Spravato Treatment for Depression: What You Need to Know

What Is Spravato?

Spravato (esketamine) is an FDA-approved nasal spray for adults with treatment-resistant depression (TRD) — major depressive disorder that has not responded adequately to at least two different antidepressant medications. Approved in 2019, Spravato represents one of the most significant advances in depression treatment in decades, offering a new mechanism of action for patients who have struggled to find relief through traditional antidepressants.

At My Psychiatrist in Reston and Falls Church, Virginia, we are proud to be a certified Spravato treatment center, bringing this innovative option to patients across Northern Virginia.

How Spravato Works

Traditional antidepressants — SSRIs and SNRIs — work primarily on the serotonin and norepinephrine systems and can take weeks to produce effects. Spravato takes a fundamentally different approach. It targets the glutamate system, the brain's most abundant neurotransmitter, by acting on NMDA receptors. This mechanism is believed to promote rapid synaptogenesis — the formation of new synaptic connections in brain regions affected by depression.

This is why many patients experience improvement in depressive symptoms within hours to days of treatment, compared with the weeks or months required by conventional medications. Research published in the American Journal of Psychiatry has demonstrated that Spravato, used alongside an oral antidepressant, produced statistically significant and clinically meaningful improvements in depression severity.

Who Is a Candidate for Spravato?

Spravato may be appropriate for adults who:

• Have been diagnosed with major depressive disorder
• Have tried at least two different antidepressant medications at adequate doses and durations without sufficient improvement
• Are currently taking an oral antidepressant (Spravato is used as an adjunctive treatment, not a standalone therapy)
• Do not have certain contraindications, including uncontrolled hypertension, aneurysmal vascular disease, or a history of intracerebral hemorrhage

Spravato is also FDA-approved for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior, making it an important option in urgent clinical situations.

What to Expect During Treatment

The Treatment Setting

Because of its potential side effects, Spravato must be administered in a certified healthcare setting under the supervision of a healthcare provider. It cannot be taken at home. At My Psychiatrist, our comfortable treatment rooms provide a calm, supportive environment for your sessions.

The Treatment Process

• Administration: Spravato is a nasal spray that patients self-administer under provider supervision. Each session involves a specific number of sprays, typically completed within a few minutes.
• Monitoring period: After administration, patients are monitored for at least two hours for potential side effects, including sedation, dissociation, dizziness, and blood pressure changes.
• Frequency: Treatment typically begins with twice-weekly sessions for the first month, followed by weekly sessions in the second month, and then weekly or every-other-week maintenance sessions based on clinical response.
• Transportation: Patients must not drive or operate heavy machinery on the day of treatment and should arrange for transportation home after each session.

Common Side Effects

The most common side effects, which typically resolve within one to two hours, include:

• Dissociation (a sense of detachment from surroundings or self)
• Dizziness or vertigo
• Nausea
• Sedation or drowsiness
• Temporary increase in blood pressure
• Altered taste or nasal discomfort

These side effects are generally mild to moderate and resolve with each session. Our providers monitor every patient closely throughout the treatment process.

The Evidence for Spravato

Multiple clinical trials have demonstrated Spravato's efficacy. In a pivotal Phase 3 trial, patients receiving Spravato plus an oral antidepressant showed significantly greater improvement in depressive symptoms compared with those receiving a placebo nasal spray plus an oral antidepressant. Long-term studies have also shown that continued Spravato treatment reduces the risk of relapse in patients who initially responded to therapy.

Spravato Treatment at My Psychiatrist

As a certified Spravato REMS (Risk Evaluation and Mitigation Strategy) center, My Psychiatrist in Reston and Falls Church, Virginia, provides comprehensive Spravato treatment for patients with treatment-resistant depression. Our experienced psychiatrists guide patients through every step of the process — from initial evaluation and insurance authorization to treatment administration and ongoing monitoring.

If you or a loved one has been struggling with depression that has not responded to traditional medications, Spravato may offer the breakthrough you have been waiting for. Contact My Psychiatrist today to learn whether Spravato is right for you.