Spravato is the brand name for esketamine, an FDA-approved nasal-spray treatment for treatment-resistant depression. It's not a take-home prescription and it's not a daily pill. It's an appointment, and knowing how that appointment actually runs takes most of the fear out of it.
What it is, in one paragraph
Esketamine works on the glutamate system in the brain, a different mechanism than the serotonin-focused antidepressants most people try first. It's given as a nasal spray in a certified medical setting, alongside an oral antidepressant, for people whose depression hasn't responded to other medications. For some people, relief can come faster than it does with a traditional pill, in days to weeks rather than months, though it doesn't work for everyone.
Walking through an appointment
The specifics vary by clinic, but the shape is consistent:
- You self-administer the spray under supervision. Staff show you how; you do it yourself.
- You're monitored for about two hours afterward. This is the part that makes it an in-clinic treatment. Esketamine can briefly raise blood pressure and change perception, so a clinician keeps an eye on you until those effects settle.
- You settle into a chair. Many people bring headphones, music, or an eye mask. Some feel floaty, dreamy, or a little detached during the session. That usually fades before you leave.
- You don't drive yourself home. Because of the lingering effects, you arrange a ride for the rest of the day.
What the schedule looks like
Treatment typically starts more frequently and then spaces out over time as things stabilize, guided by how you respond. Your clinician sets the actual cadence. This is a course of treatment, not a single visit.
Is it covered by insurance?
Esketamine is covered by many insurance plans when medical criteria are met, and coverage has broadened in recent years. In Missouri that includes many people on MO HealthNet, the state Medicaid program. Because it depends on your specific plan and situation, the honest move is to confirm details directly with the clinic and your insurer rather than assuming it's out of reach.
How it differs from ketamine therapy
Esketamine (Spravato) is a specific FDA-approved product with a defined protocol. "Ketamine therapy" is a broader family that can be given differently and is covered differently. They're related but not interchangeable. We cover the whole landscape on your options after antidepressants.
Where to ask whether esketamine fits you
If you're in St. Charles County or the greater St. Louis area, Brain Recovery Centers is a doctor-supervised clinic that provides FDA-approved esketamine for treatment-resistant depression, covered by most insurance including MO HealthNet. Their short screener will tell you honestly whether you're a candidate, or what to bring to your own doctor if you're not.
See if you qualify →