SPRAVATO Treatment
A fast-acting nasal spray for adults whose depression hasn't responded to traditional antidepressants — FDA-approved and offered at Charak Center alongside your existing oral antidepressant.
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If you've tried two or more antidepressants without finding real relief, you're not alone — and you're not out of options. SPRAVATO (esketamine) is a prescription nasal spray that targets depression differently than anything you've tried before. Used together with an oral antidepressant, it has been shown to help adults with treatment-resistant depression feel better, often within the first week or two of starting treatment.
At Charak Center, SPRAVATO is administered in a calm, supervised setting by clinicians who specialize in treatment-resistant depression. Every session is guided, monitored, and built around your safety and comfort.
The First and Only of Its Kind
SPRAVATO is the first and only NMDA receptor antagonist FDA-approved — in combination with an oral antidepressant — for treatment-resistant depression in adults. Instead of working on serotonin or norepinephrine like traditional antidepressants, it acts on the brain's glutamate system, which plays a key role in mood regulation and the formation of new neural connections. It has been studied in more than 1,700 adults with treatment-resistant depression.
For many patients, the difference isn't just that SPRAVATO works — it's how quickly it works. Traditional antidepressants typically take four to eight weeks to produce a noticeable change. SPRAVATO can begin to lift symptoms within days.
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How SPRAVATO Works
Most antidepressants you may have tried — SSRIs like Lexapro or Zoloft, SNRIs like Effexor or Cymbalta — work by adjusting serotonin or norepinephrine levels over time. They can be effective, but they don't work for everyone, and they can take weeks to make a difference.
SPRAVATO works on a completely different pathway. The active ingredient, esketamine, is an NMDA receptor antagonist that influences glutamate, the most abundant neurotransmitter in the brain. Researchers believe this helps restore connections between brain cells in regions affected by depression — essentially helping the brain rewire itself in ways that support better mood regulation.
That different mechanism is why SPRAVATO can help people who haven't responded to other medications. It isn't a stronger version of what you've already tried. It's a different approach altogether.
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Is SPRAVATO Right for You?
SPRAVATO may be a fit if you are an adult who:
- Has been diagnosed with major depressive disorder
- Has tried at least two oral antidepressants without adequate improvement
- Is currently taking, or willing to start, an oral antidepressant
- Can commit to attending in-clinic sessions with a ride home afterward
Our team will walk you through eligibility, insurance authorization, and what to expect before your first session.
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What to Expect at Your First Session
We know walking into a new treatment can feel intimidating, especially one you may have read mixed things about online. Here's what your first SPRAVATO session at Charak Center actually looks like.
Before you arrive. You'll skip food for at least two hours and liquids for at least 30 minutes before your appointment to reduce the chance of nausea. Avoid nasal decongestants within an hour of your dose. And arrange a ride — you won't be able to drive yourself home.
Check-in and prep. When you arrive, our team will check your blood pressure and review how you've been feeling. You'll be brought to a private, comfortable treatment room.
The dose itself. You'll self-administer the nasal spray under the direct supervision of a healthcare provider. Each device contains two sprays. Depending on your prescribed dose, you'll use two or three devices with short rest periods in between. The actual administration takes only a few minutes.
The next two hours. You'll stay with us in the treatment area for at least two hours. Most patients feel some level of dissociation, dizziness, or sedation during this time — this is expected and typically peaks around 40 minutes in, then gradually fades. Many patients find it helpful to rest with eyes closed and listen to calming music. We'll check your blood pressure periodically and stay close in case you need anything.
Going home. Before you leave, a clinician will assess that you're stable enough to head out. Your ride will pick you up. Most patients are advised not to make important decisions or operate machinery for the rest of the day — plan a quiet evening.
Your Treatment Schedule
SPRAVATO works best as part of a structured plan. For treatment-resistant depression, the standard protocol unfolds in three phases:
Induction phase (Weeks 1–4). Two sessions per week. This is when the medication builds its effect, and most patients begin to feel the first signs of improvement.
Stabilization phase (Weeks 5–8). One session per week, as your response is reinforced and your provider tracks your progress.
Maintenance phase (Week 9 onward). One session every one to two weeks, based on how you're doing. Many patients continue maintenance for several months or longer.
Your provider will adjust this schedule to fit your response and your life. The goal isn't just to feel better in the short term — it's to build durable improvement.
Why Charak Center
SPRAVATO can only be administered at facilities certified through the SPRAVATO REMS program, and Charak Center is proud to be one of them in Northeast Ohio. But certification is just the baseline. What sets our program apart:
Experienced psychiatric team. Our clinicians specialize in treatment-resistant depression and have guided many patients through SPRAVATO from their first hesitant question through long-term maintenance.
Comfortable, private treatment spaces. Sessions take place in calm, quiet rooms designed for the two-hour monitoring period — not a busy clinical hallway.
Insurance and authorization support. Prior authorization for SPRAVATO can be a maze. Our team handles the paperwork, advocates with your insurer, and helps you understand your coverage and copay options before you commit.
Integrated care. SPRAVATO works alongside your oral antidepressant, and often alongside therapy and other supports. Our team coordinates with your existing providers — or can connect you to ours — so your treatment is cohesive, not fragmented.
Locations across Northeast Ohio. With offices in Elyria, Garfield Heights, Mentor, Stow, Medina, and Pepper Pike, finding a convenient location for your twice-weekly induction sessions is easier than driving across the region.
For more information on SPRAVATO treatment, call our mental health clinic at 855.4CHARAK
Download Patient Referral Form >
1.SPRAVATO™ [Prescribing Information]. Titusville, NJ: Janssen Pharmaceuticals, Inc. March 2019.
2.Data on file. Janssen Pharmaceuticals, Inc. Titusville, NJ.
Indication:
SPRAVATO™ (esketamine) CIII Nasal Spray is indicated, in conjunction with an oral antidepressant (AD), for the treatment of treatment-resistant depression (TRD) in adults.
SPRAVATO™ is not approved as an anesthetic agent. The safety and effectiveness of SPRAVATO™ as an anesthetic agent have not been established.
For more information on SPRAVATO treatment, call our mental health clinic at 855.4CHARAK
Download Patient Referral Form >
Frequently asked questions
What is Spravato?
Spravato is the brand name for esketamine, a prescription nasal spray developed by Janssen (a Johnson & Johnson company). It's derived from ketamine and works on the brain's glutamate system, which is a different mechanism than traditional antidepressants that target serotonin or norepinephrine.
What is it used for?
Spravato is FDA-approved for two uses in adults: treatment-resistant depression (TRD), meaning major depressive disorder that hasn't responded adequately to at least two other antidepressants, and major depressive disorder with acute suicidal ideation or behavior. It is not approved as an anesthetic or as a replacement for hospitalization when hospitalization is needed, and its safety and effectiveness have not been established in children.
Do I still have to take my regular antidepressant?
Yes. Spravato is given alongside an oral antidepressant, not as a standalone treatment.
How is it administered?
You self-administer the nasal spray under direct supervision at a certified healthcare facility. Each device delivers two sprays containing a total of 28 mg of esketamine. FDA Depending on your prescribed dose (56 mg or 84 mg), you'll use two or three devices per session with short rest periods between them.
Why do I have to stay at the clinic afterward?
Because of the risk of sedation, dissociation, and changes in blood pressure. Patients must be monitored by a healthcare provider for at least 2 hours at each treatment session, followed by an assessment to determine when the patient is considered clinically stable and ready to leave the healthcare setting. FDA You cannot drive yourself home — you'll need a ride.
Why can't I just pick it up at a pharmacy?
Spravato is only available through a restricted program called the SPRAVATO REMS (Risk Evaluation and Mitigation Strategy). It can only be given at certified healthcare settings to patients enrolled in the program. This is due to the risks of sedation, dissociation, and potential for misuse as a Schedule III controlled substance.
What does the treatment schedule look like?
For treatment-resistant depression, the typical protocol is an induction phase of twice-weekly sessions for the first 4 weeks, then once-weekly sessions for weeks 5–8, followed by a maintenance phase of sessions every 1–2 weeks based on response. Your provider will tailor this to you.
How quickly does it work?
Many patients notice some improvement within the first week or two, which is much faster than traditional oral antidepressants that often take 4–8 weeks. Response varies significantly from person to person.
What are the most common side effects?
The most frequently reported side effects include dissociation (a feeling of being detached from your body or surroundings), dizziness, nausea, sedation, vertigo, a spinning sensation, decreased sensitivity, anxiety, increased blood pressure, vomiting, and feeling drunk. Most of these occur during or shortly after dosing and typically resolve within the 2-hour monitoring window.
Who should not take Spravato?
People with certain vascular conditions or an allergy to esketamine or ketamine should not use it. Contraindications include aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial and peripheral arterial vessels) or arteriovenous malformation FDA, a history of intracerebral hemorrhage, and hypersensitivity to esketamine, ketamine, or any excipients. Tell your provider about any history of high blood pressure, heart disease, liver problems, substance use, or psychotic symptoms.
Is it safe during pregnancy or breastfeeding?
No. Spravato is not recommended during pregnancy, and breastfeeding is not recommended during treatment because esketamine passes into breast milk. There is a pregnancy registry for patients who become pregnant during treatment.
Can I eat or drink before a session?
You'll typically be asked to avoid food for at least 2 hours and liquids for at least 30 minutes before treatment to reduce the risk of nausea and vomiting. You'll also need to avoid using nasal decongestants within an hour of your dose since they can affect absorption.
Is it addictive?
Spravato is a Schedule III controlled substance, which means it has some potential for abuse and dependence. This is part of why it's only administered in supervised settings. Your provider will monitor you for signs of misuse throughout treatment.
How much does it cost?
Without insurance, Spravato runs roughly $700–$1,200 per dose for the medication itself, plus facility and monitoring fees. With commercial insurance, most patients pay between $10 and $125 per session after meeting their deductible. Medicare typically covers 80% under Part B. Janssen's "Spravato withMe" copay assistance program can reduce out-of-pocket costs to as little as $10 per session for eligible commercially insured patients, with an annual cap. The program does not apply to Medicare or Medicaid enrollees.
Will my insurance cover it?
Most major insurers — including Aetna, Anthem/BCBS, Cigna, UnitedHealthcare, Medicare, and most state Medicaid plans — cover Spravato for approved indications, but prior authorization is almost always required. Insurers typically want documentation that you've tried and not adequately responded to at least two oral antidepressants.