• 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 Carolina Restorative Health (CRH), 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.

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

• Some contraindications for Spravato use include aneurysm, arteriovenous malformation, intracerebral hemorrhage, or psychosis.

• A clinical consultation with a psychiatric evaluation will help determine if you qualify.

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

• 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 (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:

• FDA Prescribing Information for Spravato (2023)

• Spravato.com – What is Spravato?

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:

  • FDA Prescribing Information for Spravato (2023)

  • Spravato.com – What is Spravato?

• 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 CRH, 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.

• 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.

• Everyone responds differently, which is why your provider will monitor your progress closely and adjust your care plan as needed.

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.

• 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.

• No. Your clinician will discuss a treatment plan to determine if you will continue oral antidepressants.

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.

• 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.

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.

• No-Show Policy: Missed appointments without notice will be charged per our no-show policy.

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