Spravato® & Ketamine

Esketamine and ketamine act on NMDA receptors within the brain’s glutamate signaling system, a different target from many conventional antidepressants. The exact way this produces antidepressant effects is not fully understood.

A different approach may offer another option when previous care has not helped enough. Your clinician will balance potential benefit against risks and discuss how treatment fits alongside therapy, medication management, and other support.

Spravato contains esketamine. It is FDA-approved for treatment-resistant depression in adults, either alone or with an oral antidepressant. It is also approved, with an oral antidepressant, for depressive symptoms in adults with major depressive disorder and acute suicidal thoughts or behavior.

Spravato has not been shown to prevent suicide or reduce suicidal thoughts or behavior. It does not replace hospitalization or emergency care when needed. It is not approved for children.

Spravato is administered only in a certified healthcare setting through its restricted REMS safety program. Insurance coverage depends on your benefits and authorization; our team can help verify your options.

Compass of Hope offers private-pay intranasal ketamine under medical supervision. Ketamine is not FDA-approved for depression or any psychiatric condition; this use is off-label. Compounded ketamine is not the same product as Spravato and has not been evaluated by the FDA for safety, effectiveness, or quality before marketing.

Your prescriber will explain why it may or may not be appropriate, discuss alternatives, and review the uncertainties and risks before you decide. Do not use someone else’s medication or treat yourself at home.

1. Start with an evaluation. Discuss your history, previous treatment, current medications, and goals in a psychiatric intake. A consultation does not guarantee eligibility.
2. Agree on a plan. Your prescriber reviews risks, alternatives, treatment frequency, and any insurance requirements with you.
3. Receive in-office treatment. Treatment takes place in a quiet, private suite with clinical supervision, not as a take-home session.
4. Stay for monitoring. Spravato requires at least two hours of observation and a clinical assessment before discharge. Ketamine appointments are also scheduled with supervised monitoring.
5. Review your progress. Treatment frequency and ongoing care are individualized. A typical Spravato course starts twice weekly for four weeks, then weekly for four weeks, followed by an individualized maintenance plan.

Possible effects include sleepiness, dizziness, nausea, a temporary sense of detachment or altered perception, and increased blood pressure. Serious risks include breathing problems and abuse or misuse. Your clinician will screen for relevant heart, blood-vessel, and other medical conditions, pregnancy, and substance-use history.

• Arrange a ride home before treatment
• After Spravato, do not drive or operate machinery until the next day after a restful sleep
• Follow your clinician’s food, drink, and medication instructions
• Tell the team about new symptoms or changes in your health

If you have immediate safety concerns or suicidal thoughts, call or text 988. Call 911 for an emergency. Do not wait for a treatment appointment.

Spravato intake: $400. Self-pay Spravato treatment session: $600. Coverage and medication costs depend on your individual plan and authorization.

Ketamine treatment session: $600; each new medication order: $100. Ketamine is private-pay. Visit Patient Resources for rates and cancellation fees.

Review the FDA Spravato prescribing information, the FDA’s compounded ketamine safety information, and NIMH’s guide to depression.