SPRAVATO® esketamine for treatment-resistant depression
Spravato is an FDA-approved nasal spray for adults whose depression hasn’t responded to antidepressants. Delivered under physician supervision at REMS-certified SMHWI clinics across Arizona and Texas.
What Is Spravato
A different mechanism, for depression that hasn’t responded to antidepressants
Traditional antidepressants work primarily on serotonin, norepinephrine, or dopamine. For roughly two-thirds of patients, that’s enough. For the other third, it isn’t — and the frustration of trying pill after pill without lasting improvement is where treatment-resistant depression begins.
Spravato (esketamine) works differently. It acts on the glutamate system, a separate signaling pathway in the brain that traditional antidepressants don’t reach. That’s why it can help when other medications haven’t. Spravato is FDA-approved for two indications: adults with treatment-resistant depression, and adults with major depression who are experiencing acute suicidal thoughts or behavior. It’s always used alongside a daily oral antidepressant, not as a replacement.
Because Spravato is a REMS-controlled medication, every dose must be given in a certified treatment center under clinical staff observation. SMHWI operates REMS-certified Spravato clinics in Arizona and Texas, where sessions are delivered under physician supervision as part of your coordinated psychiatric care.
How a Spravato Session Works
What actually happens on treatment day
Because Spravato is REMS-controlled, every session is standardized and monitored. The routine looks the same at every SMHWI location.
The Spravato Protocol
What a Spravato course looks like
Spravato is the first antidepressant with a fundamentally new mechanism to reach the market in decades. Here’s the regulatory record and the clinical structure of a course — the facts of what happens, independent of any individual patient’s outcome.
Every patient’s treatment plan is individualized by their physician based on history, concurrent medications, and response at scheduled check-ins. Standardized rating scales keep adjustments grounded in measurable data rather than guesswork.
Where To Get Spravato
SMHWI REMS-certified Spravato clinics
Pick your closest SMHWI clinic to see local hours, insurance, and the physician overseeing Spravato at that site.
ScottsdaleArizona
Roland Segal, MDMedical Director, Scottsdale RockwallTexas
Ryan H. Hashem, MDMedical Director, Rockwall TempeArizona
Ehab Abdallah, MDMedical Director, Tempe GlendaleArizona
Lauren T. Bonner, MDMedical Director, Glendale Who Spravato Is For
FDA-approved indications and when to consider it
Spravato isn’t a first-line treatment. It’s designed for depression that hasn’t responded to standard care, and it’s always given alongside a daily oral antidepressant.
Treatment-Resistant Depression
Adults with major depression that hasn’t responded to at least two different antidepressants tried at adequate dose and duration. This is what Spravato was designed for.
Depression careMDD with Acute Suicidal Ideation
For adults with major depressive disorder experiencing acute suicidal thoughts or behavior. Spravato works quickly in this indication and is used alongside standard care.
Depression careAlways paired with an oral antidepressant
Spravato is designed to work alongside a daily oral antidepressant, not as a replacement. Our psychiatric team manages both together.
Explore servicesAlternative interventional options
Spravato isn’t appropriate during pregnancy, with certain cardiovascular conditions, or with a history of psychosis. TMS and IV ketamine are alternatives worth discussing.
Compare TMSWhy SMHWI for Spravato
REMS-certified clinics inside an integrated psychiatric practice
Spravato works best when it’s part of a coordinated plan. At every SMHWI location, the team supervising your sessions is the same practice managing your medications and follow-up.
REMS-certified sites
Every SMHWI Spravato clinic meets the FDA REMS program requirements. Doses only happen where they’re supposed to.
One team, one plan
Your Spravato provider is the same practice managing your antidepressant and follow-up care.
Multiple locations
Clinics across Arizona and Texas. Pick the location closest to you.
Prior auth handled
Each location secures prior authorization and confirms out-of-pocket cost before your first dose.
How Spravato Compares
Spravato vs. IV ketamine
Both come from the same molecule family. They’re not the same treatment. Weigh this with your psychiatrist, not on your own.
Insurance
Spravato is covered by most insurance plans
Coverage typically requires documentation that at least two antidepressants didn’t work. Prior authorization is almost always required, and each SMHWI location’s admissions team handles it before your first session.
Frequently Asked Questions
Spravato, answered
Spravato is esketamine, a specific enantiomer of the ketamine molecule, delivered as a nasal spray and FDA-approved for treatment-resistant depression and for major depression with acute suicidal ideation. It acts on the brain’s glutamate system, a separate pathway from traditional antidepressants. Because it’s a REMS-controlled medication, every dose must be given at a certified clinic under clinical staff observation.
Two FDA-approved indications: (1) adults with treatment-resistant depression — major depression that hasn’t responded to at least two antidepressants; and (2) adults with major depressive disorder who are experiencing acute suicidal thoughts or behavior. Spravato is always used alongside an oral antidepressant.
Spravato is esketamine specifically, a single-enantiomer form of the ketamine molecule. It’s delivered as a nasal spray, FDA-approved for treatment-resistant depression, and covered by most insurance plans. IV ketamine is racemic ketamine given as a slow infusion, used off-label for depression, and usually not covered by insurance. Both influence the glutamate system but differ in delivery, regulatory status, cost, and clinical protocol.
Yes, for most adults with treatment-resistant depression. Major commercial plans, Medicare, and Tricare cover Spravato when medical necessity is documented — typically proof that at least two antidepressants have failed. Prior authorization is almost always required. Each SMHWI location’s admissions team handles the paperwork before your first session.
About two hours per session. The nasal spray itself is self-administered under staff observation and takes just a few minutes. Then you’re monitored for at least two hours by trained clinical staff before being released. Because Spravato can cause sedation and dissociation, you cannot drive yourself home.
During induction (weeks 1–4), sessions are usually twice weekly. During initial maintenance (weeks 5–9), sessions move to once weekly. From week ten forward, most patients transition to sessions every one to two weeks.
The most common effects are dissociation, dizziness, nausea, sedation, and a temporary rise in blood pressure — all monitored by clinical staff during your session. Most effects fade before you leave. Your psychiatrist reviews your risk profile in detail before recommending Spravato.
Spravato is available at REMS-certified SMHWI clinics in Scottsdale, AZ, Tempe, AZ, Glendale, AZ, and Rockwall, TX. Every dose is delivered under physician supervision as part of a coordinated psychiatric care plan.
Ready to see if Spravato is right for you?
Pick the SMHWI location closest to you. Each clinic verifies your insurance and starts prior authorization before you commit to anything.
In a crisis
Get help right now
SMHWI is an outpatient practice and cannot respond to emergencies. If you or someone you know is in danger or thinking about suicide, use these free, confidential resources, available 24/7.
- Call 911Life-threatening emergency, or someone at immediate risk of harm.
- Call or text 988Suicide & Crisis Lifeline, 24/7. Chat at 988lifeline.org/chat.
- Dial 988, then press 1Veterans Crisis Line, or text 838255.
- Text HOME to 741741Crisis Text Line, free 24/7 support with a trained counselor.
