Beginning a new depression treatment can bring relief, questions, and sometimes both at once. If you are considering SPRAVATO® treatment, it helps to know that this is not a medication you pick up at the pharmacy and use on your own at home. It is a structured treatment experience with an evaluation, in-clinic dosing, observation, and ongoing conversations about how you are feeling.
At HavenNexus Advanced Psychiatry & TMS, we believe preparation can make the first visit feel more manageable. We help you understand what treatment involves, whether it may fit your needs, and what practical support you may need around each appointment.
SPRAVATO® is not a standard oral antidepressant
SPRAVATO® is the brand name for esketamine, a nasal spray medication given under clinical supervision. It differs from a daily oral antidepressant in how it is taken and how each visit works. You self-administer the nasal spray during an appointment while our team is available to monitor you.
For its labeled uses, SPRAVATO® is used with an oral antidepressant for adults with treatment-resistant depression and for adults with major depressive disorder with acute suicidal ideation or behavior. It is not a one-size-fits-all next step. Your symptoms, treatment history, current medications, medical history, and ability to attend monitored visits all matter.
A review of ketamine and esketamine treatment describes why careful patient selection and follow-up remain important parts of care (Feeney et al., 2023). The goal is not simply to find a different medication. It is to build a plan that makes sense for you.
You can read about our SPRAVATO® treatment options before an evaluation. The evaluation, though, is where we can answer the questions that apply to your own history.
The evaluation comes before the first dose
Before treatment begins, we will talk with you about your symptoms, previous medication trials, current prescriptions and supplements, substance use history, medical conditions, and safety concerns. We also want to understand how symptoms affect your daily life.
Depression is not only a score on a questionnaire. It can affect sleep, work, relationships, concentration, appetite, and your sense of what is possible. Information on depression and related mental health concerns recognizes that these conditions can affect many parts of day-to-day functioning (National Institute of Mental Health, n.d.).
We will discuss whether SPRAVATO® belongs in your broader treatment plan. That includes the oral antidepressant used alongside it and other psychiatric care that may be appropriate. A study comparing esketamine nasal spray with quetiapine in treatment-resistant depression highlights why treatment decisions should account for both clinical response and the demands of ongoing care (Reif et al., 2023).
Please bring an up-to-date medication list to your evaluation. Be direct about alcohol, cannabis, sedatives, stimulants, opioids, and other substances. This is not about judgment. It helps us make safer decisions and prepare you properly.
What happens during a SPRAVATO® visit
A SPRAVATO® appointment is intentionally different from a routine medication-management visit. You will come to our clinic, administer the nasal spray as directed, and remain with us for observation afterward. This monitored setting is part of treatment, not an inconvenience added around it.
During the visit, we will check in on how you are doing and watch for effects that can occur after dosing. Some people experience sleepiness, dizziness, nausea, a sense of disconnection, or changes in perception. These effects are often temporary. They are also a reason to plan for a calm, supervised setting after administration.
Clinical guidance on intranasal esketamine monitoring emphasizes observation, practical planning, and regular assessment throughout treatment (Hope et al., 2023). Plan to be here for more than a quick appointment. The observation period is generally at least two hours. We may need more time depending on how you feel and what we observe.
Wear comfortable clothing. Arrive with enough time. Avoid scheduling demanding obligations right after your appointment.
Arrange transportation before you arrive
You will need a reliable adult to drive you home after every treatment session. Do not drive or operate machinery until the next day after a restful sleep. It is wise to arrange your transportation for every scheduled dose in advance, rather than trying to solve those logistics at the last minute.
You may also want to give yourself a quieter evening after treatment. That might mean preparing a simple meal, telling a family member you may need downtime, and avoiding major work or social commitments.
What to do before treatment days
Your care instructions may be individualized. Practical preparation often includes following guidance about eating, drinking, and medications before your appointment. Ask us before changing or skipping any prescribed medication. We will tell you what applies to your situation.
It can help to keep a simple record between visits. Notice your mood, sleep, anxiety, energy, irritability, and ability to function. Bring up changes that feel encouraging, uncomfortable, or confusing. We want you to be an active observer of your experience.
A case series of unexpected depressive responses is a reminder that close communication matters when symptoms change in a direction you did not expect (Ontiveros-Sánchez de la Barquera et al., 2024). Tell us promptly if your mood worsens, if you feel unusually activated, or if you have new safety concerns.
SPRAVATO® and IV ketamine are different treatments
It is understandable to hear “esketamine” and “ketamine” and assume they are interchangeable. They are related, but they are not the same treatment experience.
SPRAVATO® is intranasal esketamine given in a supervised clinical setting. IV ketamine is delivered by infusion. Psychiatric uses of ketamine are off-label. The evaluation, administration process, monitoring, and treatment planning differ from SPRAVATO® care.
If you are comparing options, we can talk honestly about those differences and whether ketamine therapy should be part of the conversation for your needs. We also offer TMS therapy, along with other psychiatric treatment services. Your care should not be reduced to one medication or procedure.
When urgent support cannot wait
SPRAVATO® appointments are planned care, not emergency care. If you are in immediate danger, call 911 or go to the nearest emergency room. If you are having thoughts of suicide, emotional distress, or a mental health crisis, call or text 988 for the 988 Suicide & Crisis Lifeline at any time (988 Suicide and Crisis Lifeline, n.d.).
If you are considering SPRAVATO® treatment in Palm Coast, FL, we invite you to begin with a conversation rather than assumptions. You can request an appointment with HavenNexus Advanced Psychiatry & TMS. We will help you understand the evaluation process, visit expectations, and the questions that matter most to you.
Works Cited
1. Feeney A, et al. Pharmacotherapy: Ketamine and Esketamine. https://pubmed.ncbi.nlm.nih.gov/37149345/
2. Reif A, et al. Esketamine Nasal Spray versus Quetiapine for Treatment-Resistant Depression. https://pubmed.ncbi.nlm.nih.gov/37792613/
3. Hope J, et al. What clinicians need to know about intranasal esketamine for treatment-resistant depression?. https://pubmed.ncbi.nlm.nih.gov/37961848/
4. Ontiveros-Sánchez de la Barquera JA, et al. Paradoxical Depressive Response to Intranasal Esketamine in Treatment-Resistant Depression: A Case Series. https://pubmed.ncbi.nlm.nih.gov/39731271/
5. National Institute of Mental Health. Health Topics. https://www.nimh.nih.gov/health/topics
6. 988 Suicide and Crisis Lifeline. https://988lifeline.org/
Disclaimer
This article is for educational purposes only and is not a substitute for individualized evaluation, diagnosis, or treatment from a qualified healthcare professional.