation) | 45–60 min + recovery | 45–60 min + recovery |
| Frequency (Induction) | Twice weekly for 4 weeks | 6 sessions over 2–3 weeks | 6 sessions over 2–3 weeks |
| Conditions Treated | TRD, MDSI specifically | Broader range | Broader range |
| Requires Concurrent Antidepressant | Yes | No | No |
The best option depends on your specific diagnosis, insurance situation, treatment history, symptom severity, and personal preferences. During your consultation, we’ll review each of these factors carefully and help you determine whether IV ketamine, IM ketamine, or Spravato is the most appropriate and effective path forward.
REMS (Risk Evaluation and Mitigation Strategy) is an FDA-mandated safety program that ensures certain high-risk medications are used safely and effectively under controlled conditions.
Seaside Ketamine is a REMS-certified provider, which means we meet all FDA requirements for training, monitoring, and patient safety when administering Spravato.
This matters because Spravato cannot be prescribed for at-home use. Every session must be administered in a certified clinic with medical supervision and a mandatory observation period to monitor for side effects and ensure patient safety.
A: Specifically, some patients notice relief within 24 hours of their first treatment. However, Spravato builds up over time, and the full starting phase requires 4 weeks of twice-weekly sessions. Consequently, we track your progress at every visit using standard medical scales.
A: Effects usually begin within 15–20 minutes and include relaxation, mild dizziness, and sometimes a feeling of floating. In fact, most patients describe it as milder than IV ketamine. Ultimately, these sensations fully fade away within the 2-hour monitoring window.
A: Spravato is FDA-approved for use specifically with a daily oral depression pill. In other words, it is not a direct replacement for your current meds. Consequently, any treatment changes should be discussed with Dr. Gillin and made slowly and safely.
A: The most common side effects include dissociation, dizziness, nausea, high blood pressure, and sedation. Specifically, these typically occur during the observation period and subsequently resolve before you leave. Fortunately, serious side effects are rare with proper medical monitoring. In addition, we check health status, gut health analysis, and genetic testing when appropriate. Indeed, these aren’t standard screening labs—instead, they’re deep dives into the biological systems that affect brain function.
A: Treatment time varies for everyone. Specifically, some patients use Spravato for several months and then transition off. On the other hand, others benefit from long-term care. At Seaside Ketamine, we combine Spravato with metabolic psychiatry and lifestyle medicine to support lasting healing. Ultimately, our core goal is simply finding the right long-term plan for you.
A: First, our team handles prior approvals and appeals. If insurance coverage is not given at the start, we subsequently work with your health plan. Specifically, our staff will provide the medical records needed to get approval. In addition, we offer simple self-pay options if you need them.
A: No. You must specifically have a designated driver, and you cannot drive until the following day after your session. Crucially, this is a REMS safety requirement that applies simultaneously to all Spravato patients.
Schedule a free 15-minute consultation to determine if you qualify for Spravato — and whether your insurance will cover it.