TMS Therapy Near Me connects patients with Spravato (esketamine) treatment – an FDA-approved nasal spray therapy for depression that hasn’t responded to traditional antidepressants. If you’ve tried medication after medication and still feel stuck, there is a different path forward.
Spravato represents one of the most significant shifts in depression care in decades. Rather than working slowly on serotonin over weeks, it acts on a different neurochemical pathway – one that can begin easing symptoms in days. Every session happens in a certified, supervised setting designed to keep you safe while your brain does the work of healing.
Spravato is the brand name for esketamine, a nasal spray derived from the ketamine molecule and formulated specifically for therapeutic use. It is FDA-approved for:
Adults with treatment-resistant depression (TRD)
Depressive symptoms in adults with major depressive disorder (MDD) experiencing acute suicidal ideation or behavior
Spravato is administered only in a REMS-certified healthcare setting under medical supervision.
Traditional antidepressants target serotonin, norepinephrine, and dopamine. Spravato works on the glutamate system, the brain’s most abundant neurotransmitter network, by modulating NMDA (N-methyl-D-aspartate) receptors.
Encourages synaptogenesis – the regrowth of connections between neurons that chronic depression erodes
Helps repair neural pathways tied to mood regulation, cognition, and emotional processing
Ketamine and esketamine are chemically related but clinically distinct. Esketamine is one of the two mirror-image molecules that make up ketamine.
Spravato: FDA-approved prescription nasal spray, standardized dosing (56 mg or 84 mg), defined protocol, taken with or without an oral antidepressant, strict medical supervision
Ketamine: Used off-label via IV infusion, oral, or intramuscular routes for depression, anxiety, and chronic pain – more dose flexibility, varying protocols and oversight, typically less insurance support
Both deliver rapid-acting antidepressant effects through similar brain pathways
Spravato addresses several overlapping clinical needs – part of what makes it so valuable for people who feel out of options.
Treatment-Resistant Depression (TRD): Adults who haven’t responded adequately to at least two different oral antidepressants in the current moderate to severe episode
MDD with Acute Suicidal Ideation or Behavior: Rapid reduction of depressive symptoms in adults facing this severe, urgent condition
March 2019: FDA approval for treatment-resistant depression
August 2020: Approval expanded to MDD with acute suicidal ideation or behavior
Approval was supported by rigorous randomized, double-blind trials measuring symptom reduction alongside a continued oral antidepressant
Published trial data show meaningful, rapid symptom improvement in a substantial portion of patients with treatment-resistant depression, with many achieving response or remission during induction and maintaining gains through continued dosing.
Individual outcomes vary based on diagnosis, treatment history, and adherence to the full protocol. Your provider will review realistic expectations and measurement tools before you begin.
Not every patient is a candidate – and honest screening is part of good care. A comprehensive evaluation reviews your medical history, current mental health status, and previous treatment experiences.
Spravato is generally considered for adults who:
Have been diagnosed with major depressive disorder
Have tried two or more antidepressants without adequate relief
Are willing to continue an oral antidepressant during treatment
Can arrange transportation home after each session
Are experiencing acute suicidal thoughts and need a faster-acting option alongside comprehensive care
Spravato may not be appropriate for individuals with:
Allergy or hypersensitivity to esketamine or ketamine
Aneurysmal vascular disease or arteriovenous malformation
History of intracerebral hemorrhage
Uncontrolled hypertension, or heart attack or stroke within the last six months
Pregnancy or breastfeeding, due to potential risks to the fetus or infant
Significant liver impairment
A history of psychosis or substance use disorder (requires careful evaluation)
A full medical and psychiatric history determines eligibility.
Spravato carries a boxed warning regarding potential for abuse and misuse, which is why it is dispensed only through the REMS program and never taken home. Because each dose is administered and observed in a certified clinic, the structure of the program itself is a safeguard. Patients with a history of substance use disorder should discuss this openly during evaluation.
Plan for roughly two to two and a half hours per visit in a quiet, private, low-stimulation room
Staff guide you through administering the nasal spray, then monitor vital signs and well-being
Many patients bring headphones, music, an eye mask, or a book – or simply rest
Avoid food for two hours and liquids for 30 minutes beforehand, and hold off on nasal decongestants
Continue taking your oral antidepressant as prescribed
There are many clinics to choose from – that’s exactly why we exist. TMS Therapy Near Me offers a comprehensive directory of certified Spravato providers, so you’re not guessing your way through one of the most important decisions of your life.
How long does a Spravato session last? Administration takes only a few minutes, but plan for two to two and a half hours onsite for required observation.
How quickly does Spravato work? Some patients notice improvement within 24 hours to a few days; full effect is assessed over the four-week induction phase.
Can I drive myself home? No. Arrange transportation for the remainder of the day after every session, and avoid heavy machinery until the next day.
Do I have to stop my current antidepressant? No – Spravato can be used together with an oral antidepressant.
How should I prepare for a session? Avoid food for two hours and liquids for 30 minutes beforehand, skip nasal decongestants, and take your oral antidepressant as prescribed.
How long will I need treatment? Most courses begin with twice-weekly dosing for four weeks, then taper to weekly or biweekly maintenance based on your response.
Will my insurance cover Spravato? Coverage varies by plan and provider. Our team can help you review your benefits and explore financing options.
Depression can make it feel like you’ve reached the end of your options – but you may have more choices than you realize. If traditional antidepressants haven’t provided the relief you need, Spravato could be an evidence-based treatment worth exploring. Use our directory to find a certified provider near you and take the next step toward personalized, compassionate depression care.
