SPRAVATO® (Esketamine) Nasal Spray
An FDA-approved treatment for adults with treatment-resistant depression — administered and monitored in our Beachwood, Ohio office.
Interventional Psychiatry · Beachwood, Ohio
A different pathway when antidepressants haven't worked
If you have lived with depression that keeps returning despite trying one medication after another, the exhaustion is real — and it isn't a personal failure. Depression that doesn't respond to two or more adequate antidepressant trials has a name: treatment-resistant depression (TRD), and it calls for a different approach.
CarePoint Infusion Center offers SPRAVATO® (esketamine) CIII nasal spray, an FDA-approved medication that works through a completely different brain pathway than the daily pills you have already tried. It is not experimental and not a wellness trend — it is a rigorously studied prescription therapy that must be given in a certified medical setting with monitoring after every dose.
What SPRAVATO is approved to treat
SPRAVATO is FDA-approved for adults with treatment-resistant depression, and for depressive symptoms in adults with major depressive disorder (MDD) who have acute suicidal ideation or behavior. It is not a first-line treatment and is not approved for children or adolescents.
SPRAVATO® is a registered trademark of Janssen Pharmaceuticals, Inc. CarePoint Infusion Center is an independent provider and is not affiliated with or endorsed by Janssen.
How SPRAVATO works differently
Most antidepressants — SSRIs and SNRIs — work by gradually raising levels of serotonin or norepinephrine. That process usually takes four to six weeks before you notice anything, and for some people it never delivers meaningful relief.
Esketamine acts on an entirely different system. It blocks the NMDA receptor, part of the brain's glutamate network, which triggers a rapid downstream cascade that helps strengthen and rebuild connections between neurons.
A useful way to picture it: prolonged stress and long-standing depression can cause the communication branches between brain cells to thin out and retract. Rather than simply adjusting the chemical signal traveling along those pathways, esketamine helps encourage the pathways themselves to regrow. That structural repair is why relief can appear far faster than with a daily pill — sometimes within the first 24 to 48 hours — and why SPRAVATO can help some people who never responded to serotonin-based medications.
Realistic expectations
Rapid relief happens for some patients, but not everyone. Many people need several sessions before noticing a clear, sustained change in mood, motivation, or clarity. Your response is formally reassessed at the end of the four-week induction phase.
SPRAVATO vs. IV ketamine at CarePoint
We offer both SPRAVATO and IV ketamine therapy. Patients often ask which is "better" — but they are genuinely different tools that suit different situations. Here is how they compare.
| SPRAVATO® (esketamine) | IV Ketamine | |
|---|---|---|
| Formulation | Esketamine — the S-enantiomer of ketamine | Racemic ketamine — both R- and S-enantiomers |
| How it's given | Nasal spray you self-administer under direct staff observation | Intravenous infusion placed and managed by an infusion nurse |
| FDA status | FDA-approved for TRD and for MDD with acute suicidal ideation or behavior | FDA-approved as an anesthetic; used off-label for mood and pain conditions |
| Regulatory program | Available only through the SPRAVATO REMS program | Not REMS-regulated |
| Conditions treated | Severe depression meeting the approved indications | Broader use, including depression, PTSD, anxiety, and certain chronic pain conditions |
| Monitoring | Minimum two-hour observation required after every dose | Monitored during the infusion plus a shorter recovery period |
| Coverage | Often billable to insurance when criteria are met; prior authorization required | Typically self-pay, since off-label use is rarely covered |
The practical difference for most patients comes down to two things: insurance coverage and what you're treating. SPRAVATO offers an insurance-billable route for approved depression indications, while IV ketamine remains valuable for conditions outside those indications, such as chronic pain. Our team will talk through both with you and your referring provider.
What a SPRAVATO session looks like
SPRAVATO is never dispensed for home use. Every dose is taken in our office, under observation, following the same structured process.
- Check-in and baseline vitals A team member reviews how you have been doing since your last visit and records your baseline blood pressure before any medication is given.
- You self-administer the spray Each single-use device delivers 28 mg — one spray in each nostril. Depending on your prescribed dose, you will use two devices (56 mg) or three (84 mg), with a five-minute rest between each one.
- You settle in and rest You recline in a private, comfortable room. Most people feel the effects begin within minutes.
- Two-hour monitored observation Staff check your blood pressure at roughly 40 minutes and again before discharge, watching for sedation or dissociation to resolve. This monitoring period is required after every single dose.
- Discharge with your ride You are released only once a provider confirms you are alert and stable, into the care of the person driving you home.
How to prepare
- No solid food for 2 hours before your appointment — this substantially reduces the chance of nausea.
- No liquids for 30 minutes before your scheduled dose.
- If you use a nasal decongestant or steroid nasal spray, use it at least 1 hour before so it doesn't interfere with absorption.
- Arrange your ride home before you arrive. This is required, not optional.
- Wear loose, comfortable clothing with sleeves that roll up easily for blood pressure checks.
- Consider bringing an eye mask and headphones with calm instrumental music — many patients find this makes the two hours far more restful.
No driving on treatment days
Esketamine impairs alertness, judgment, and motor coordination. You must not drive, operate machinery, or make significant decisions for the remainder of the day. Most patients can resume normal activities the next day after a full night's sleep.
The treatment schedule
SPRAVATO follows a defined cadence that starts intensive and tapers as you stabilize. Plan for roughly three hours per visit, including check-in and the monitoring period.
Induction
Two sessions per week. This is the most demanding stretch, and it's when the neuroplastic changes behind symptom relief begin.
Optimization
Once weekly, if you responded during induction. Your provider evaluates progress before this transition.
Maintenance
Every one or two weeks, individualized to how you're doing. The goal is preserving gains with the least frequent dosing that works.
Dosing for treatment-resistant depression typically starts at 56 mg and may be adjusted to 84 mg based on response and tolerability. For MDD with acute suicidal ideation or behavior, the protocol uses 84 mg twice weekly for four weeks alongside standard psychiatric care. Your exact plan is set by your prescriber.
Important safety information
Boxed Warning
SPRAVATO carries an FDA Boxed Warning for:
- Sedation and dissociation — temporary drowsiness and a sense of disconnection from yourself or your surroundings
- Respiratory depression — slowed breathing, which is why on-site monitoring is mandatory
- Abuse and misuse potential — esketamine is a Schedule III controlled substance
- Increased risk of suicidal thoughts and behaviors in patients under 25
Common effects during a session
The most frequent experiences are temporary and typically resolve before you leave. These include dissociation, dizziness or a spinning sensation, nausea, sedation, headache, a numb sensation in the nose or throat, and a short-lived rise in blood pressure that usually peaks around 40 minutes after dosing. In long-term studies, the large majority of dissociation and sedation events resolved the same day.
Who should not take SPRAVATO
SPRAVATO is not appropriate if you have:
- Aneurysmal vascular disease of the brain, chest, or abdomen
- An arteriovenous malformation
- A history of intracerebral hemorrhage
- Known hypersensitivity to esketamine, ketamine, or any component of the formulation
It is also not recommended during pregnancy or breastfeeding, and uncontrolled hypertension or unstable cardiovascular disease requires careful evaluation before treatment. Our clinical team reviews your full medical history, current medications, and blood pressure control before you begin.
This page is a summary
The information here does not replace the full Prescribing Information, including the Boxed Warning and Medication Guide, or a conversation with your prescriber. Ask us for the complete Prescribing Information at any point.
The SPRAVATO REMS program
Because of the risks above, the FDA restricts SPRAVATO to a controlled distribution system called a Risk Evaluation and Mitigation Strategy (REMS). You cannot pick it up at a retail pharmacy, and it is never sent home with you.
Treatment can only take place in a certified healthcare setting, and before your first dose you will enroll in the REMS program. Enrollment involves a counseling conversation covering sedation, dissociation, and blood pressure effects, followed by signing a patient enrollment form in which you agree to:
- Remain on-site for the full monitoring period after every dose
- Not drive or operate machinery until the next day, after restful sleep
- Take each dose only in the clinic, under supervision
After every session, our clinical team documents your blood pressure readings, any sedation or dissociation, and your discharge status — and reports required information to the REMS program. These requirements exist to keep this treatment safe, and we build them into every visit rather than treating them as paperwork.
Insurance and cost
This is one of the clearest practical advantages of SPRAVATO over off-label IV ketamine. Because SPRAVATO is FDA-approved for specific depression indications, it is generally recognized as medically necessary and is covered by many commercial plans, Medicare, and Ohio Medicaid managed care plans when criteria are met.
Coverage is never automatic, though. Nearly every payer requires prior authorization before your first dose. Our administrative team handles that process for you, which typically requires:
- A documented diagnosis of treatment-resistant depression, or MDD with acute suicidal ideation or behavior
- A record of at least two prior antidepressant trials — medication names, doses, duration, and why each was stopped
- Recent standardized depression scores, such as a PHQ-9 or MADRS
Even with approval, deductibles and coinsurance can leave a balance. Eligible patients with commercial insurance may qualify for the manufacturer's SPRAVATO withMe savings program, which can substantially reduce out-of-pocket medication cost. Federal rules prohibit patients with Medicare, Medicaid, TRICARE, or other government coverage from using manufacturer copay assistance.
We verify your benefits first
Before you commit to anything, our team confirms your specific coverage, estimated cost per session, and assistance eligibility. Call 216-755-4044 to start a benefits check.
For referring providers
CarePoint functions as an interventional partner, not a replacement for your care. We handle drug procurement, administration, REMS documentation, monitoring, and prior authorization. You remain the patient's primary psychiatric provider, managing their oral regimen, therapy, and longitudinal care. We send treatment documentation back to your office.
To initiate a referral, please include:
- Documented diagnosis of TRD, or MDD with acute suicidal ideation or behavior
- Detailed antidepressant trial history — agents, maximum doses, duration, and reason for discontinuation
- Recent PHQ-9 or MADRS scores
- Relevant medical history, including blood pressure control and any vascular contraindications
Call 216-755-4044 or fax records to 330-967-0571 and our referral coordinator will begin verification and REMS enrollment.
Common questions
Do I stop my current antidepressant?
Usually not. SPRAVATO is most often used alongside a daily oral antidepressant, and it is designed to augment that treatment rather than replace it. Keep taking your current medications unless your prescribing psychiatrist directs otherwise. Bring a full medication list to your intake visit so we can review for interactions.
What does dissociation actually feel like?
Most people describe a floaty, dreamlike sensation — a feeling of distance from their body, altered sense of time, or unusual visual impressions. It can feel strange the first time, which is why we prepare you for it in advance. It typically fades well within the two-hour monitoring window, and staff are with you throughout.
How soon might I feel better?
Some patients notice a meaningful lift within 24 to 48 hours of the first session, including reduced suicidal thoughts. Others need several sessions before the change becomes clear. We formally assess response at the end of the four-week induction phase to decide whether to continue.
Why is my blood pressure checked so often?
Esketamine can temporarily raise blood pressure, generally peaking around 40 minutes after dosing before returning toward baseline. We check before dosing, around the 40-minute mark, and again before discharge. This is also why a history of aneurysm, AV malformation, or brain hemorrhage rules out treatment.
How long will I be in the office?
Plan for about three hours: check-in and vitals, dosing with rest periods between devices, and the required two-hour monitoring. Bring something comfortable to rest with — most patients prefer quiet over screens.
Is SPRAVATO a cure?
No. It is a powerful catalyst for recovery, not a standalone cure. The strongest outcomes come from combining SPRAVATO with ongoing psychiatric care, therapy, and your oral medication regimen. Many patients continue maintenance dosing to protect the gains they've made.
Take the next step
If depression has not responded to the medications you have tried, SPRAVATO may be worth discussing. Our team will review your history, verify your benefits, and coordinate with your psychiatrist or primary care provider.
If you are in crisis right now
This page is not for emergencies. If you are having thoughts of harming yourself, call or text 988 (Suicide & Crisis Lifeline), call 911, or go to your nearest emergency department.
Serving Northeast Ohio Communities
CarePoint Infusion Center provides SPRAVATO (esketamine) treatment and IV ketamine therapy throughout Northeast Ohio. We're located in Beachwood, convenient to Cleveland and communities across Cuyahoga County. Whether you're searching for a SPRAVATO provider near you in Cleveland, esketamine treatment in Beachwood OH, or depression care anywhere in Northeast Ohio, we're here to help.
We conveniently serve patients from:
And throughout Cuyahoga County and Northeast Ohio. Contact us today to learn about SPRAVATO treatment in Beachwood or Cleveland, Ohio.
Related pages
- IV Ketamine Therapy — our infusion-based option for depression, anxiety, and chronic pain
- Ketamine for PTSD & Trauma
- What Does Ketamine Therapy Feel Like?
- Ketamine vs. Traditional Antidepressants
Selected references
- SPRAVATO® (esketamine) Prescribing Information, including Boxed Warning and Medication Guide. Janssen Pharmaceuticals. spravato.com
- U.S. Food and Drug Administration. FDA approves new nasal spray medication for treatment-resistant depression. fda.gov
- Popova V, et al. Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression (TRANSFORM-2). Am J Psychiatry. 2019. PubMed
- Daly EJ, et al. Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Treatment-Resistant Depression (SUSTAIN-1). JAMA Psychiatry. 2019. PubMed
- National Institute of Mental Health. Depression — overview and treatment options. nimh.nih.gov
Medical disclaimer: This page is general educational information and does not replace the full Prescribing Information or medical advice from your provider. SPRAVATO is a Schedule III controlled substance available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS). Eligibility, dosing, and response vary by individual and are determined by your prescriber. SPRAVATO® is a registered trademark of Janssen Pharmaceuticals, Inc.