Spravato Treatment

Find Relief from Treatment-Resistant Depression with Spravato®

Carolina Restorative Health proudly offers Spravato® (esketamine) nasal spray, an FDA-approved treatment for adults living with treatment-resistant depression (TRD). If you’ve tried other antidepressants without success, Spravato may offer a new path forward.

Administered in a clinical setting under medical supervision, Spravato works differently than traditional oral medications, targeting brain pathways linked to mood and depression to help you feel better, faster.

We welcome Medicaid patients and accept most major insurance plans. Our clinic offers short wait times and extended evening hours to make access to care easier for you and your family.

Want to learn more? Keep scrolling or visit the official Spravato website.

  • Spravato® (esketamine) is FDA-approved for use in combination with an oral antidepressant to treat:

    • Treatment-Resistant Depression (TRD)
      For adults who have not responded to at least two previous antidepressant treatments.

    • Major Depressive Disorder (MDD) with Suicidal Thoughts or Behavior
      For adults experiencing acute suicidal ideation or behavior, in conjunction with other therapies.

    Spravato must be administered under medical supervision at a certified treatment center, as required by the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program.

    Sources:

  • While Spravato® can be a helpful treatment for certain forms of depression, it is not approved for the following uses:

    • Use in children or adolescents
      Spravato has not been studied in pediatric patients and is not approved for anyone under 18.

    • Treatment of anxiety disorders, bipolar depression, or PTSD
      These conditions are not listed as approved uses for Spravato, and clinical evidence is limited.

    • At-home or unsupervised use
      Spravato must be administered in-person at a certified treatment center due to safety monitoring requirements.

    • General or first-line depression treatment
      It is only prescribed when other antidepressants have failed to provide relief (treatment-resistant depression).

      Always consult your provider to understand whether Spravato is appropriate for your specific condition and treatment history.


      Sources:

    • Spravato contains esketamine, a form of ketamine that targets NMDA receptors in the brain.

    • Unlike traditional antidepressants that affect serotonin or norepinephrine, Spravato works through a different pathway—often providing noticeable relief within hours to days.

    • It's delivered as a nasal spray and must be administered in a certified healthcare setting due to safety monitoring requirements.

    • Spravato is intended for adults diagnosed with treatment-resistant depression (TRD)—typically defined as major depressive disorder that hasn’t responded to at least two other antidepressants.

    • If you’ve tried multiple medications with little or no improvement, Spravato may be an option worth exploring.

    • Eligibility is determined through a clinical assessment with your provider.

    • Spravato is taken as a nasal spray, followed by a period of monitoring in our office.

    • Each session typically lasts about two hours.

    • Most patients start with twice-weekly treatments for the first four weeks, then taper to once a week or every two weeks depending on their response.

    • You’ll need someone to drive you home after each session.

    • If you're experiencing persistent depression despite multiple treatments, Spravato may offer a new approach to healing.

    • A clinical consultation will help determine if you qualify.

    • This includes reviewing your medical history, current symptoms, and treatment response to past medications.

    • The cost of Spravato treatment varies depending on factors like dosage, frequency of treatment, and is not covered by your insurance.

    • Please contact our office for pricing.

    • Appointments may be rescheduled within the same week, even at short notice, without a fee.

    • No-shows will be charged the full visit fee.

    • Exceptions are made for extenuating circumstances, and our staff will do their best to accommodate your schedule.

    • There are no refunds on Spravato bundle packages.

    • We will do our best to accommodate your schedule if you need to reschedule.

    • We accept most major insurance plans, including Medicaid.

    • Our team can help verify coverage for Spravato and guide you through the prior authorization process, if required.

    • We’re here to help you understand costs and options.

    • Ready to explore whether Spravato could be right for you?

    • Our team can typically schedule your initial consultation within 7 days—often faster than larger health systems in the area.

    • Get in touch today or call us at 336-579-0708 to learn more or request an appointment.

    • Is Spravato covered by insurance?
      Many insurance plans cover Spravato, including Medicaid. Our office will help you verify coverage and determine out-of-pocket costs.

    • Do I need to stop my current antidepressants?
      No. Spravato is usually prescribed alongside your existing oral antidepressant.

    • How quickly does it work?
      Some patients report improvement within hours or days; for others, it may take several weeks.

  • At Carolina Restorative Health, your safety is our top priority throughout your treatment. Spravato® (esketamine) must be administered in-office under the direct supervision of a licensed healthcare provider, following strict protocols for patient monitoring and emergency preparedness.

    Here's what you can expect:

    • In-Office Administration Only: Spravato® is an FDA-approved nasal spray treatment that can only be administered in a certified healthcare setting. Home use is not permitted.

    • Licensed, Trained Professionals: All Spravato® sessions are managed by trained clinicians who monitor your vital signs and overall response before, during, and after treatment.

    • Post-Treatment Observation: After each Spravato® dose, patients remain in the office for at least 2 hours for monitoring. This allows the care team to respond promptly to any side effects, which are typically mild and temporary.

    • Emergency Protocols in Place: Our team follows established safety protocols to ensure quick response to any unexpected reactions. You’ll also receive clear instructions and support throughout the process to help you feel confident and informed.

    • Research-Backed Safety: Spravato® has a favorable safety profile when administered properly. Clinical studies and FDA data confirm its safety and effectiveness for individuals with treatment-resistant depression when used under supervision.

    Learn more from Spravato Prescribing Information (Janssen Pharmaceuticals) and the Spravato Label.

  • Getting started is simple. Here’s what to expect:

    1. Referral or Consultation – You can be referred by your provider or contact our office directly to request an initial consultation.

    2. Eligibility Screening – We’ll review your medical history, past treatments, and insurance to determine if Spravato is a good fit for you.

    3. Prior Authorization – If you’re eligible, we’ll begin the insurance approval process, which typically takes 5–7 business days.

    4. Intake Appointment – Once approved, you’ll come in for a detailed intake visit to walk through the treatment process and set expectations.

    5. Treatment Schedule – If everything is in place, your Spravato treatments can begin as soon as the following week.

    Have questions along the way? Our staff is here to guide you through every step—just give us a call at 336-579-0708.

Woman using Spravato nasal spray
Man using Spravato nasal spray with clinician in background
Woman listening to headphones in a quiet space

Hear Real Stories and Learn More About Spravato®

These short videos offer insights into how Spravato works, what to expect during treatment, and personal stories from people who’ve been there.

Why Choose Us for Spravato® Treatment?

  • We Accept Medicaid and Most Major Insurances
    Carolina Restorative Health is one of the few clinics in the region offering Spravato® treatment to patients with Medicaid. We believe access to care shouldn’t depend on your insurance card.

  • Shorter Wait Times
    While other clinics may have long intake processes, we can typically schedule your first visit within a week—helping you get the care you need, faster.

  • Extended Evening Hours
    Our Spravato® clinic is open later than most, with appointments available until 7:30 p.m. on Tuesdays and Thursdays to fit your schedule.

  • Private, Comfortable Environment
    Treatments take place in a calming, semi-private suite with individual bays separated by dividers—designed with your comfort and peace of mind in mind.

  • Local, Compassionate Care
    We’re located right here in your community, committed to walking with you through every step of your treatment journey.

Want to know if Spravato is right for you?

Fill out the form and a member of our care team will be in touch to answer your questions.

    • Spravato® (esketamine) is a prescription nasal spray approved by the FDA for adults with treatment-resistant depression or major depressive disorder with suicidal thoughts or actions.

    • It works differently from traditional antidepressants by targeting a specific brain receptor (NMDA) and is believed to help restore connections in the brain related to mood and emotion.

    • Unlike medications you take daily at home, Spravato® must be administered in a certified medical office.

    • At CRHNC, patients receive their treatment in a safe, supportive environment under close medical supervision.

    • Each session includes time for self-administration followed by a two-hour observation period.

    • Spravato® is not a first-line treatment—it’s intended for individuals who haven’t responded to two or more other antidepressants.

    • Many patients who qualify report improved mood, increased motivation, and reduced depression symptoms after completing their treatment plan.

    • Spravato® is a prescription nasal spray used to treat adults with treatment-resistant depression.

    • It works differently than most antidepressants by targeting a part of the brain called the NMDA receptor, which can help improve symptoms more quickly.

    • At CRHNC, you take Spravato in our office under the care of our trained staff.

    • After using the nasal spray, you’ll stay for at least two hours so we can monitor your safety and response.

    • Most insurance plans—including Medicaid—cover Spravato when certain criteria are met.

    • Our team will help you check your coverage and walk you through the approval process before starting treatment.

    • Spravato® has been shown to help many adults with treatment-resistant depression who haven’t found relief from traditional antidepressants.

    • In clinical studies, some patients experienced improvement in their symptoms within just a few weeks when Spravato was used along with an oral antidepressant.

    • While results vary, many patients report feeling better, more hopeful, and more engaged in daily life after starting treatment.

    • Your provider will closely monitor your progress and adjust your care plan as needed.

    • Keep in mind that Spravato isn’t a cure, but it can be an important part of your recovery.

    • Some people begin to notice improvements in their depression symptoms within the first few weeks of starting Spravato® treatment—sometimes as early as the first or second session.

    • For others, it may take longer.

    • Everyone responds differently, which is why your provider will monitor your progress closely and adjust your care plan as needed. Spravato is always used alongside an oral antidepressant to help maximize results.

    • If you have questions or concerns during treatment, we’re here to support you every step of the way.

  • At our clinic, we aim to make your Spravato treatment as comfortable and supportive as possible.

    Here’s what you can expect during your session:

    • Tranquil Environment: Our treatment space features soft lighting, tranquil music, and natural decor to create a calming atmosphere.

    • Private, Clean and Relaxing Spaces: Each treatment area is separated by privacy dividers, offering you a sense of personal space during your session.

    • Comfort Amenities: We provide noise-canceling headphones, a cozy blanket, and masks to help you relax fully during your treatment.

    • Private Room Option: For those who prefer more privacy, we offer one private room, available on a first-come, first-served basis.

    In addition to day time hours, we offer extended hours to accommodate those with other obligations who still need this level of care and support.

  • Like any medication, Spravato (esketamine) can cause side effects. Most are mild and temporary, and your care team will monitor you during treatment to help ensure your safety.

    Common side effects may include:

    • Dizziness

    • Nausea or vomiting

    • Drowsiness

    • Feeling disconnected or “spacey”

    • Increased blood pressure

    • Headache

    These typically occur shortly after treatment and usually improve the same day. Because of these effects, patients are monitored for at least two hours after each session.

    Serious but less common risks include:

    • Sedation (feeling very sleepy or groggy)

    • Dissociation (feeling disconnected from yourself, your thoughts, or surroundings)

    • Abuse or misuse (why Spravato is only available at certified clinics under close supervision)

    Your provider will review all safety information with you before you begin, and you’ll be monitored during and after each visit to manage any symptoms that arise.

    Sources:
    Spravato Prescribing Information – Janssen Pharmaceuticals (PDF)
    DailyMed Official Label – U.S. National Library of Medicine

    • The cost of Spravato treatment depends on your dosage, treatment frequency, and insurance coverage.

    • Some insurance plans may cover part or all of the treatment, while others may not.

    • Please contact our office directly for personalized pricing and to verify your coverage.

  • Spravato is FDA-approved for treatment-resistant depression and is often covered by insurance. However, coverage can vary depending on your plan and provider.

    Our team can help you:

    • Verify your benefits and eligibility

    • Submit any required documentation

    • Navigate the prior authorization process if needed

    If you have Medicaid or a commercial plan, we recommend calling us to discuss your coverage details. We’re happy to help you understand your options before starting treatment.

  • Spravato is only available as a nasal spray and must be administered in a certified healthcare setting under medical supervision.

    If you’ve tried two or more antidepressants without success, Spravato may be an option for you.

    Our team will work closely with you and your referring provider to:

    • Review your treatment history

    • Determine if you meet clinical eligibility

    • Explain what to expect during treatment

    • Discuss how Spravato fits into your care plan

    We’ll help you decide if Spravato is the right next step based on your symptoms, health status, and insurance coverage.

  • At Carolina Restorative Health, your safety is our top priority throughout your treatment. Spravato® (esketamine) must be administered in-office under the direct supervision of a licensed healthcare provider, following strict protocols for patient monitoring and emergency preparedness.

    Here's what you can expect:

    • In-Office Administration Only: Spravato® is an FDA-approved nasal spray treatment that can only be administered in a certified healthcare setting. Home use is not permitted.

    • Licensed, Trained Professionals: All Spravato® sessions are managed by trained clinicians who monitor your vital signs and overall response before, during, and after treatment.

    • Post-Treatment Observation: After each Spravato® dose, patients remain in the office for at least 2 hours for monitoring. This allows the care team to respond promptly to any side effects, which are typically mild and temporary.

    • Emergency Protocols in Place: Our team follows established safety protocols to ensure quick response to any unexpected reactions. You’ll also receive clear instructions and support throughout the process to help you feel confident and informed.

    • Research-Backed Safety: Spravato® has a favorable safety profile when administered properly. Clinical studies and FDA data confirm its safety and effectiveness for individuals with treatment-resistant depression when used under supervision.

    Learn more from Spravato Prescribing Information (Janssen Pharmaceuticals) and the Spravato Label.

    • Flexible Scheduling: Appointments may be rescheduled within the same week, even on short notice, at no charge.

    • No-Show Policy: Missed appointments without notice will be charged the full visit fee.

    • Extenuating Circumstances: We understand that emergencies happen and will do our best to work with you when they do.

    • Bundle Packages: Spravato bundle packages are non-refundable.

    Our team is here to support you and will always do our best to accommodate your needs.

  • Spravato treatment refers to the use of esketamine for treating mental health conditions, particularly depression, anxiety, and post-traumatic stress disorder (PTSD). Unlike traditional antidepressants, which can take weeks to show effects, ketamine can often produce rapid improvements in mood, sometimes within hours.

    The therapy typically involves a healthcare provider administering ketamine in a controlled environment. Sessions are usually short, and patients are monitored for side effects.

    Ketamine can be used to treat conditions such as anxiety, depression, PTSD, OCD, and even chronic migraines that impact quality of life and cause emotional distress. Ketamine, in its various forms, has been shown to have rapid-acting antidepressant effects and can be effective for treatment-resistant cases where other medications have not worked. Here’s how each form can help:

    1. Nasal ketamine (compounded, not approved by insurance)

    • Potential Benefits: Nasal ketamine has also been used off-label for other conditions such as anxiety, PTSD, OCD, and migraines. The nasal form allows for rapid absorption, providing quick relief for symptoms.

    • Effectiveness: Multiple studies have indicated that nasal ketamine, including compounded versions, can rapidly reduce symptoms of depression, particularly in individuals with treatment-resistant depression (TRD). The fast-acting nature of ketamine, compared to traditional antidepressants, makes it an appealing option.

    • Advantages: Non-invasive and often less intimidating than injections.

    2. Oral ketamine

    • Uses: Oral ketamine is used off-label to treat depression, anxiety, PTSD, OCD, and in some cases, chronic migraines.
    • Effectiveness: While absorption is slower than nasal or injection forms, oral ketamine can still provide significant symptom relief, especially in patients with mood disorders.
    • Suitability: It can be an option for at-home therapy, making it more accessible for ongoing care, though it may require more careful monitoring due to slower onset.

    Migraines and Mental Health

    • Chronic migraines are known to cause emotional distress, which can lead to or worsen conditions like depression and anxiety. Ketamine’s mechanism of action not only helps alleviate depressive symptoms but can also reduce migraine severity and frequency, improving overall quality of life.

  • Targeting the glutamate system instead of serotonin receptors, ketamine therapy differs from traditional treatments because it repairs neural damage in the brain, allowing for new neural connections to form.

    Research suggests that ketamine therapy may work by increasing levels of certain neurotransmitters in the brain, promoting neural plasticity, and providing a dissociative experience that can help patients process emotions.

    While many people report significant benefits, ketamine therapy is still being studied, and it’s important for patients to work closely with their healthcare providers to weigh the risks and benefits.

  • Ketamine therapy is effective in over 70% of patients with treatment-resistant psychiatric disorders such as depression, anxiety, PTSD, and bipolar disorder.

    Administered by a medical professional, ketamine infusion therapy helps patients to reclaim their lives and live pain-free.

  • Ketamine can produce significant relief from symptoms after administration, but the response time is individually based. If you have any side effects at all, they usually subside by the end of the treatment session.

  • Tranquil Healing Environment for Your Spravato treatment

    At our clinic, we aim to make your Spravato treatment as comfortable and supportive as possible. Here’s what you can expect during your session:

    • Tranquil Environment: Our treatment space features soft lighting, tranquil music, and natural decor to create a calming atmosphere.

    • Private, Clean and Relaxing Spaces: Each treatment area is separated by privacy dividers, offering you a sense of personal space during your session.

    • Comfort Amenities: We provide noise-canceling headphones, a cozy blanket, and masks to help you relax fully during your treatment.

    • Private Room Option: For those who prefer more privacy, we offer one private room, available on a first-come, first-served basis.

    In addition to day time hours, we offer extended hours to accommodate those with other obligations who still need this level of care and support.

  • Ketamine therapy have a range of side effects, which can vary depending on the dosage and method of administration. Common side effects include:

    1. Dissociation: A feeling of detachment from reality or oneself, which can be distressing for some people.

    2. Dizziness: A sense of lightheadedness or unsteadiness.

    3. Nausea and Vomiting: Some individuals may experience gastrointestinal upset.

    4. Increased Blood Pressure: Ketamine can cause a temporary rise in blood pressure and heart rate.

    5. Visual Disturbances: Changes in vision, such as blurred or double vision.

    6. Confusion: Some patients may feel confused or disoriented during or after treatment.

    7. Sedation: A feeling of drowsiness or sleepiness.

    Less common but more serious side effects can include:

    • Hallucinations: Distorted perceptions of reality.

    • Allergic Reactions: Rare but possible, leading to symptoms like rash or difficulty breathing.

    • Urinary Issues: Long-term use can lead to bladder problems or cystitis.

    It’s essential for patients to discuss potential side effects with their healthcare provider and to report any unusual or severe symptoms promptly.

  • The cost of ketamine varies depending on factors like dosage, frequency of treatment, and is not covered by your insurance. Please contact our office for pricing.

    Appointments may be rescheduled within the same week, even at short notice, without a fee. No-shows will be charged the full visit fee. Exceptions are made for extenuating circumstances, and our staff will do their best to accommodate your schedule.

    There are no refunds on ketamine bundle packages. We will do our best to accommodate your schedule if you need to reschedule.

  • Ketamine therapy is not covered by insurance and is considered a private pay service unless you are seeking treatment for Spravato (Esketamine).

    However, our office may send you for baseline labs and that will be the only time your insurance is used. In this case, you may go to a local Quest or LabCorp and use your insurance.

  • Ketamine can be used to treat conditions such as anxiety, depression, PTSD, OCD, and even chronic migraines that impact quality of life and cause emotional distress. Ketamine, in its various forms, has been shown to have rapid-acting antidepressant effects and can be effective for treatment-resistant cases where other medications have not worked. Here’s how each form can help:

    1. Nasal ketamine (compounded, not approved by insurance)

    • Potential Benefits: Nasal ketamine has also been used off-label for other conditions such as anxiety, PTSD, OCD, and migraines. The nasal form allows for rapid absorption, providing quick relief for symptoms.

    • Effectiveness: Multiple studies have indicated that nasal ketamine, including compounded versions, can rapidly reduce symptoms of depression, particularly in individuals with treatment-resistant depression (TRD). The fast-acting nature of ketamine, compared to traditional antidepressants, makes it an appealing option.

    • Advantages: Non-invasive and often less intimidating than injections.

    2. Oral ketamine

    • Uses: Oral ketamine is used off-label to treat depression, anxiety, PTSD, OCD, and in some cases, chronic migraines.
    • Effectiveness: While absorption is slower than nasal or injection forms, oral ketamine can still provide significant symptom relief, especially in patients with mood disorders.
    • Suitability: It can be an option for at-home therapy, making it more accessible for ongoing care, though it may require more careful monitoring due to slower onset.

    Migraines and Mental Health

    • Chronic migraines are known to cause emotional distress, which can lead to or worsen conditions like depression and anxiety. Ketamine’s mechanism of action not only helps alleviate depressive symptoms but can also reduce migraine severity and frequency, improving overall quality of life.

  • Whether you choose in-home ketamine therapy or in-office therapy, rest assured that your care will always be provided by a licensed and trained professional who follows strict safety protocols.

    • In-Home Therapy: You will receive step-by-step instructions on what to do in case of an emergency, along with continuous monitoring, including vital signs, and the presence of a required support person for your safety, although rare. Your treatment options at home include nasal or oral administration. 

    • In-Office Therapy: You can choose from injection, nasal, or oral treatment options.

    Our goal is to ensure that your experience is safe, comfortable, and supportive, regardless of where you receive treatment.

    Your safety is our top priority throughout your treatment. We want you to feel confident and informed as you embark on your ketamine therapy journey. Here’s what you can expect regarding safety protocols and emergency preparedness:
    • Clear Emergency Instructions: Before your ketamine session, we will provide you with detailed instructions on what to do in case of an emergency. This ensures you and your support person are fully prepared.
    • In-Home Treatment: For patients receiving in-home therapy, you will receive step-by-step guidance for your support person on how to respond effectively in case of unexpected reactions.
    • In-Office Treatment: During in-office sessions, our licensed professionals will continuously monitor your vital signs and are trained to respond swiftly to any unexpected situations, ensuring your safety at all times.
    • Research-Backed Safety: Ketamine has been shown to have a favorable safety profile when administered by trained professionals. According to the American Psychiatric Association, ketamine is considered effective for treatment-resistant depression and is generally well tolerated by patients. Additionally, the National Institute of Mental Health emphasizes the importance of monitoring during treatment to minimize risks.

    Sources:

    1. American Psychiatric Association. (2019). “Clinical Practice Guideline for the Treatment of Patients With Major Depressive Disorder.”
    2. National Institute of Mental Health. (2020). “Ketamine for Depression.”
    3. Zanos, P., & Gould, T. D. (2018). “Mechanisms of Ketamine Action as an Antidepressant.” Journal of Clinical Psychiatry, 79(5).
    4. Keresztury, K. K., et al. (2020). “Safety and Efficacy of Ketamine in Treatment-Resistant Depression: A Review of Current Literature.” Frontiers in Psychiatry.

    Ketamine is safe because it will be given in a controlled  environment, under the guidance of a trained and licensed professional with strict protocols in place. Additionally, you will be receiving smaller doses of Ketamine that have been quantified by licensed pharmacist that also have strict protocols in place. 

    1. American Psychiatric Association: Their guidelines on the use of ketamine for treatment-resistant depression can provide valuable context on safety protocols.
    • Source: American Psychiatric Association. (2019). “Clinical Practice Guideline for the Treatment of Patients With Major Depressive Disorder.”
    2. National Institute of Mental Health (NIMH): The NIMH provides information on various mental health treatments, including ketamine.
    • Source: National Institute of Mental Health. (2020). “Ketamine for Depression.”
    3. The Journal of Clinical Psychiatry: This journal often publishes studies on the safety and efficacy of ketamine treatments.
    • Source: Zanos, P., & Gould, T. D. (2018). “Mechanisms of Ketamine Action as an Antidepressant.” Journal of Clinical Psychiatry, 79(5).
    4. BCIA (Biofeedback Certification International Alliance): While focused more broadly, this organization offers guidelines and certification for practitioners using biofeedback and may touch on safety in complementary therapies, including ketamine.
    • Source: BCIA. “About Biofeedback and Neurofeedback.”
    5. Katalin K. Keresztury et al. (2020): A research study discussing the safety profile of ketamine in treatment-resistant depression.
    • Source: Keresztury, K. K., et al. (2020). “Safety and Efficacy of Ketamine in Treatment-Resistant Depression: A Review of Current Literature.” Frontiers in Psychiatry.