Esketamine Nasal Spray at a Glance

1) FDA-approved for the treatment of treatment-resistant depression (TRD) and depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior. Must be used in conjunction with an oral antidepressant.

2) Esketamine nasal spray (Spravato®) is the only FDA-approved ketamine-based depression treatment.

3) Available only through a restricted program called the Spravato® Risk Evaluation and Mitigation Strategy (REMS) Program. The medical staff at Greenbrook’s certified treatment centers are trained to prescribe, dispense, and administer Spravato®, and we have established processes and procedures in accordance with the REMS program. 

4) Covered by most major insurance following two failed antidepressant trials; Medicaid and Medicare accepted in select locations (Call 855-940-4867 for more information).

5) Performed in an office setting. Average treatment duration is 2 hours.  A typical treatment plan consists of: 

 • Phase One: 2 treatments a week for 4 weeks

 • Phase Two: 1 treatment a week for 4 weeks

 • Phase Three: 1 treatment every 1-2 weeks

 • Phase Four: Maintenance program consisting of 12-14 additional treatments

6) Common side effects include dissociative or perceptual changes (including distortion of time, space, and illusions), derealization, and depersonalization.

7) Possible contraindications:

 • History of abnormal blood vessels, such as an Arteriovenous Malformation or Aneurysm

 • History of hyper-sensitivity to esketamine or ketamine

 • High blood pressure that is not currently under control with medications or lifestyle management (blood pressure over 140/90)