If you have been living with depression that hasn't responded to antidepressants, you may have come across the name Spravato — and wondered whether it could finally be the answer. At Oasis Behavioral Health Center in Norwood, MA, we are a fully REMS- certified Spravato provider, and we believe every patient deserves honest, research- backed information before making a decision about their care. Here is everything you need to know about Spravato, how it works, and whether it might be right for you.
What Is Spravato?
Spravato is the brand name for esketamine, a nasal spray medication approved by the U.S. Food and Drug Administration (FDA) for two specific indications in adults: treatment-resistant depression (TRD) — meaning depression that has not adequately responded to at least two different oral antidepressants — and major depressive disorder (MDD) with acute suicidal ideation or behavior.
In January 2025, the FDA granted Spravato an additional milestone approval as the first and only monotherapy for adults with treatment-resistant depression, meaning it can now be used on its own rather than requiring a concurrent oral antidepressant in all cases. This approval was based on clinical trial data showing significant improvement in depression scores compared to placebo as early as 24 hours after the very first dose.
Spravato is manufactured by Janssen Pharmaceuticals (a Johnson & Johnson company) and has been approved in 77 countries, with more than 140,000 patients treated worldwide.
How Is Spravato Different From Traditional Antidepressants?
Most conventional antidepressants — including SSRIs like Prozac or Zoloft, and SNRIs like Effexor — work by increasing levels of serotonin or norepinephrine in the brain. While effective for many people, these medications do not work for everyone, and they can take 6 to 8 weeks to show results, leaving patients vulnerable during that waiting period.
Spravato works through an entirely different mechanism. It is an NMDA receptor antagonist — it targets glutamate, the brain's most abundant excitatory neurotransmitter. By blocking NMDA receptors, esketamine triggers a surge in glutamate transmission that activates AMPA receptors, increases synaptic activity, and enhances communication between neurons. It also promotes the release of brain- derived neurotrophic factor (BDNF), which supports the growth of new synaptic connections — a process called synaptogenesis and neuroplasticity.
This fundamentally different mechanism is why Spravato can work for patients who have not responded to multiple serotonin-based treatments, and why its effects can be felt so rapidly — often within hours rather than weeks.
What Happens During a Spravato Session?
Spravato is not a medication you take at home. Because of its potential side effects — including temporary sedation and dissociation — it must be administered in a certified healthcare setting under direct medical supervision. At Oasis, every Spravato session takes place in our comfortable, supervised treatment suite.
Here is what a typical session looks like:
- You self-administer the nasal spray under the guidance of our clinical team.
- You remain in our facility for at least two hours of monitoring while any effects — such as dizziness, sedation, or a temporary dissociative feeling — subside.
- A clinician assesses you before you leave to confirm you are stable and ready to go.
- Because of the potential for delayed sedation, you will need someone to drive you home after each session — you cannot drive on the day of treatment.
In terms of scheduling, the standard Spravato protocol begins with twice-weekly sessions for the first four weeks (the induction phase), followed by once-weekly sessions for weeks five and eight, and then a maintenance phase of once-weekly or once every two weeks depending on your response.
Who Is a Good Candidate for Spravato?
Spravato may be right for you if:
- You have been diagnosed with major depressive disorder and have tried at least two different antidepressants at therapeutic doses for at least 8 weeks each without achieving meaningful improvement.
- You are experiencing major depressive disorder with acute suicidal ideation or behavior and need rapid symptom relief.
- You are 18 years of age or older.
- You are willing to commit to in-clinic sessions and the required monitoring period.
Spravato is not recommended during pregnancy. A thorough psychiatric evaluation with one of our physicians will determine whether Spravato is a safe and appropriate option for your individual situation.
Is Spravato Covered by Insurance?
Yes — Spravato is covered by most major insurance plans, including Medicare, Medicaid, Aetna, Cigna, Blue Cross Blue Shield, and United Healthcare, when prior authorization criteria are met. Coverage typically requires documented prior failures of at least two antidepressant medications and a confirmed diagnosis of treatment- resistant depression.
At Oasis Behavioral Health Center, we work with our patients to navigate the prior authorization process and help make treatment as accessible as possible. We accept most major commercial insurance plans in Massachusetts.
What Is the REMS Program?
Because of Spravato's potential for sedation and dissociation, the FDA requires it to be dispensed only through a restricted program called the Risk Evaluation and Mitigation Strategy (REMS). Under this program, only certified healthcare settings enrolled in the REMS program can prescribe and administer Spravato. Oasis Behavioral Health Center is fully REMS-certified, ensuring your treatment meets the highest standards of safety and compliance.
Take the First Step
At Oasis Behavioral Health Center, our board-certified psychiatrists have been delivering advanced, evidence-based mental health care since 2012. If you have struggled with depression that has not responded to medication, Spravato may offer the rapid, meaningful relief you have been searching for.
Call us at (617) 401-7700 or visit obhi.org to schedule your consultation. You deserve to feel better — and we are here to help you get there.
Works Cited
Johnson & Johnson. (2025, January 21). SPRAVATO (esketamine) approved in the U.S. as the first and only monotherapy for adults with treatment-resistant depression.
https://www.jnj.com/media-center/press-releases/spravato-esketamine-approved-in-the-u-s-as-the-first-and-only-monotherapy-for-adults-with-treatment-resistant-depression
Psychiatric Times. (2026, March). Esketamine CIII Nasal Spray: First and Only Monotherapy for Treatment-Resistant Depression.
https://www.psychiatrictimes.com/view/esketamine-ciii-nasal-spray-first-and-only-monotherapy-for-treatment-resistant-depression
Pearl Psychedelic Institute. (2025, December). The Science Behind Spravato Treatment: How Esketamine Targets Treatment-Resistant Depression.
https://www.pearlpsychedelicinstitute.org/post/the-science-behind-spravato-treatment-how-esketamine-targets-treatment-resistant-depression
MindBrain TMS. (2025, January). FDA Approval of Spravato (Esketamine) for Treatment-Resistant Depression: A Psychiatrist's Perspective.
https://mindbraintms.com/depression-treatment-2025/
Janssen Medical Connect. (2025, December). Mechanism of Action of SPRAVATO.
https://www.jnjmedicalconnect.com/products/spravato/medical-content/mechanism-of-action-of-spravato
U.S. Food & Drug Administration. (2025). SPRAVATO (esketamine) Prescribing Information.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211243s019lbl.pdf
UnitedHealthcare. (2025). Spravato (esketamine) Prior Authorization/Medical Necessity Policy.
https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/drugs-pharmacy/commercial/r-z/PA-Med-Nec-Spravato.pdf
Ketamine Therapy for Depression. (2026). Does Insurance Cover Spravato? Coverage Table + Policy Links.
https://ketaminetherapyfordepression.org/does-insurance-cover-spravato/
Next Step Psychiatry. (n.d.). Spravato REMS Program Explained.
https://nextsteppsychiatry.com/spravato-hub/rems-program
