If you've been living with depression that hasn't responded to antidepressants, you may have heard about Spravato (esketamine) — the first FDA-approved nasal spray for treatment-resistant depression. But knowing a treatment exists and understanding what it actually involves are two different things.
At Elevate Psychiatry in Miami, we offer Spravato treatment as part of our comprehensive approach to hard-to-treat depression. This guide walks you through exactly what to expect before, during, and after your Spravato treatment session — so you can walk in prepared and confident.
Spravato is the brand name for esketamine, a nasal spray derived from ketamine. It was approved by the FDA in 2019 specifically for adults with treatment-resistant depression (TRD) — meaning those who have tried at least two antidepressants without adequate relief — and in 2020 for major depressive disorder with acute suicidal ideation or behavior (MDSI).
Unlike traditional antidepressants that target serotonin or norepinephrine, Spravato works on the NMDA receptor system in the brain. This different mechanism of action is why it can work for people for whom conventional treatments have failed — and why it often produces results within hours to days rather than the weeks typical antidepressants require.
Because of its unique pharmacological profile, Spravato is only available through a restricted program called REMS (Risk Evaluation and Mitigation Strategy). This means it can only be administered at certified healthcare settings — like Elevate Psychiatry — under direct medical supervision. You cannot take it home.
Spravato may be right for you if you have been diagnosed with major depressive disorder (MDD), you have tried at least two different antidepressants at adequate doses and durations without sufficient improvement, you are 18 years of age or older, and you do not have certain contraindications such as aneurysmal vascular disease, history of intracerebral hemorrhage, or known hypersensitivity to esketamine or ketamine.
Our board-certified psychiatrists conduct a thorough evaluation before recommending Spravato. This includes reviewing your psychiatric history, prior medication trials, current medications, blood pressure baseline, and overall medical history.
Here is a detailed, step-by-step breakdown of what a Spravato session at Elevate Psychiatry looks like.
Do not eat for at least 2 hours before your session (small sips of water are okay up to 30 minutes before) — eating beforehand increases the risk of nausea. Avoid alcohol and cannabis the evening before and the morning of your session. Arrange transportation, as you will not be able to drive yourself home; a friend, family member, or rideshare is required. You will not be permitted to drive or operate heavy machinery for the rest of the day. Wear comfortable clothing — you will be reclining in a monitored setting for about two hours total.
When you arrive at our Miami office, a staff member will check you in and take your blood pressure. Spravato can temporarily elevate blood pressure, so we take a baseline reading before every session. If your blood pressure is too high, we may postpone the session to protect your safety.
You will be shown to a private, comfortable treatment room with a reclining chair. The room is calm and quiet. Many patients find it helpful to bring headphones and relaxing music for the session, though this is entirely optional.
The Spravato device contains a specific dose of esketamine (56 mg or 84 mg, as prescribed by your psychiatrist). Your provider will walk you through how to use the device. The spray is administered in two devices with each spray alternating nostrils, with a brief rest between sprays. If your dose is 84 mg, you will use a third device. The administration itself takes only a few minutes.
After administering the spray, you will relax in the treatment room for at least 2 hours. This is a required monitoring period under the REMS program. During this time, your blood pressure will be checked at regular intervals (typically at 40 minutes, 1 hour, and 1.5 hours post-dose), and a staff member will be available throughout.
You may experience dissociative effects — a sense of detachment, altered perceptions of time or space, or feeling "floaty." This is expected, temporary, and typically resolves before the monitoring period ends. Some patients feel drowsy, and it is perfectly fine to rest or nap. Nausea is possible; if you experience it, let your provider know. The dissociative experience is considered by many patients to be manageable, and some describe the session as calm or even meaningful.
Before you leave, your provider will check your blood pressure one final time and assess how you are feeling. When you are cleared to go, your designated driver will take you home. For the rest of that day, plan to relax at home. Most patients feel back to normal by the following morning.
Spravato treatment follows a structured schedule based on FDA-approved protocols. The induction phase covers the first 4 weeks with two sessions per week. The maintenance phase (weeks 5 through 8) involves one session per week. Ongoing maintenance from week 9 onward is one session every 1 to 2 weeks, based on your clinical response.
Many patients begin to notice improvement after the first or second session. Your psychiatrist at Elevate Psychiatry will monitor your progress closely and adjust the schedule as needed. Spravato is used alongside your existing oral antidepressant — it is an add-on treatment designed to break through medication-resistant depression, not a standalone replacement.
Yes — Spravato is FDA-approved and covered by many major insurance plans, including Medicare and Medicaid, when medically necessary criteria are met (typically documentation of two failed antidepressant trials). Prior authorization is almost always required. Our clinical team handles the prior authorization process and assists with documentation of your treatment history to support approval.
Janssen (the manufacturer) also offers a patient assistance program for those who are uninsured or underinsured. We can connect you with those resources during your evaluation.
Both Spravato and TMS (Transcranial Magnetic Stimulation) are FDA-approved, non-addictive options for treatment-resistant depression. The right choice depends on your history, preferences, and clinical profile. Read our detailed comparison: Spravato vs TMS for Treatment-Resistant Depression in Miami.
Elevate Psychiatry is a REMS-certified Spravato treatment center in Miami with multiple locations across South Florida. Our board-certified psychiatrists evaluate your candidacy and supervise every session. We offer comfortable, private treatment rooms designed for a calm and supportive experience, insurance navigation support including prior authorizations, integrated psychiatric care where Spravato is coordinated with your ongoing medication management and therapy, and same-week appointments available for new patients.
We serve patients throughout the Miami metro area including Brickell, Coconut Grove, Doral, and surrounding communities. Telehealth appointments are available for initial evaluations and follow-up care, though Spravato sessions must be in-person.
For a deeper look at the science behind esketamine, including how it compares to IV ketamine infusions and the full clinical evidence, read: Esketamine for Depression in Miami: How It Works and Who It Helps.
If you have been struggling with depression that has not responded to medication, Spravato may be the breakthrough you have been waiting for. Our team at Elevate Psychiatry is ready to help you find out if you are a candidate and guide you through every step of the process.
Call us at (305) 908-1115 or contact us online to schedule your Spravato evaluation in Miami today.
