The Questions I Hear Most Often About Spravato Therapy

When someone reaches the point of asking about Spravato, they've rarely just started their mental health journey.

More often, they've tried therapy, changed medications, adjusted dosages, and waited weeks or months hoping something would finally make a difference. Some have experienced partial relief. Others feel like they've run out of options entirely.

It's understandable why Spravato has become a topic of conversation. As the first FDA-approved esketamine nasal spray for adults with treatment-resistant depression, it represents a different approach from conventional antidepressants. Naturally, that has led to curiosity, and plenty of questions.

At Marpa Minds, these conversations happen every day. While every person's situation is unique, there are a handful of questions that come up more than any others.

What exactly is Spravato?

Spravato is the brand name for esketamine, a prescription nasal spray approved by the U.S. Food and Drug Administration (FDA) for specific forms of depression.

Unlike traditional antidepressants that primarily influence serotonin, Spravato works through a different pathway involving glutamate, one of the brain's most important neurotransmitters. Researchers believe this mechanism may help restore connections between brain cells that can be affected by chronic depression.

Spravato isn't designed to replace every other depression treatment. Instead, it's intended for carefully selected patients who meet specific clinical criteria and receive treatment under medical supervision.

Who is Spravato intended for?

This is probably the most important question.

Spravato is generally considered for adults with treatment-resistant depression, people who haven't achieved adequate improvement after trying at least two different antidepressant medications or for certain patients with major depressive disorder experiencing acute suicidal thoughts or behaviors, depending on the approved indication.

That doesn't automatically mean it's the right choice for everyone.

Before recommending any treatment, experienced clinicians look at much more than a diagnosis. Medical history, previous medications, current symptoms, other health conditions, and personal goals all play an important role in determining whether Spravato is an appropriate option.

How is Spravato different from ketamine therapy?

People often use these terms interchangeably, but they aren't the same.

Spravato contains esketamine, a specific component of ketamine that has gone through the FDA approval process for particular depression-related conditions.

Ketamine therapy may involve intravenous (IV), intramuscular (IM), oral, or other formulations depending on the clinical setting.

Both treatments have similarities, but they differ in how they're administered, the evidence supporting specific uses, regulatory requirements, and treatment protocols.

Rather than asking which treatment is "better," a more useful question is which treatment is most appropriate for a particular individual. That's a decision that should always be made through a comprehensive clinical evaluation.

What happens during a Spravato appointment?

Many people imagine the experience is far more complicated than it actually is.

Treatment begins with a scheduled appointment at a certified treatment center.

After checking in, the medication is self-administered under the supervision of trained medical professionals. Patients then remain in the clinic for observation, typically for around two hours, while the care team monitors blood pressure, response to treatment, and overall well-being.

Some people experience temporary dizziness, dissociation, nausea, or sleepiness. These effects usually lessen before patients leave the clinic.

Because Spravato can temporarily affect alertness and coordination, patients need someone else to drive them home afterward.

Knowing what to expect often makes the entire process feel much less intimidating.

Is Spravato safe?

Safety is another question I hear regularly.

Spravato isn't a treatment people simply pick up at a pharmacy and take at home.

It's available only through the FDA's Risk Evaluation and Mitigation Strategy (REMS) program, which requires treatment to be administered in certified healthcare settings under medical supervision.

This structured process exists to help ensure patient safety while allowing clinicians to monitor for temporary side effects and determine how each individual responds.

Like any medical treatment, Spravato has potential risks and isn't appropriate for everyone. That's why careful screening and ongoing monitoring are essential parts of the treatment process.

Does insurance cover Spravato?

Coverage varies depending on the insurance provider, individual plan, and medical eligibility.

Many commercial insurance plans and Medicare plans may provide coverage for eligible patients, although prior authorization is often required.

One of the first conversations people have with our team involves understanding what their insurance may cover and what financial considerations should be expected before treatment begins.

Having those answers early helps reduce unnecessary stress during an already difficult time.

Why these conversations matter at Marpa Minds

One thing I've learned over the years is that people aren't simply looking for medication.

They're looking for clarity.

By the time someone asks about Spravato, they've usually spent months or even years trying to understand why they still don't feel like themselves. 

That's one of the reasons we built Marpa Minds around a collaborative model of care rather than focusing solely on administering treatment. 

As a mental health clinic in Westchester County and Rockland County, these conversations have become a meaningful part of our work. 

Our clinical team brings together expertise in psychiatry, psychiatric nursing, psychotherapy, and innovative depression treatments so every recommendation is guided by the individual's history, symptoms, and treatment goals. 

Medical Director Dr. Benjamin Medrano is a board-certified psychiatrist whose work focuses on evidence-based psychiatric care, including ketamine-assisted treatments and other emerging approaches for treatment-resistant depression.

The team also includes Amy Della Rocca, PMHNP-BC, whose experience overseeing thousands of ketamine and Spravato treatment sessions provides valuable insight into patient care before, during, and after treatment.

Just as importantly, every recommendation begins with a conversation. Sometimes Spravato is an appropriate option. Sometimes another treatment path makes more sense. The goal is never to fit patients into a particular treatment. It's to understand what gives them the best chance of meaningful improvement. 

One question I wish more people asked

Most people ask,

"Does Spravato work?"

It's an understandable question.

But I think an even better one is,

"Is Spravato the right treatment for me?"

Depression isn't a single disease with a single solution. Two people can have the same diagnosis while responding very differently to the same medication.

The right treatment plan depends on far more than symptoms alone.

That's why comprehensive evaluations matter so much. They help ensure treatment decisions are guided by clinical evidence, individual history, and realistic expectations—not by headlines or social media discussions.

Final thoughts

The growing interest in Spravato reflects something encouraging: people are continuing to look for better answers when traditional treatments haven't provided enough relief.

That doesn't mean Spravato is the answer for everyone.

It does mean more people are learning that depression treatment has evolved, and that conversations with experienced mental health professionals can open doors they may not have realized existed.

Whether someone ultimately pursues Spravato, another treatment approach, or a combination of therapies, asking informed questions is one of the most important steps they can take.

And in my experience, those conversations are often where hope begins.