Spravato (esketamine) is one of the most significant developments in depression treatment in the past three decades. FDA-approved in 2019 for treatment-resistant depression and in 2020 for depression with active suicidal ideation, it is the first depression treatment with a novel mechanism of action approved by the FDA since the 1980s. At Hamilton Behavioral, we offer Spravato across our New Jersey offices for patients whose depression hasn’t responded to traditional antidepressants.
What Spravato is, and how it’s different from generic ketamine
Spravato is a nasal spray containing esketamine, the S-enantiomer of the anesthetic ketamine. The two terms get used interchangeably online, but they aren’t the same thing for treatment purposes:
- Spravato is FDA-approved for depression, manufactured by Janssen, administered as a nasal spray under medical supervision, and covered by most insurance plans.
- Generic IV or intramuscular ketamine is used off-label for depression at standalone “ketamine clinics.” It is not FDA-approved for depression and is rarely covered by insurance, leaving patients to pay $400–$800 per session out of pocket.
Spravato is the only ketamine-based depression treatment that has been through the full FDA approval process, so insurance plans treat it like any other prescription medication when prior-authorization criteria are met.
Who is a candidate for Spravato?
Spravato is approved for adults with treatment-resistant depression — defined as depression that hasn’t responded adequately to at least two different oral antidepressants — and for adults with major depressive disorder who have active suicidal thoughts or behaviors. Spravato is always prescribed alongside an oral antidepressant, not as a standalone monotherapy.
It is generally not appropriate for patients with uncontrolled high blood pressure, a history of cardiovascular disease, certain forms of psychotic illness, or active substance use disorders. Your psychiatrist will review your full medical history during the initial evaluation.
What a Spravato session actually looks like
Because Spravato can cause sedation, dissociation, and short-term blood pressure changes, the FDA requires it to be administered in a certified treatment center under direct medical supervision. Here’s what to expect:
- Before the session: No food for two hours and no liquids for 30 minutes prior. Don’t take any medications that could cause sedation that morning.
- Self-administration: You spray the medication into each nostril under our staff’s direct supervision. The full dose takes about 10 minutes to administer.
- The two-hour monitoring period: You stay in a quiet treatment room with vital signs monitored at intervals. Most patients describe a 40–90 minute dissociative experience, often feeling distant from their body or surroundings.
- After: You cannot drive yourself home. Plan for someone to pick you up, or arrange a ride.
The treatment schedule is twice a week for the first four weeks (the induction phase), then once a week for weeks five through nine, then every one to two weeks for the maintenance phase. Many patients notice improvement within the first one to two weeks — much faster than the four-to-eight-week onset of traditional antidepressants.
Cost and insurance coverage
Without insurance, Spravato costs roughly $590–$885 per dose, plus the cost of the monitored treatment session. With insurance, most patients pay only their plan’s deductible and copay. Hamilton Behavioral is in-network with most major commercial and Medicare plans that cover Spravato, including Aetna, Horizon Blue Cross Blue Shield of NJ, Cigna, UnitedHealthcare, AmeriHealth NJ, and Medicare.
Janssen, the manufacturer, also runs a patient assistance program called Spravato withMe that can lower out-of-pocket costs for commercially insured patients to as little as $10 per dose. Our office helps eligible patients enroll. Prior authorization is required for all insurance plans; we handle that paperwork for you.
Getting started
The first step is a psychiatric evaluation to determine whether Spravato is appropriate and to begin the prior-authorization process. Call 1-800-883-7556 or visit our contact page to schedule a consultation. You can also learn more about our Spravato program, see all four NJ office locations, or read about our TMS therapy if you’re weighing your treatment-resistant depression options.
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