How to Get Esketamine Nasal Spray: Eligibility, Treatment, and Next Steps

Living with depression that has not improved enough with standard treatment can feel exhausting. You may have tried antidepressant medications, attended therapy, and followed your treatment plan without experiencing the relief you hoped for. If this describes your experience, you may be wondering how to get esketamine nasal spray and whether it could be an appropriate option.

Esketamine nasal spray is available in the United States under the brand name SPRAVATO®. It is a prescription treatment used for specific indications, including treatment-resistant depression in adults. Unlike ordinary nasal sprays, it must be administered in a certified healthcare setting with medical supervision and monitoring.

Family Care Psychiatry helps patients explore psychiatric treatment options and understand the steps involved in pursuing appropriate care.

What Is Esketamine Nasal Spray?

Esketamine is a medication related to ketamine that acts on the brain's glutamate system, including NMDA receptors. SPRAVATO is the brand name for esketamine nasal spray approved by the U.S. Food and Drug Administration (FDA).

The medication differs from many conventional antidepressants because it works through a different mechanism. However, it is not appropriate for everyone, and its effects and risks require careful medical evaluation.

The FDA-approved indications include:

• Treatment-resistant depression (TRD) in adults: SPRAVATO is used with an oral antidepressant for this indication.
• Depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior: SPRAVATO is used with an oral antidepressant in this setting.

SPRAVATO has not been established as a treatment for every type of depression or every psychiatric condition. A qualified clinician must determine whether your diagnosis and treatment history fit an approved indication.

You can learn more about the medication and its clinical use through SPRAVATO treatment at Family Care Psychiatry.

Who May Qualify for Esketamine Nasal Spray?

Eligibility depends on your diagnosis, previous treatments, current symptoms, medical history, and individual risk factors.

1. Adults With Treatment-Resistant Depression

Treatment-resistant depression generally describes depression that has not improved adequately after appropriate treatment attempts. A clinician reviews the medications you have tried, their doses and duration, your response, and any side effects or barriers to treatment.

There is no single self-assessment that can determine whether you qualify for SPRAVATO. Your psychiatrist must review your clinical history and determine whether the treatment is suitable.

2. Adults With Major Depressive Disorder and Acute Suicidal Ideation or Behavior

SPRAVATO also has an FDA-approved indication for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior, when used with an oral antidepressant.

Importantly, the FDA states that SPRAVATO has not been demonstrated to prevent suicide or to reduce suicidal ideation or behavior itself. It does not replace hospitalization when clinically warranted or other necessary safety measures.

If you are experiencing an immediate risk of suicide, seek emergency assistance rather than waiting for a routine treatment appointment.

3. People Who Can Safely Receive Supervised Treatment

Your clinician will assess factors that may increase the risks of treatment. These may include uncontrolled high blood pressure, certain vascular conditions, a history of substance misuse, pregnancy considerations, and medications or medical conditions that affect safety.

SPRAVATO is contraindicated in certain conditions, including aneurysmal vascular disease, arteriovenous malformation, and a history of intracerebral hemorrhage. Your prescriber must review the current prescribing information and your medical history before making a decision.

How to Get Esketamine Nasal Spray: Step by Step

Step 1: Arrange a Psychiatric Evaluation

Start by contacting a qualified psychiatric provider who can evaluate depression and discuss treatment options.

During your appointment, explain your current symptoms, how long they have lasted, and how they affect your daily life. Bring a list of current medications and details about previous antidepressants, therapy, and other treatments.

Be honest about side effects, substance use, medical conditions, and any suicidal thoughts. This information helps your clinician make a safer and more accurate treatment recommendation.

Step 2: Review Your Previous Depression Treatments

Your clinician will assess which treatments you have tried and whether they provided adequate relief.

They may review:

• Previous antidepressant medications and treatment duration
• Symptom changes during treatment
• Side effects or reasons for stopping medication
• Psychotherapy and other treatment approaches
• Relevant medical conditions and current prescriptions

For treatment-resistant depression, the clinician will determine whether your history supports considering SPRAVATO or whether another approach may be more appropriate.

Step 3: Discuss Benefits, Risks, and Alternatives

Before starting treatment, ask your clinician what improvement you might reasonably expect, which side effects require attention, and how the treatment will fit into your overall care plan.

SPRAVATO can cause sedation, dizziness, dissociation, nausea, and temporary changes in blood pressure. More serious risks include respiratory depression and misuse or abuse potential. The medication carries a boxed warning, and its restricted distribution program requires supervised administration.

Your clinician should also explain alternatives, including other medication strategies, psychotherapy, and appropriate treatments for depression that has not responded adequately to initial care.

For further background, read How Does SPRAVATO Work in the Brain? Benefits and Side Effects Explained.

Step 4: Find a Certified Treatment Center

SPRAVATO is not an ordinary prescription nasal spray that you collect and use independently at home.

The treatment must be administered in a healthcare setting certified through the SPRAVATO Risk Evaluation and Mitigation Strategy (REMS) program. The provider supervises administration and monitors you for adverse effects.

When contacting a clinic, ask whether it is certified to administer SPRAVATO, whether its clinicians evaluate treatment-resistant depression, and what the assessment and treatment process involves.

Family Care Psychiatry can discuss psychiatric care options and help you understand whether an evaluation for SPRAVATO may be appropriate.

Step 5: Complete the Required Monitoring

During treatment, a healthcare professional observes you for at least two hours after administration, assessing your recovery and monitoring for adverse effects.

You should arrange transportation home because you must not drive, operate machinery, or perform activities requiring full alertness until the next day after a restful sleep.

Follow the clinic's instructions about food, liquids, medications, transportation, and preparation for each appointment. Your treatment team will explain the dosing schedule and any additional precautions relevant to your circumstances.

Does Insurance Cover Esketamine Nasal Spray?

Coverage varies by insurance provider, plan, diagnosis, and clinical eligibility requirements. Some plans may require prior authorization, documentation of previous treatment attempts, or use of specific treatment centers.

Before beginning treatment, after you meet with the Psychiatrist if Spravato is appropriate for you our Prior Authorization team would investigate the following information for you

• Coverage for SPRAVATO and its administration
• Prior authorization requirements
• Your deductible, copayment, or coinsurance
• Separate charges for psychiatric visits or monitoring

The clinic's billing team may help you understand the documentation your insurer requires. However, coverage and out-of-pocket costs should be confirmed directly with your insurance provider. We also enroll all patients in Spravato with me (program by Spravato manufacturer Johnson and Johnson). This program covers a certain amount of deductible so you do not have to pay that.

Do not assume that medication coverage automatically includes every appointment or administration-related charge.

How Is Esketamine Different From Ketamine?

Esketamine and ketamine are related medications, but their formulations, regulatory status, and clinical uses differ.

SPRAVATO is an FDA-approved esketamine nasal spray with specific indications and a mandatory supervised-administration program. Other ketamine formulations, including intravenous, Intramuscular or oral ketamine used in some psychiatric settings, have different regulatory and clinical considerations. They are also not FDA approved for treatment of depression.

The FDA approval of SPRAVATO does not mean that every ketamine treatment has the same approval, evidence, or safety requirements.

Your psychiatrist can explain which treatments are appropriate for your diagnosis and discuss their benefits, limitations, costs, and risks.

Frequently Asked Questions

Can I buy esketamine nasal spray online?

You cannot obtain SPRAVATO for unsupervised home use through an ordinary online prescription. It must be administered in a certified healthcare setting under the required monitoring program.

Do I need an antidepressant with SPRAVATO?

Recently FDA changed the guidance and approved Spravato without concomitant antidepressant medication however evidence indicates that patients who also take an antidepressant with spravato respond better. Most insurance companies also still require concomitant oral antidepressant medication when receiving Spravato.

How long does SPRAVATO treatment take?

Treatment involves repeated visits rather than a single appointment. The schedule depends on the indication, treatment phase, response, and prescribing clinician's plan.

Can I drive after receiving esketamine nasal spray?

No. You must not drive or operate machinery until the next day after a restful sleep. Arrange transportation home and follow your treatment center's instructions.

Is SPRAVATO suitable for everyone with depression?

No. A psychiatric evaluation is necessary to assess the diagnosis, previous treatments, medical history, contraindications, and potential benefits and risks.

Explore Your Depression Treatment Options

Finding an appropriate treatment can take time, especially when previous approaches have not provided sufficient relief. Esketamine nasal spray may be an option for some adults with depression, but eligibility and safety require individualized assessment.

Family Care Psychiatry can help you understand available psychiatric services, review your treatment history, and discuss the next steps toward appropriate care.

Contact Family Care Psychiatry about SPRAVATO treatment to learn more about the evaluation process and whether this treatment may be suitable for your needs.