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Spravato® (Esketamine) Therapy in Weston, FL – FDA-Approved for Treatment-Resistant Depression
FDA-approved nasal spray delivering rapid relief for patients who have not responded to traditional antidepressants.
Treatment Time:~2 hours per session
FDA Approved:Yes (2019)
Results Onset:Within 24 hours
Sessions Needed:Twice weekly initially
When Depression Persists Despite Treatment
Understanding Treatment Resistance
Living with treatment-resistant depression can feel like an endless cycle of hope and disappointment. You may have tried two, three, or more antidepressant medications, each time waiting weeks to see if they would help, only to find your symptoms unchanged or barely improved. The weight of persistent depression affects every aspect of daily life — your energy, your relationships, your ability to work and find joy in activities you once loved. Many patients describe feeling trapped, wondering if anything will ever make a difference.
Spravato (esketamine) nasal spray works through a fundamentally different mechanism than traditional antidepressants. Rather than targeting serotonin or norepinephrine pathways, esketamine acts on the NMDA glutamate receptor system, promoting rapid formation of new neural connections in brain regions affected by depression. Many patients experience noticeable improvement within hours to days rather than the weeks required by oral medications. Used alongside an oral antidepressant, Spravato offers a clinically proven path forward for those who thought they had exhausted their options.
What Is Spravato (Esketamine)?
The Science of Glutamate Modulation
Spravato® (esketamine) is an FDA-approved prescription nasal spray manufactured by Janssen Pharmaceuticals (Johnson & Johnson) for the treatment of treatment-resistant depression (TRD) in adults. First approved in March 2019 for TRD, it received a second indication in August 2020 for major depressive disorder (MDD) with acute suicidal ideation or behavior. Esketamine is the S-enantiomer of ketamine and must be administered in conjunction with an oral antidepressant.
How Spravato Works for Depression
Unlike traditional antidepressants that target serotonin, norepinephrine, or dopamine, esketamine is an NMDA (N-methyl-D-aspartate) receptor antagonist that modulates the glutamate system — the brain's most abundant excitatory neurotransmitter. By temporarily blocking NMDA receptors, esketamine triggers a cascade of neuroplastic changes, increasing brain-derived neurotrophic factor (BDNF) and promoting synaptogenesis — the rapid formation of new synaptic connections in prefrontal and limbic brain regions impaired by chronic depression. In the landmark TRANSFORM-2 trial, patients receiving esketamine plus an oral antidepressant showed statistically significant improvement in depressive symptoms compared to placebo at day 28.
What Happens During Spravato Treatment
Spravato is administered as a nasal spray under the REMS (Risk Evaluation and Mitigation Strategy) program, meaning it can only be given in a certified healthcare setting like Refresh TMS. You self-administer the nasal spray under clinical supervision, then remain in our comfortable monitoring suite for a minimum of two hours while our team monitors your blood pressure and overall response. Most patients describe the experience as deeply relaxing, with mild dissociative effects that resolve within the monitoring period.
Spravato Results and Duration
Many patients report initial mood improvement within 24 hours of their first treatment, though the full therapeutic effect typically builds over the first four weeks of twice-weekly sessions. After the initial induction phase, treatments transition to once weekly and then to once every one to two weeks for ongoing maintenance, allowing sustained relief with less frequent visits.
Treatment Timeline
First Signs
Within 24 hours to a few days
Full Effect
4-8 weeks (induction phase)
Treatment Time
~2 hours per session (including monitoring)
Recovery
No driving day of treatment; resume activities next day
What to Expect During Your SPRAVATO® Treatment
Benefits of Spravato Therapy
Rapid-Acting Depression Relief
- 01
Rapid Onset
Many patients experience mood improvement within 24 hours, unlike weeks with oral antidepressants
- 02
FDA Approved
Rigorously tested and approved through multiple phase III clinical trials for TRD and MDD with suicidal ideation
- 03
Insurance Coverage
Most major insurance plans cover Spravato, unlike IV ketamine which is typically out-of-pocket
- 04
Novel Mechanism
Works through the glutamate/NMDA pathway, offering relief when serotonin-based medications have not
- 05
Non-Invasive Delivery
Self-administered nasal spray eliminates the need for IV lines or injections
- 06
Supervised Safety
Administered in a certified clinical setting with two-hour monitoring for your safety and comfort
Spravato vs. Alternatives
Compare Your Options
| Treatment | Mechanism | Time | Results | Duration | Downtime | Best For |
|---|---|---|---|---|---|---|
| Spravato (Esketamine) | NMDA receptor antagonist | ~2 hours/session | Within 24 hours | Ongoing maintenance | No driving same day | Treatment-resistant depression |
| IV Ketamine Therapy | NMDA receptor antagonist | 40-60 min infusion | Within hours | Requires repeat sessions | No driving same day | TRD, off-label use |
| TMS Therapy | Magnetic brain stimulation | 19-37 min/session | 4-6 weeks | 9-12+ months | None | MDD, OCD, anxiety |
| Antidepressant Medication | Serotonin/norepinephrine modulation | Daily oral pill | 4-8 weeks | Ongoing daily use | None | First-line depression treatment |
Who Is a Good Candidate for Spravato?
Finding Your Path Forward
Spravato is specifically designed for adults whose depression has not adequately responded to conventional antidepressant treatments. Dr. Francis will evaluate your treatment history and current symptoms to determine if Spravato is the right option for you.
Ideal Candidates for Spravato Therapy
- Adults aged 18 and older diagnosed with treatment-resistant depression (failure of at least two adequate antidepressant trials)
- Adults with major depressive disorder experiencing acute suicidal ideation or behavior
- Patients currently taking or willing to start an oral antidepressant (Spravato must be used in combination)
- Individuals in stable enough health to tolerate temporary blood pressure elevation during treatment
- Patients who can arrange transportation home after each session (no driving on treatment days)
Who Should Wait or Avoid Spravato
- Individuals with aneurysmal vascular disease (including intracranial and aortic aneurysms) or arteriovenous malformation
- Patients with a history of intracerebral hemorrhage
- Individuals with known hypersensitivity to esketamine, ketamine, or any excipients
- Patients with conditions where increased blood pressure or intracranial pressure poses a serious risk
- Individuals currently pregnant or breastfeeding
- Patients unable to commit to the required two-hour post-dose monitoring period
Dr. Francis conducts a thorough psychiatric evaluation and medical history review before recommending Spravato to ensure it is safe and appropriate for each patient.
What Happens During Spravato Treatment
Administration
Under Dr. Francis's supervision, you self-administer the Spravato nasal spray device — typically two or three sprays per nostril, five minutes apart.
Monitoring
You relax in our comfortable monitoring suite for a minimum of two hours while our clinical team periodically checks your blood pressure and assesses your response.
Discharge
Once Dr. Francis confirms your vital signs are stable and dissociative effects have resolved, you are discharged with a pre-arranged ride home.
Risks and Side Effects
What to Know
Common Spravato Side Effects
The most frequently reported side effects include dissociation (a temporary feeling of disconnection from surroundings, reported in approximately 40% of patients), dizziness, nausea, sedation, vertigo, decreased sensation, anxiety, increased blood pressure, vomiting, and feeling drunk. These effects typically appear shortly after dosing and resolve within 1.5 to 2 hours during the required monitoring period.
Rare but Serious Complications
Serious adverse events are uncommon but may include significant blood pressure elevation requiring medical intervention (reported in less than 1% of patients), prolonged dissociative episodes, and respiratory depression, particularly if combined with CNS depressants. Spravato carries a Boxed Warning for sedation, dissociation, and potential for abuse and misuse.
Safety and FDA Status
Spravato was approved by the FDA in March 2019 for treatment-resistant depression and in August 2020 for MDD with acute suicidal ideation. It is available exclusively through the REMS program, which requires administration in certified healthcare settings with post-dose monitoring. Dr. Francis's comprehensive psychiatric training and REMS certification ensure that each treatment session is conducted with the highest safety standards.
Spravato Cost in Weston
Pricing and Payment Options
The cost of Spravato treatment in the South Florida area typically ranges from $590 to $885 per dose for the medication itself, depending on whether the 56 mg or 84 mg dose is prescribed. Total session costs, including the required clinical monitoring and facility fee, generally range from $750 to $1,500 per session. However, one of Spravato's significant advantages over IV ketamine is insurance coverage.
Insurance Coverage for Spravato
As an FDA-approved treatment, Spravato is covered by most major insurance plans, including Aetna, Cigna, Blue Cross Blue Shield, UnitedHealthcare, and Medicare. Many patients pay significantly less out-of-pocket than the full session cost once insurance benefits are applied. Our team at Refresh TMS works directly with your insurance provider to verify benefits and obtain prior authorization before your first treatment.
Janssen Savings Program
For commercially insured patients, the Janssen CarePath Savings Program may reduce out-of-pocket costs to as little as $10 per treatment session. Our staff will help determine your eligibility and assist with enrollment.
Exact pricing will be discussed during your consultation based on your individual insurance coverage and treatment plan. Contact Refresh TMS at (754) 216-0840 for a complimentary insurance verification.
Why Choose Refresh TMS for Spravato in Weston
Weston's Trusted Provider
Certified REMS Provider
Fully certified Spravato treatment center meeting all FDA-mandated safety and monitoring protocols
Psychiatric Expertise
Board-certified psychiatrist with 13+ years specializing in treatment-resistant conditions
Spa-Like Environment
Comfortable, calming treatment suites designed to make your monitoring period relaxing and restorative
Comprehensive Care
Integrated approach combining Spravato with medication management and therapy for optimal outcomes
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Frequently Asked Questions About Spravato
Your Questions Answered
01 What is the difference between Spravato and IV ketamine?
Spravato (esketamine) is the FDA-approved S-enantiomer of ketamine delivered as a nasal spray, while IV ketamine is racemic ketamine administered intravenously as an off-label treatment. The key practical difference is that Spravato is typically covered by insurance, whereas IV ketamine generally requires out-of-pocket payment. Both target the NMDA receptor system.
02 How many Spravato treatments will I need?
The standard protocol begins with twice-weekly sessions during a four-week induction phase, followed by once-weekly sessions for four weeks, and then once every one to two weeks for ongoing maintenance. Dr. Francis will adjust the frequency based on your individual response.
03 Is Spravato covered by insurance?
Yes, most major insurance plans cover Spravato as an FDA-approved treatment for treatment-resistant depression. Our team handles insurance verification and prior authorization. The Janssen CarePath Savings Program may further reduce costs for commercially insured patients.
04 Does Spravato treatment hurt?
Spravato is a nasal spray, so there are no needles or IV lines involved. Some patients experience a temporary bitter taste or mild nasal discomfort during administration. The most common sensation during the monitoring period is a feeling of relaxation or mild dissociation, which resolves within two hours.
05 Can I combine Spravato with other treatments?
Spravato must be used alongside an oral antidepressant — it is not approved as a standalone treatment. Many patients at Refresh TMS also benefit from combining Spravato with TMS therapy, individual therapy, or psychiatric medication management for comprehensive mental health care.
06 Why do I need to stay for two hours after treatment?
The FDA requires a minimum two-hour monitoring period after each Spravato dose as part of the REMS program. This ensures any temporary side effects such as dissociation, dizziness, or blood pressure changes are safely managed before you leave. You also cannot drive until the following day.
07 Am I a good candidate for Spravato?
Spravato is FDA-approved for adults with treatment-resistant depression who have not responded to at least two adequate antidepressant trials, or for adults with MDD and acute suicidal ideation. Dr. Francis will conduct a thorough evaluation to determine if Spravato is appropriate for your specific situation.
08 What if I am already doing TMS therapy?
Spravato and TMS therapy work through different mechanisms and can complement each other as part of a comprehensive treatment plan. Dr. Francis can evaluate whether combining these approaches may provide additional benefit for your depression management.
Location17110 Royal Palm Blvd, Suite 1
Weston, FL, 33326
Weston, FL, 33326
Phone(754) 216-0840
Schedule Your Spravato (Esketamine) Therapy Consultation
References
- PubMed (PMID: 31109201) - Popova V, Daly EJ, Trivedi M, et al. TRANSFORM-2 trial demonstrated statistically significant improvement in depressive symptoms with esketamine nasal spray plus oral antidepressant versus placebo in treatment-resistant depression.
- PubMed (PMID: 31166571) - Daly EJ, Trivedi MH, Janik A, et al. Phase 3 randomized withdrawal study showed continued esketamine plus oral antidepressant significantly delayed relapse compared to antidepressant plus placebo in patients with treatment-resistant depression.
- PubMed (PMID: 32412700) - Fu DJ, Ionescu DF, Li X, et al. ASPIRE I trial demonstrated rapid reduction of depressive symptoms with esketamine nasal spray in patients with MDD and active suicidal ideation with intent.
- PubMed (PMID: 32861217) - Ionescu DF, Fu DJ, Qiu X, et al. ASPIRE II trial confirmed rapid and robust reduction of depressive symptoms with esketamine in severely ill patients with MDD and active suicidal ideation.
- PubMed (PMID: 37792613) - Reif A, Bitter I, Engel RR, et al. ESCAPE-TRD trial published in NEJM showed esketamine nasal spray was superior to quetiapine for remission in treatment-resistant depression at week 8 and week 32.
- PubMed (PMID: 32316080) - Wajs E, Aluisio L, Grigoriou SS, et al. SUSTAIN-2 long-term open-label safety study confirmed manageable safety profile of esketamine nasal spray with sustained depression improvements over 12 months.
- FDA - Spravato (esketamine) CIII nasal spray approved March 2019 for treatment-resistant depression; supplemental approval August 2020 for MDD with acute suicidal ideation or behavior.