Spravato® is the first and only FDA-approved nasal spray for treatment-resistant depression — offering a new path to remission for patients who have tried multiple antidepressants without success.
Spravato® (esketamine) is the S-enantiomer of ketamine, developed by Janssen Pharmaceuticals and approved by the FDA in 2019 for two specific indications: treatment-resistant depression (TRD) in adults who have failed at least two adequate antidepressant trials, and major depressive disorder (MDD) with acute suicidal ideation or behavior.
Unlike IV ketamine, Spravato has a defined FDA approval status, an established REMS (Risk Evaluation and Mitigation Strategy) program, and is more consistently covered by insurance. It is always used in combination with an oral antidepressant, not as a standalone treatment.
At Mental Health Associates San Antonio, we are a certified Spravato treatment site. Our clinical team administers the nasal spray in our office and monitors you for the required 2 hours after each session, ensuring safety and comfort throughout your treatment journey.
Am I a Spravato Candidate?We conduct a comprehensive psychiatric evaluation and confirm your diagnosis of treatment-resistant depression. We also initiate insurance authorization — Spravato has defined coverage criteria and our team manages this process on your behalf.
Treatment begins with twice-weekly in-office sessions. You self-administer the nasal spray under clinical supervision, then remain in our office for 2 hours of monitoring. Sessions are typically scheduled in the morning.
Sessions reduce to once weekly during months 2–3, then to every 1–2 weeks for ongoing maintenance. Your provider adjusts the schedule based on your response and stability.
For patients who achieve remission, individualized maintenance dosing is planned collaboratively. We also coordinate with your oral antidepressant management to ensure the most comprehensive care possible.
Both work on the glutamate system and have rapid antidepressant effects. Spravato is FDA-approved specifically for TRD and MDD with suicidality, has defined insurance coverage criteria, and is delivered nasally. IV ketamine uses racemic ketamine administered intravenously — it has more robust evidence and flexibility in dosing but is often not covered by insurance for psychiatric indications. Our team can help you determine which is best for your situation.
Yes — commercial insurance plans (including Aetna, BCBS, Cigna, United Healthcare, and Humana) and Medicare Part D may cover Spravato when criteria are met. TRICARE coverage is reviewed on a case-by-case basis. Our team manages the prior authorization process for you.
No. The REMS program requires that you not drive or operate heavy machinery on the day of your Spravato session. You must arrange for a responsible adult to drive you home after the 2-hour observation period.
Common side effects include dissociation, dizziness, nausea, sedation, and headache — most of which resolve within 1–2 hours. This is why the 2-hour observation period is required. Serious adverse events are rare and managed on-site by our clinical team.
Contact us to schedule an evaluation and find out if Spravato is covered by your insurance.
Mental Health Associates San Antonio is a proud member of Privia Medical Group — a high-performance physician network committed to coordinated, patient-first care across San Antonio and beyond.