Spravato® is an FDA-approved esketamine nasal spray for adults with treatment-resistant depression. Ketamine is a related medication whose use for depression is off-label. The main differences include FDA approval, how treatment is administered, monitoring requirements, and insurance coverage.
At Salado Creek Mental Health in San Antonio, Texas, we offer Spravato evaluations and onsite treatment for eligible adults, including evening appointments. Our providers take a personalized approach to depression care, including patients with complex medical needs.
Ketamine vs. Spravato: A Comparison
| Question | Ketamine for depression | Spravato for depression |
|---|---|---|
| What medication is used? | Ketamine | Esketamine |
| Is it FDA-approved for depression? | No. Psychiatric use is off-label. | Yes, for treatment-resistant depression in adults. |
| How is it administered? | May include IV infusions or other formulations | Nasal spray administered under direct supervision |
| Where does treatment occur? | Depends on the formulation and provider | A healthcare setting certified through the Spravato REMS program |
| What monitoring is required? | Protocols vary by treatment and provider | At least two hours of observation after each dose |
| Can insurance cover it? | Coverage must be verified for the specific service | Coverage may be available, subject to eligibility and plan requirements |
Ketamine and esketamine are closely related but are not interchangeable. Standard ketamine contains two mirror-image forms of the molecule; esketamine contains one.
What Is Treatment-Resistant Depression?
Treatment-resistant depression generally means depression has not improved adequately after at least two antidepressant treatments taken at appropriate doses for an adequate length of time.
If previous medications have not helped, a comprehensive psychiatric evaluation can clarify your diagnosis, review your treatment history, and identify appropriate next steps. Your provider should also consider physical health conditions, sleep, medication interactions, and other factors that may affect treatment.
Is Ketamine FDA-Approved for Depression?
No. Ketamine is FDA-approved for anesthesia, but it is not FDA-approved for depression or other psychiatric disorders. Clinicians may prescribe it off-label when they determine that doing so is appropriate.
Off-label treatment and compounded medication are different concepts. Compounded ketamine products are not FDA-approved, and the FDA does not review their safety, effectiveness, or quality before they are marketed. Patients should ask which formulation is being used and how their safety will be monitored.
Is Spravato the Same as Ketamine?
No. Spravato is the brand name for a specific esketamine nasal spray with FDA-approved prescribing instructions and required safety monitoring.
For adults with treatment-resistant depression, Spravato may be prescribed alone or with an oral antidepressant. Compounded ketamine nasal sprays are not equivalent to Spravato.
What Happens During a Spravato Appointment?
You administer the nasal spray under the direct supervision of a healthcare professional. Your care team monitors you during treatment and for at least two hours afterward, until you are safe to leave.
Treatment usually begins with twice-weekly appointments for four weeks, followed by weekly appointments during weeks five through eight. Your provider then individualizes the schedule based on your response and tolerability.
You must arrange transportation home. Do not drive or operate machinery until the next day after a restful sleep.
What Are the Risks of Spravato?
Spravato can cause sedation, dissociation, breathing problems, and increased blood pressure. It also carries risks of abuse and misuse.
A medical evaluation is necessary because some conditions make treatment inappropriate. Discuss your cardiovascular history, current medications, substance use history, and other health concerns with your provider.
Ketamine also carries important risks. The FDA has warned about compounded ketamine for psychiatric treatment, particularly use at home without onsite monitoring.
Is Spravato Better Than IV Ketamine?
Neither treatment is the best choice for everyone. FDA approval does not establish that Spravato is more effective than every IV ketamine protocol.
Your provider should discuss the evidence, medical risks, treatment setting, cost, and follow-up plan. Neither option guarantees improvement, and continued assessment is essential.
Does Insurance Cover Spravato for Depression?
Insurance may cover Spravato for eligible patients with treatment-resistant depression. Coverage can fall under a medical or pharmacy benefit, and prior authorization may be required.
Ask your treatment center to verify coverage for both the medication and the monitoring appointments. Your deductible, copay, and other costs depend on your insurance plan.
Where Can I Get Spravato Treatment in San Antonio?
Salado Creek Mental Health offers onsite Spravato treatment in San Antonio, including evening appointments for eligible adults.
Our psychiatric providers review your previous treatments, symptoms, medical history, and goals to determine whether Spravato may be appropriate. We also provide ongoing psychiatric care for depression and other mental health conditions.
Psychiatric consultations may be available through telehealth throughout Texas. Spravato treatment itself requires an in-person appointment at our clinic.
Schedule a Treatment-Resistant Depression Evaluation
You do not have to navigate persistent depression alone. An evaluation can help you understand your options and develop a plan tailored to your needs.
Call or text Salado Creek Mental Health at 210-405-3008 to schedule an appointment in San Antonio or ask about Spravato treatment and evening availability.
This article is for general education and does not replace personalized medical advice.
