When patients in Flagstaff ask us about SPRAVATO®, the conversation often begins with uncertainty. They may have heard about it in connection with ketamine but are not sure what it is, whether they qualify, or what treatment involves. At Revitalize Ketamine Clinic in Flagstaff, we offer SPRAVATO® treatment as part of our approach to treatment-resistant depression. Better-informed patients can make more grounded decisions about care, and our patient evaluation guide can help you prepare for that conversation.
This guide explains what SPRAVATO® is, what the evidence and FDA labeling support, what treatment looks like in practical terms, and how insurance may factor into access.
What Is SPRAVATO®?
SPRAVATO® is the brand name for esketamine, a nasal spray medication derived from ketamine. It is an NMDA receptor antagonist indicated for adults with treatment-resistant depression, either alone or with an oral antidepressant. It is also indicated, with an oral antidepressant, for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior.
Treatment-resistant depression generally refers to major depression that has not responded adequately to at least two antidepressant trials. People experiencing this pattern may also recognize symptoms such as difficulty functioning, low motivation, or feeling emotionally shut down. Our article on depression paralysis explores one way depression can affect everyday life.
SPRAVATO® is distinct from IV ketamine treatment. IV ketamine for psychiatric conditions is an off-label treatment, while SPRAVATO® is an FDA-approved esketamine product with a specific REMS safety program, dosing structure, and monitoring requirements.
Who May Qualify for SPRAVATO®?
Candidacy for SPRAVATO® at our Flagstaff location is evaluated during an intake consultation. For treatment-resistant depression, clinical and insurance criteria commonly require documentation of inadequate response to at least two oral antidepressants.
The FDA label lists contraindications including aneurysmal vascular disease, arteriovenous malformation, a history of intracerebral hemorrhage, and hypersensitivity to esketamine, ketamine, or product ingredients. Blood pressure, cardiovascular history, psychiatric history, medications, and substance-use history should also be discussed during evaluation.
Results vary by individual. Our goal is to provide an honest assessment of whether SPRAVATO® is appropriate, rather than to place every patient into the same treatment pathway.
How SPRAVATO® Is Administered at Revitalize Flagstaff
SPRAVATO® is self-administered as a nasal spray under the direct observation of a healthcare provider. It is available only through the SPRAVATO® REMS program, which requires treatment in a certified healthcare setting and at least two hours of post-dose monitoring. SPRAVATO® is never dispensed directly to patients for home use.
During monitoring, staff assess for dissociation, sedation, blood-pressure changes, respiratory concerns, and other treatment responses. The current FDA label also advises patients not to drive or operate machinery until the next day after a restful sleep.
For treatment-resistant depression, the labeled schedule is generally twice weekly during weeks one through four, once weekly during weeks five through eight, and then once weekly or every two weeks based on clinical response and tolerability. The specific dose and schedule are individualized. You can learn more about the overall treatment process in our guide on what to expect after a Spravato session.
Insurance Coverage for SPRAVATO®
SPRAVATO® may be reimbursable through insurance for qualifying patients, unlike IV ketamine for psychiatric indications, which is generally self-pay. Coverage depends on your plan, prior authorization requirements, clinical history, and documentation of previous antidepressant trials.
Revitalize’s Arizona access and coverage guide explains current distinctions between IV ketamine, SPRAVATO®, and TMS. Our team can help verify coverage and discuss authorization requirements before treatment begins.
SPRAVATO® Compared to IV Ketamine
Patients often ask how SPRAVATO® compares with IV ketamine. Both are related to ketamine and involve NMDA receptor activity, but they are different medications with different routes of administration, regulatory statuses, monitoring requirements, and coverage profiles.
IV ketamine is administered by infusion and used off-label for psychiatric indications. SPRAVATO® is administered intranasally under the REMS program and is FDA-approved for treatment-resistant depression in adults. There is no universal answer to which option is best. Clinical history, prior treatment response, safety considerations, access, insurance coverage, and patient preferences all matter.
TMS as Another Depression Treatment Option
TMS therapy is another non-medication treatment option that may be considered for an appropriately diagnosed depressive condition. TMS is FDA-cleared for major depressive disorder and may be covered by insurance for patients who meet plan-specific criteria.
TMS, SPRAVATO®, medication management, psychotherapy, and other approaches should be considered as part of an individualized treatment plan. Whether one option, or more than one, is appropriate depends on the person’s clinical history and provider assessment.
The Dissociative Experience: What to Expect
One common concern is uncertainty about dissociation. SPRAVATO® can cause altered perceptions, changes in attention or time perception, dizziness, sedation, nausea, and temporary blood-pressure increases. These effects are part of why monitored, in-clinic administration is required.
We prepare patients for the treatment experience in advance and remain available throughout the observation period to answer questions and provide support. Transportation planning is important because patients cannot drive themselves home after treatment.
Frequently Asked Questions
Is SPRAVATO® the same as ketamine infusions?
No. SPRAVATO® is esketamine nasal spray administered under a REMS monitoring program. IV ketamine is administered by infusion and is used off-label for psychiatric indications. Both are ketamine-related treatments, but they differ in formulation, delivery method, monitoring, regulatory status, and insurance coverage.
How long before SPRAVATO® starts working?
Some patients may notice changes in depressive symptoms early in treatment, but response varies. The FDA labeling recommends evaluating therapeutic benefit at the end of the four-week induction phase to determine whether ongoing treatment is appropriate.
Does SPRAVATO® need to be combined with an oral antidepressant?
For treatment-resistant depression, current FDA labeling allows SPRAVATO® as monotherapy or in combination with an oral antidepressant. For depressive symptoms in major depressive disorder with acute suicidal ideation or behavior, SPRAVATO® must be used with an oral antidepressant.
What are the most important risks of SPRAVATO®?
The boxed warning addresses sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors associated with antidepressant treatment. Blood-pressure increases, dizziness, nausea, and impaired ability to drive are also important considerations.
Will my insurance cover SPRAVATO®?
Coverage depends on your insurer, plan, clinical criteria, and prior-authorization requirements. Our team can help verify benefits before treatment begins. Review our ketamine access and coverage guide for more information.
Key Takeaways
- SPRAVATO® is FDA-approved for treatment-resistant depression in adults, either alone or with an oral antidepressant.
- It is also indicated with an oral antidepressant for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior.
- SPRAVATO® must be administered in a certified healthcare setting with direct observation and at least two hours of monitoring.
- Insurance coverage may be available for qualifying patients, but verification and prior authorization requirements vary.
- IV ketamine, SPRAVATO®, TMS, and psychotherapy are different options that should be evaluated individually.
If you have tried multiple antidepressants without adequate relief, SPRAVATO® may be one potential treatment option to discuss with a qualified provider. At Revitalize Ketamine Clinic, we provide information about the clinical, practical, and financial factors involved so you can make an informed decision about your next step. Schedule a SPRAVATO® consultation with our team today. We also serve Northern Arizona patients through our Sedona location at 928-325-2323 and Prescott Valley location at 928-493-8222.
References
Daly, E. J., Trivedi, M. H., Janik, A., Li, H., Zhang, Y., Li, X., Lane, R., Lim, P., Duca, A. R., Hough, D., Thase, M. E., Zajecka, J., Winokur, A., Divacka, I., Fagiolini, A., Cubała, W. J., Bitter, I., Blier, P., Shelton, R. C., … Singh, J. B. (2019). Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: A randomized clinical trial. JAMA Psychiatry, 76(9), 893–903. https://pubmed.ncbi.nlm.nih.gov/31166571/
Janssen Pharmaceuticals, Inc. (2025). SPRAVATO® (esketamine) nasal spray: Prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211243s016lbl.pdf
SPRAVATO® REMS. (n.d.). SPRAVATO® REMS program requirements. https://www.spravatorems.com/
Medical Disclaimer: The information in this blog is for educational purposes only and does not constitute medical advice. Ketamine therapy, TMS, SPRAVATO®, and medication management should only be pursued under the supervision of a licensed provider familiar with your full medical and psychiatric history. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide & Crisis Lifeline or go to your nearest emergency room.