Depressive symptoms are often treated with a combination of medications, such as SSRIs and SNRIs, and therapy, such as cognitive behavioral therapy, dialectic behavioral therapy, and psychodynamic therapy. But these treatments don’t work on everyone, especially those with severe cases. In these instances, Spravato treatment may be the ideal solution.
Spravato treatment is a nasal spray approved by the FDA for adults with treatment-resistant depression (TRD), a condition diagnosed in 30% of patients with depression, and major depressive disorder (MDD). The prescription medicine offers a mitigation strategy for patients who have not responded adequately to at least two oral antidepressants.
What is Spravato?
Spravato is a nasal spray containing esketamine, a derivative of ketamine. Unlike traditional antidepressants that act on serotonin or dopamine, Spravato targets the glutamate system in the brain, which plays a critical role in mood regulation and neural connectivity.
The medication has been shown to reduce depression symptoms in clinical trials. According to a 2026 study of patients, it decreased depression after four weeks, with effects sustained after 16 weeks.
How Does Spravato Work?
Spravato impacts several brain mechanisms to treat depressive symptoms, as follows:
- It blocks NDMA receptors, leading to the rapid release of glutamate in the brain, a chemical involved in mood and thinking.
- Boosts neuroplasticity in the brain, strengthening synapses that are inactive in depression.
- Starts changing circuits in hours to days, producing faster results than typical medications.
Eligibility Criteria
You may be eligible for Spravato if you;
- Are 18 or over
- Have tried at least two antidepressant medicines without effective results
- Have been diagnosed with major depressive disorder with suicidal thoughts
Treatment Administration and Schedule
Spravato is administered in outpatient healthcare settings. The dose treatment schedule are as follows:
Induction Phase ( first 1-4 weeks)
- Schedule: 2 times per week
- Dose: Starts at 56mg and may increase to 84mg after first dose
Maintenance Phase 1 (5-8 weeks)
- Schedule: Once a week
- dose: 56mg or 84mg
Maintenance Phase 2 (9 weeks and beyond)
- Schedule: Once every two weeks (although some may continue on the once-a-week schedule)
- dose: 56mg or 84mg
This table lays out the treatment and administration schedule, making it easy to understand:
| Phase | Timeframe | Visit Frequency | Dose |
| Induction | Weeks 1-4 | 2 times per week | First dose: 56mg, may increase to 84mg |
| Maintenance 1 | Weeks 5-8 | Once a week | 56mg or 84mg |
| Maintenace 2 | 9 Weeks and beyond | Once every two weeks (sometimes once a week) | 56mg or 84mg |
Safety Considerations and Side Effects
The nasal spray can cause side effects such as:
- Dizziness, light-headedness
- Nausea and vomiting
- Increased blood pressure
- Sudden severe headache
- Anxiety
- Altered taste or numbness in mouth
- Dissassocitaion Drowsiness/sedation
- Feeling drunk or high
More serious but less common risks include severe blood pressure spikes, worsening suicidal thoughts, and severe dissaciation.
The medication is not recommended for anyone with a history of severe brain injury and may be unsafe for people with heart conditions, high blood pressure, severe mental illnesses, and those who are pregnant or breastfeeding.
Important Precautions
The following safety precautions will minimize risks:
- Arrange transportation to and from facility. It is dangerous to drive after esketamine nasal spray treatment.
- Avoid driving, using recreational drugs, and sedatives for at least 24 hours after treatment.
- Be honest about any medical conditions that may cause side effects or reactions. If you experience side effects or reactions, report them to a healthcare provider immediately.
Risk of Dependence and Abuse
Spravato is a ketamine derivative and, therefore, carries a risk of physical and psychological dependence. however, substance abuse risks are typically controlled as the medication is administered in healthcare settings certified for medical care. Home use is not allowed.
A healthcare provider determines an acceptable dose to ensure safe and appropriate use.
Support System
A strong support system plays a key role in the administration of Spravato. A caregiver or family member should accompany patients to treatment and assist with post-treatment monitoring, given possible side effects and restrictions on activities such as driving.
BNI Clinics’ Approach to Treatment-Resistant Depression (TRD)
BNI understands the challenges of fighting depression symptoms and other serious mental illnesses. Our certified treatment center takes a holistic approach and can use medications in treatment-resistant cases. We help teens achieve a higher quality of life and a brighter future.
Contact us to learn more about our comprehensive services.
FAQs
How is Spravato different from other antidepressants?
Spravato is different from other antidepressant because it works on the brain’s glutamate system rather than serotonin receptors, leading to faster results. It is also taken only in outpatient settings, and is not made for home use.
Do I still need to take an oral antidepressant?
Yes, you will still need to take an oral antidepressant alongside Spravato. It is an add-on treatment.
What does a Spravato session feel like?
Shortly after a Spravato session, you may feel drowsiness, dissociation, and changes in your perception of time, sound, and space, due to its effects on the central nervous system. These effects will typically fade in 90 minutes to two hours.
How fast does it work?
Most patients treated with Spravato notice improvement in hours to days. It works much faster than traditional antidepressants.
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General Clinic FAQs
What conditions do BNI Clinics treat?
BNI Clinics evaluate and treat a wide range of neurological and mental health conditions, including anxiety, depression, ADHD, PTSD, memory issues, migraines, sleep disorders, and brain-related performance concerns. Each patient receives a personalized care plan from licensed clinicians.
Who will be assessing or treating me?
All assessments and treatments at BNI Clinics are carried out by qualified, licensed healthcare professionals, including neurologists, psychiatrists, psychologists, and certified therapists. Our team follows evidence-based guidelines and continues to undergo ongoing clinical training.
How does BNI diagnose brain-related conditions?
Diagnosis is done through a structured, clinical process that may include a physical exam, neurological evaluation, mental health screening, cognitive testing, and, when appropriate, advanced diagnostic tools. We use validated, research-backed methods aligned with global clinical standards.
Do I need a referral to visit BNI Clinics?
Most patients do not need a referral. You may schedule an appointment directly. However, some insurance plans may have referral requirements, and our team can guide you based on your coverage.
What happens during my first visit?
Your first appointment includes a detailed consultation with a clinician to review your symptoms, medical history, lifestyle factors, and goals. You will receive a clear explanation of any recommended tests, next steps, and treatment options.
Are the treatments at BNI Clinics evidence-based?
Yes. All therapies, medications, and clinical protocols offered at BNI Clinics follow evidence-based standards, supported by current research, clinical guidelines, and real-world patient outcomes.
Can BNI help if I have already tried treatments elsewhere?
Many patients come to BNI Clinics after trying other providers or treatment options. Our multidisciplinary team can review your past records, reassess your condition, and offer a more comprehensive or targeted care plan.
How long does treatment usually take?
Treatment duration varies based on the condition and severity. Some patients see improvement within weeks, while chronic or complex cases may require longer monitoring. Your clinician will outline a realistic timeline during your consultation.
Is my information kept confidential?
Yes. We follow all required medical privacy regulations, including HIPAA (if US-based). Your personal and medical information is securely stored and never shared without your consent.
Do BNI Clinics support ongoing care and follow-ups?
Yes. After your initial diagnosis and treatment plan, our clinicians schedule regular follow-ups to track progress, adjust treatment, and ensure long-term wellness.
