Spravato (esketamine)
Spravato (Esketamine) in Louisville, KY
Spravato is an FDA-approved esketamine nasal spray for adults with treatment-resistant depression, used together with an oral antidepressant. It is given in our Louisville office and never taken home. You self-administer the spray under supervision and stay with us for monitoring afterward.
What Spravato is
- Spravato (esketamine) nasal spray is FDA-approved for treatment-resistant depression in adults, taken together with an oral antidepressant.
- It is self-administered by the patient under the supervision of a healthcare provider, in a certified healthcare setting. It is never dispensed to take home.
- It is only available through a restricted program called the Spravato REMS (Risk Evaluation and Mitigation Strategy).
- Patients are monitored in our office for at least 2 hours after each dose.
- You cannot drive or operate machinery for the rest of the day after a dose. Arrange a ride home before you come in.
- Sessions start twice weekly and step down over time. The exact schedule is set by your prescriber.
- Also FDA-approved for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior.
- Also FDA-approved for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior.
- It works through a different mechanism than standard antidepressants, which is why it can help some people when several medications have not.
Spravato is esketamine — a related but distinct molecule from ketamine. It is a prescription product with its own approved labelling and its own required safety program.
Who it is for
- Adults who have tried at least two antidepressants at an adequate dose and for an adequate length of time without enough relief.
- Your provider reviews your medication history with you and says plainly whether it is a reasonable option.
- It is not a first-line treatment, and it is not right for everyone.
What a Spravato visit actually looks like
- You self-administer the nasal spray yourself, in our office, under supervision. It is never dispensed for you to take home.
- You stay with us for at least two hours afterward while we monitor your blood pressure and how you are feeling.
- Bring something to do. Most people read or listen to music.
- You cannot drive for the rest of the day. Arrange a ride home before you come in. You can drive the next day after restful sleep.
- No food for two hours before your dose, and no drink for thirty minutes before.
Treatment schedule
- 1
Induction — weeks 1 to 4
Twice weekly in our office. This is the most demanding stretch of the schedule, so plan rides in advance. - 2
Weeks 5 to 8
Once weekly, with the same two-hour monitoring period after each dose. - 3
Maintenance
Weekly or every other week from that point, decided with your provider based on how you have responded.
Safety and the REMS program
- Spravato is available only through a restricted program called a REMS (Risk Evaluation and Mitigation Strategy), because of the risk of sedation, dissociation, and the potential for misuse.
- It can only be given in a certified healthcare setting, and it is never dispensed to take home.
- Common side effects include dissociation, dizziness, nausea, sedation, and raised blood pressure. That is exactly why the monitoring period exists — these usually settle within the two hours you spend with us.
- Tell your provider about any history of high blood pressure, aneurysm, or bleeding in the brain.
Spravato or TMS?
Spravato (esketamine)
- What it is
- Medication — an esketamine nasal spray
- Where
- In our office only, never at home
- Time per visit
- About two hours, including monitoring
- Frequency at first
- Twice weekly for four weeks
- Driving
- You need a ride home; no driving the rest of the day
- Used with
- Taken together with an oral antidepressant
NeuroStar TMS
- What it is
- Magnetic stimulation — no drug involved
- Where
- In our office
- Time per visit
- 19 to 37 minutes per session
- Frequency at first
- Five days a week for four to six weeks
- Driving
- You drive yourself; no sedation
- Used with
- Often continued alongside existing medication
Because we offer both, the decision gets made inside one practice by the provider who already knows your history. You are not sent elsewhere to be assessed. Read about TMS therapy.
Insurance
- Covered by many plans, including Medicare and TRICARE, when their criteria are met — typically after a documented history of medication trials that did not give enough relief.
- We handle the prior authorization and tell you your expected cost before you start.
Coverage depends on your individual plan, so we verify your benefits rather than guessing. See insurance & billing for the plans we work with.
Spravato questions, answered
Is Spravato the same as ketamine?
No. Spravato is esketamine, a related but distinct molecule. It is an FDA-approved prescription nasal spray with its own labelling, its own dosing, and a required safety program. It is not the same product as ketamine infusions, and the two are not interchangeable.
How long does each Spravato appointment take?
Plan on about two hours. You self-administer the nasal spray under supervision, then stay with us for at least two hours while we monitor your blood pressure and how you are feeling. Bring something to do — most people read or listen to music.
Can I drive myself home after Spravato?
No. You cannot drive for the rest of the day after a dose. Arrange a ride home before you come in. You can drive the next day after a restful night of sleep.
Is Spravato covered by insurance in Kentucky?
Many plans cover it, including Medicare and TRICARE, when their criteria are met — typically after a documented history of antidepressant trials that did not give enough relief. Coverage depends on your individual plan. We handle the prior authorization and tell you your expected cost before you start.
Do I keep taking my other antidepressant?
Yes. Spravato is approved for use together with an oral antidepressant, not instead of one. Your prescriber manages both, and no medication change happens without a conversation with you.
How is Spravato different from TMS?
Spravato is a medication given in the office over about two hours per visit, twice weekly at first, and you need a ride home. TMS is magnetic stimulation with no drug, 19 to 37 minutes per session, five days a week for four to six weeks, and you drive yourself. Because we offer both, your provider can compare them against your own history in one visit.
Ask about Spravato
Tell us how to reach you and we will review whether Spravato is a reasonable option, check your benefits, and explain the next step. We respond within one business day — no medical details needed in the request.
Also consider
NeuroStar TMS therapy
TMS is another option for depression that has not responded to medication alone — an FDA-cleared, non-invasive treatment delivered in our office with no drug and no sedation. Because we offer both, you can compare them with the provider who already knows your history.
Read about TMS therapyRequest an appointment
Tell us how to reach you and what you're looking for. We'll confirm your insurance, answer your questions, and find a time that works. No long intake before you hear from a person.
- We respond within one business day.
- Most insurance accepted, including TRICARE and Medicare.
- In-office visits on Newburg Road, plus telehealth.
