---
type: Service
title: Spravato (Esketamine)
description: FDA-approved esketamine nasal spray for treatment-resistant depression, self-administered in-office under supervision with a two-hour monitored observation period.
resource: https://carmahealth.com/services/spravato
tags: [carmahealth, service, spravato, esketamine, treatment-resistant-depression]
timestamp: 2026-07-08T20:00:00Z
---

# Spravato (Esketamine)

## Overview

Spravato (esketamine) at [CARMAhealth](../carmahealth.md) is an FDA-approved nasal spray for [treatment-resistant depression](../conditions/treatment-resistant-depression.md), administered under the supervision of a physician or nurse practitioner. Per the site, it works through the glutamate system rather than serotonin, is always used alongside an oral antidepressant, and is self-administered by the patient in a certified in-office treatment setting followed by a monitored observation period. The site contrasts Spravato with [ketamine therapy](./ketamine-therapy.md) (generic ketamine, IM/IV, off-label, typically not insurance-covered) — Spravato is FDA-approved and covered by most major plans. It may be integrated with [medication management](./medication-management.md) or [TMS therapy](./tms-therapy.md).

## How it works (as described by the provider)

1. **Psychiatric evaluation** — a [psychiatric evaluation](./psychiatric-evaluation.md) of symptoms, medication history, and goals determines whether Spravato is appropriate.
2. **Insurance verification** — CARMAhealth contacts the insurer to verify coverage and obtain prior authorization.
3. **In-office sessions** — the patient self-administers the nasal spray in a private treatment room; the care team monitors blood pressure, heart rate, and well-being for two hours after each dose (an FDA-required REMS monitoring protocol, per the site). Total visit time is approximately two and a half hours. Sessions occur twice weekly during the first month, then taper to weekly or biweekly.
4. **Progress tracking** — the practitioner assesses response after each phase and adjusts the plan; the site states many patients notice meaningful improvement within the first few weeks.

Side effects described by the site: temporary dissociation, dizziness, nausea, sedation, and transient blood pressure increase, typically peaking within 40 minutes and resolving within two hours; patients should not drive until the following day.

## Conditions addressed

- [Treatment-resistant depression](../conditions/treatment-resistant-depression.md) — defined on the page as inadequate response to at least two antidepressants in the current episode
- [Depression](../conditions/depression.md) — specifically major depressive disorder with acute suicidal ideation or behavior (indication expanded in 2020, per the site)

## Availability & locations

An in-office service. The page is framed around the Austin, TX practice ([Austin](../locations/austin-tx.md), [Dripping Springs](../locations/dripping-springs-tx.md)); availability at [Coral Springs, FL](../locations/coral-springs-fl.md): unable to verify from the source pages.

## Insurance & payment

The site states most major insurance plans (including Aetna, BCBS, Cigna, and United Healthcare) cover Spravato for treatment-resistant depression, typically requiring documentation of at least two inadequate antidepressant trials; CARMAhealth handles verification and prior authorization.

## Claims noted

- The site states Spravato received FDA approval in March 2019 for treatment-resistant depression, with the indication expanded in 2020 to major depressive disorder with acute suicidal ideation or behavior, and that it holds FDA Breakthrough Therapy designation.
- The site cites the TRANSFORM-2 trial as showing a statistically significant reduction in depression scores for Spravato plus an oral antidepressant versus antidepressant plus placebo.
- The site cites the SUSTAIN-3 extension study for a long-term remission rate of roughly 50 percent ("nearly half of participants") with continued treatment, and lower relapse rates versus placebo switch.

## Sources

- Canonical page: https://carmahealth.com/services/spravato
- Machine-readable mirror: https://mr.carmahealth.com/services/spravato
- Retrieved 2026-07-08.