FDA-APPROVED DEPRESSION TREATMENT
Spravato® (esketamine) is an FDA-approved nasal medication for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior. Treatment takes place under medical supervision at a REMS-certified healthcare setting, with monitoring for at least two hours after each dose.
Seaside Ketamine provides physician-led Spravato treatment at our Cardiff-by-the-Sea and Newport Beach locations. Insurance may cover treatment for eligible patients, and our team can verify benefits and handle prior authorization before treatment begins.
SPRAVATO
Spravato is the brand name for esketamine, an FDA-approved prescription nasal spray used to treat specific forms of depression in adults.
Esketamine is the S-enantiomer of ketamine. Unlike IV or IM ketamine used for depression, Spravato has specific FDA-approved psychiatric indications and is administered only in a certified healthcare setting under medical supervision.
QUIZ
QUALIFICATION
Spravato is FDA-approved for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior.
Spravato may be considered for adults with major depressive disorder who have not responded adequately to previous antidepressant treatment. For TRD, current FDA labeling allows Spravato to be used either alone or together with an oral antidepressant.
Spravato is also FDA-approved, together with an oral antidepressant, for depressive symptoms in adults with MDD who have acute suicidal ideation or behavior.
Eligibility also depends on medical history, medications, blood pressure, psychiatric history, potential contraindications, and insurance requirements. Seaside Ketamine evaluates each patient individually before treatment.
A DIFFERENT PATHWAY
Quick Answer: Spravato affects the brain’s glutamate system through NMDA receptors, a different pathway from most traditional antidepressants. Its exact antidepressant mechanism is still being studied.
Spravato® (esketamine) works differently from traditional antidepressants by acting on the brain’s glutamate system. Esketamine blocks NMDA receptors, which are receptors involved in glutamate signaling. Glutamate is the brain’s most abundant excitatory neurotransmitter and plays an important role in communication between brain cells.
Traditional antidepressants primarily affect neurotransmitter systems such as serotonin, norepinephrine, or dopamine. Spravato targets a different pathway, which is one reason it may be considered for people with treatment-resistant depression who have not responded adequately to conventional antidepressant medications.
Research suggests that changes in glutamate signaling may influence communication and adaptability within brain networks involved in mood and depression. However, the precise mechanism responsible for Spravato’s antidepressant effects is not fully understood, and it would be inaccurate to say that Spravato simply “repairs” or “rewires” the brain.
YOUR SPRAVATO VISIT
Spravato treatment takes place at Seaside Ketamine under medical supervision. Here’s what you can expect during your visit.
We’ll review how you’re feeling, check your blood pressure, and make sure you’re ready to proceed with treatment.
You’ll self-administer Spravato as a nasal spray under the direct supervision of our medical team.
You’ll relax in a comfortable treatment room while our clinical team monitors your response, blood pressure, respiratory status, and overall well-being for at least two hours.
Before you leave, we’ll make sure you’re clinically stable. You’ll need a designated driver to take you home and should not drive until the following day after a restful sleep.
TREATMENT SCHEDULE
Spravato treatment is generally more frequent when you first begin and becomes less frequent over time.
For treatment-resistant depression, treatment typically begins twice a week. After the initial treatment period, sessions usually transition to once a week and may eventually decrease to weekly or every-other-week maintenance treatment.
There is no single long-term schedule that is right for everyone. Your treatment plan is individualized based on how you respond, how well you tolerate treatment, your clinical needs, and insurance requirements.
Some patients continue maintenance treatment when it is helping them maintain improvement. We regularly reassess your response rather than automatically continuing treatment on a fixed schedule.
INSURANCE & COST
Spravato may be covered by commercial insurance or Medicare for eligible patients, depending on your individual plan and its medical-necessity requirements. Many insurance plans require prior authorization before treatment begins.
At Seaside Ketamine, our team can verify your benefits, determine whether prior authorization is required, and help you understand your expected out-of-pocket costs before starting treatment. Insurance verification does not guarantee coverage or payment.
Many commercial insurance plans provide coverage for Spravato when eligibility and medical-necessity requirements are met. Our team verifies your benefits and helps manage the prior authorization process when required.
Medicare may provide coverage for Spravato when applicable coverage and medical-necessity requirements are met. We can verify your benefits and help you understand your expected financial responsibility.
Many insurance plans require prior authorization for Spravato. Requirements vary by plan and may include documentation of your diagnosis, previous antidepressant treatment, and treatment history. Our team can help manage this process.
If Spravato is not covered by your insurance, or if you prefer to self-pay, we’ll explain your available options before treatment begins. Eligible patients may also qualify for manufacturer savings or assistance programs.
Not sure whether your insurance covers Spravato?
Our team can verify your benefits, explain any prior authorization requirements, and help you understand your estimated costs before treatment begins.
UNDERSTANDING YOUR OPTIONS
Spravato and IV ketamine affect similar brain pathways, but they are different treatments with important differences in FDA approval, administration, insurance coverage, and treatment requirements.
| Feature | Spravato® | IV Ketamine | IM Ketamine |
|---|---|---|---|
| FDA Approval for Depression | Yes | Off-label | Off-label |
| How It's Given | Nasal spray, self-administered under medical supervision | Intravenous infusion | Intramuscular injection |
| Where Treatment Occurs | REMS-certified healthcare setting | Medical clinic | Medical clinic |
| Monitoring | At least 2 hours after treatment | Monitored during treatment and recovery | Monitored during treatment and recovery |
| Insurance Coverage | May be covered for eligible patients | Typically self-pay for mental health treatment | Typically self-pay for mental health treatment |
| FDA-Approved Depression Indications | TRD and depressive symptoms in adults with MDD with acute suicidal ideation or behavior | Not FDA-approved for depression | Not FDA-approved for depression |
| Oral Antidepressant Required? | Not required for TRD; required for the MDD acute suicidal ideation or behavior indication | No | No |
| REMS Program Required? | Yes | No | No |
Not sure which treatment is appropriate? During your consultation, we’ll review your history and explain the differences between Spravato, IV ketamine, and other treatment options available at Seaside Ketamine.
REQUIRED SAFETY PROGRAM
Spravato is available only through a Risk Evaluation and Mitigation Strategy, or REMS, designed to help ensure the medication is administered and monitored safely.
Because Spravato can cause sedation, dissociation, respiratory depression, and has the potential for abuse and misuse, it cannot be prescribed for patients to take home.
Treatment must occur in a certified healthcare setting. Patients administer the medication under medical supervision and remain under observation for at least two hours afterward.
Seaside Ketamine participates in the Spravato REMS program and provides the required medical supervision and monitoring during treatment.
FREQUENTLY ASKED QUESTIONS
Some patients experience improvement relatively early in treatment, while others require multiple treatments before noticing meaningful changes. Response varies from person to person, and not everyone responds to Spravato.
Spravato is generally given as a course of treatment rather than as a single treatment. Treatment is more frequent initially and may become less frequent as treatment continues.
The length of treatment varies based on your response, tolerability, clinical needs, and insurance coverage. Some patients continue maintenance treatment when they are benefiting from it.
Experiences vary. Some people feel relaxed, lightheaded, sleepy, or temporarily disconnected from their surroundings. Changes in perception can also occur.
These effects are one reason Spravato must be administered in a monitored healthcare setting rather than taken at home.
Common side effects can include dissociation, dizziness, nausea, sedation, vertigo, decreased sensation, anxiety, lethargy, increased blood pressure, and feeling intoxicated.
Most treatment-related effects occur during the monitoring period, but individual experiences vary. Our clinical team monitors you throughout your visit.
No. You will need to arrange transportation home after every Spravato treatment.
You should not drive, operate machinery, or perform activities requiring complete mental alertness until the following day after a restful sleep.
For adults with treatment-resistant depression, current FDA labeling allows Spravato to be used either by itself or together with an oral antidepressant.
For depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior, Spravato is used together with an oral antidepressant.
Spravato may be covered for eligible patients, but coverage depends on your insurance plan and whether you meet its medical-necessity requirements.
Our team can verify your benefits and determine whether your plan requires prior authorization before treatment begins.
Medicare may provide coverage for Spravato when applicable coverage and medical-necessity requirements are met. Coverage and patient responsibility can vary.
Our team can verify your benefits before treatment and help explain what your plan indicates it may cover.
An initial denial does not always mean treatment cannot ultimately be covered. Depending on the reason for the denial, additional documentation, clarification of previous treatments, or an appeal may be appropriate.
Our team can help determine why authorization was denied and what options may be available.
Spravato contains esketamine, which is closely related to ketamine but is a distinct medication. Spravato has specific FDA-approved psychiatric indications and must be administered through a REMS-certified healthcare setting.
IV and IM ketamine are used off-label for psychiatric conditions and have different administration, treatment, and insurance considerations.
Spravato is not appropriate for everyone. It is contraindicated in people with certain vascular conditions, including aneurysmal vascular disease or arteriovenous malformation, a history of intracerebral hemorrhage, or hypersensitivity to esketamine, ketamine, or its ingredients.
Other medical conditions, medications, pregnancy considerations, substance-use history, and psychiatric history may also affect whether Spravato is appropriate. This is why we perform a medical evaluation before treatment.
Spravato is a controlled substance and has the potential for abuse and misuse. This is one reason it is administered only under medical supervision through the REMS program rather than prescribed for patients to use at home.
We review substance-use history and other risk factors as part of determining whether treatment is appropriate.
PHYSICIAN-LED CARE
Spravato treatment takes place at Seaside Ketamine under medical supervision. Here’s what you can expect during your visit.
Seaside Ketamine is led by Scott Gillin, MD, a board-certified anesthesiologist and pediatric anesthesiologist with more than 30 years of medical experience.
Dr. Gillin brings experience with more than 3,500 ketamine treatments and a medical background centered on medication safety, physiology, monitoring, and patient care.
Our team helps with benefits verification and prior authorization so you can understand your coverage before beginning treatment.
Spravato treatment is available through Seaside Ketamine in Cardiff-by-the-Sea and Newport Beach.
If depression hasn’t improved enough with previous treatments, Spravato may be an option. Our team can review your treatment history, discuss whether Spravato may be appropriate, and verify your insurance benefits before treatment begins.
