Spravato (Esketamine) Treatment for Treatment-Resistant Depression
If multiple antidepressants have not worked, Spravato (esketamine) may be the next step. SMHWI is a certified Spravato treatment center in Scottsdale, Tempe, and Glendale, AZ and Rockwall, TX, offering FDA-approved esketamine sessions in a monitored clinical setting.
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Request a Spravato Consultation
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Insurance We Work With
Coverage varies. Prior authorization is required for most Spravato treatment. Our team handles the authorization process on your behalf.
Spravato (Esketamine): FDA-Approved Treatment for Depression That Hasn't Responded
Spravato is the brand name for esketamine, an FDA-approved nasal spray developed by Janssen Pharmaceuticals for adults with treatment-resistant depression (TRD). TRD is defined as major depressive disorder that has not responded adequately to at least two different antidepressants. In 2020, Spravato received a second approval for adults with MDD experiencing acute suicidal ideation or behavior (MDSI).
Esketamine works differently from every antidepressant that came before it. Instead of targeting serotonin, dopamine, or norepinephrine, Spravato modulates glutamate by blocking NMDA receptors. This mechanism can produce antidepressant effects more rapidly than conventional treatments, often within hours to days, which is why it can be meaningful for patients who have not responded to other approaches.
At SMHWI, Spravato is administered by licensed psychiatric providers in a certified REMS (Risk Evaluation and Mitigation Strategy) treatment center. You self-administer the nasal spray under clinical supervision and remain in the office for a two-hour monitoring period after each session. It is always used alongside an oral antidepressant as part of an individualized treatment plan.
SMHWI offers Spravato at four locations: Scottsdale, Tempe, and Glendale in Arizona, and Rockwall, Texas. Our team handles prior authorization, insurance verification, and the admissions process so you can focus on getting better.
Treatment-Resistant Depression (TRD)
For adults with major depressive disorder that has not responded to at least two adequate antidepressant treatments.
MDD with Acute Suicidal Ideation (MDSI)
For adults with major depressive disorder experiencing acute suicidal ideation or behavior, used alongside standard care.
A Different Mechanism Than Any Other Antidepressant
Spravato works on a completely different system in the brain than SSRIs, SNRIs, or other antidepressants. That difference is precisely why it can work when other medications have not.
Spravato vs. Standard Antidepressants
Targets Glutamate, Not Serotonin
Traditional antidepressants increase serotonin, dopamine, or norepinephrine availability. Spravato blocks NMDA receptors, disrupting abnormal glutamate signaling linked to depression. It is a fundamentally different pathway, and one that can be effective for patients whose brains have not responded to monoamine-based medications.
Faster Onset Than Conventional Antidepressants
Most traditional antidepressants take four to eight weeks to produce a meaningful response. Clinical trials showed significant antidepressant effects in some patients within 24 hours of the first Spravato session, with continued improvement through the induction phase. This rapid onset can be especially important for patients with severe or acute symptoms.
Used Alongside an Oral Antidepressant
Spravato is not a standalone replacement for your current medication. It is used in combination with an oral antidepressant, typically one that has not been tried before or one your prescriber believes is appropriate. Your SMHWI psychiatrist will coordinate both as part of your treatment plan.
About the REMS Program: Spravato is only dispensed to certified healthcare settings, not to patients directly. Due to risks of dissociation and sedation, the FDA requires all sessions to be completed in a certified facility with mandatory post-dose monitoring. SMHWI is a fully certified REMS treatment center at all four locations.
Is Spravato Right for You?
Spravato is FDA-approved specifically for adults with treatment-resistant depression, meaning major depressive disorder that has not responded to at least two adequate antidepressant trials. It is also approved for adults experiencing major depressive disorder with acute suicidal ideation or behavior.
If you have been working with a psychiatrist for months or years and have tried multiple medications without adequate relief, Spravato may be worth evaluating. A psychiatrist at SMHWI will review your history and determine whether you meet clinical criteria for treatment.
Spravato is not appropriate for everyone. Your SMHWI provider will screen for contraindications including certain cardiovascular conditions, a history of psychosis or mania, active substance use disorders, and other factors. Our goal is to recommend Spravato only when it is clinically appropriate and likely to benefit you.
You have been diagnosed with major depressive disorder (MDD) and are currently experiencing depressive symptoms
At least two antidepressant medications at adequate doses and durations have not produced sufficient relief
You are an adult (18+) and are willing to attend in-clinic sessions with post-dose monitoring
You are able to arrange transportation — you cannot drive or operate heavy machinery on the day of your Spravato session
You are currently being treated with an oral antidepressant, or your psychiatrist will start one alongside Spravato
Not sure if you meet the criteria for Spravato?
Our psychiatric team can evaluate your history and answer your questions.
Spravato Treatment Schedule: Three Phases
Spravato follows an evidence-based dosing protocol structured in three phases. Your psychiatrist will guide you through each phase based on your clinical response.
The induction phase establishes your initial response to Spravato. Sessions are held twice a week for four weeks to build the treatment effect and give your psychiatrist time to evaluate how you are responding.
- Two sessions per week, typically on non-consecutive days
- Each session: self-administer nasal spray, then a 2-hour monitoring period
- Most patients begin to notice improvement within the first one to two weeks
- Your oral antidepressant begins or continues concurrently
Once your initial response is established, sessions reduce to once a week. This allows your brain to continue building on the treatment effect while reducing the time commitment each week.
- One session per week for four weeks
- Clinical team monitors ongoing response and tolerability
- Treatment plan adjusted as needed based on your progress
- Continued coordination with oral antidepressant
In the maintenance phase, your psychiatrist determines how often you need sessions to stay well, typically every one to two weeks based on symptom stability and insurance authorization.
- Sessions every one to two weeks based on clinical response
- Ongoing psychiatric support and medication management
- Regular reassessment of treatment goals
- Coordination with therapy and other components of your care
What Happens During a Spravato Session at SMHWI
Each Spravato session takes approximately two hours from start to finish. Here is what to expect from the moment you arrive to the moment you leave.
Arrival & Pre-Session Assessment
~15 min beforeArrive at your scheduled appointment time. A clinical staff member will check your blood pressure and conduct a brief pre-session assessment to confirm it is safe to proceed. Avoid eating for at least two hours before your session and avoid nasal sprays or decongestants for at least one hour prior.
Self-Administration of Esketamine Nasal Spray
~10 minYou self-administer the Spravato nasal spray device under the direct supervision of a clinician. The dose (56mg or 84mg, as prescribed) is divided across two or three nasal spray devices, with a five-minute rest between each. You remain seated or reclined in a private, comfortable treatment room throughout.
Mandatory Monitoring Period
2 hoursFollowing administration, you remain in the clinic for a required two-hour observation period. A clinician monitors for dissociation, sedation, nausea, and blood pressure changes, which are common during and shortly after the session and typically resolve within the monitoring window. Many patients use this time to rest, listen to music, or reflect quietly.
Post-Session Check and Discharge
~15 minBefore you leave, a clinician will conduct a brief post-session assessment to confirm your symptoms have resolved and that you are safe to be discharged. A responsible adult must drive you home or accompany you; you cannot drive or operate heavy machinery on the day of your session. Your SMHWI team is available by phone if you have questions after you leave.
Does Insurance Cover Spravato?
Most major commercial insurance plans, Medicare, and many Medicaid programs cover Spravato when it is medically necessary. Coverage requires prior authorization, and our team manages that process for you.
Spravato coverage is available through most major insurance plans, but it typically requires prior authorization — a formal review process in which your insurer approves treatment based on documented clinical need. SMHWI's admissions and billing team initiates and manages that process on your behalf, which generally involves submitting your diagnosis, prior antidepressant treatment history, and current symptom severity.
Prior authorization requirements vary by insurer but commonly include documentation that you meet the FDA criteria for treatment-resistant depression: a diagnosis of MDD and an inadequate response to at least two antidepressant medications at appropriate doses and durations. Our psychiatric team provides the clinical documentation needed to support your authorization.
If you are commercially insured, the Spravato WithMe support program offered by Janssen may reduce your out-of-pocket costs significantly. Eligibility requirements apply. Your SMHWI admissions coordinator can walk you through the program at intake.
SMHWI verifies your insurance benefits and explains any out-of-pocket costs before treatment begins, so there are no surprises.
Most Plans Cover Spravato
Aetna, BCBS, Cigna, United Healthcare, Humana, and most major commercial plans cover Spravato when prior authorization criteria are met. Copays and deductibles vary.
Medicare Part B Coverage Available
Medicare Part B covers Spravato as an outpatient treatment when administered in a certified facility. Patients are typically responsible for 20% of the Medicare-approved amount after meeting the Part B deductible.
Copay Assistance for Eligible Patients
Janssen's Spravato WithMe support program offers copay assistance for commercially insured patients and care coordination support. Our team will help determine your eligibility at intake.
We Handle the Process
SMHWI's team initiates and manages prior authorization requests on your behalf. We submit the required clinical documentation and follow up with your insurer.
Certified Spravato Treatment Centers Near You
SMHWI offers FDA-approved Spravato (esketamine) treatment at four certified REMS locations across Arizona and Texas.
SMHWI Scottsdale
8350 E Raintree Dr, Ste 125 & 130Scottsdale, AZ 85260
Serving Scottsdale, Paradise Valley & North Phoenix (623) 288-2628
SMHWI Tempe
1492 S Mill Ave, Ste 206 & 214Tempe, AZ 85281
Serving Tempe, Mesa & South Phoenix (623) 288-3656
SMHWI Glendale
6120 W Bell Rd, Ste 130Glendale, AZ 85308
Serving Glendale, Peoria & West Phoenix (623) 288-0133
SMHWI Rockwall
810 E Ralph Hall Pkwy, Ste 140Rockwall, TX 75032
Serving Rockwall, Rowlett & East Dallas area (972) 638-0947
Common Questions About Spravato Treatment
What is Spravato (esketamine) and how is it different from ketamine?
How does Spravato work for treatment-resistant depression?
Who qualifies for Spravato treatment?
Is Spravato covered by insurance?
How much does Spravato cost?
What side effects can I expect during a Spravato session?
Can I take Spravato at home?
How quickly does Spravato work?
Do I need a referral to start Spravato at SMHWI?
Can I drive after a Spravato session?
Is Spravato the same as ketamine infusion therapy?
More Ways SMHWI Can Help
Spravato is one part of a comprehensive continuum of psychiatric care at SMHWI. Explore related services available at our locations.
When Other Treatments Haven't Worked, There Is a Next Step
SMHWI's certified Spravato treatment centers in Arizona and Texas are ready to evaluate your history, verify your insurance, and help you get started.
Request a Spravato Consultation