Excel Psychiatry

What is Spravato Treatment? When is Spravato Right for My Depression Treatment


Quality sleep is a cornerstone of overall well-being, playing a pivotal role in both physical and emotional health. When we talk about the importance of sleep, we’re referring to the intricate processes that occur during those restful hours, allowing our bodies and minds to recharge and rejuvenate. Physically, sleep is the time when our cells repair and regenerate, muscles rebuild, and the immune system strengthens its defenses. Emotionally, it acts as a crucial reset button, influencing mood regulation, stress resilience, and cognitive functions. 

In this blog, we will delve deeper into the profound impact that adequate and restful sleep can have on various aspects of our health, shedding light on its significance in maintaining a balanced and fulfilling life.

Understanding Treatment-Resistant Depression

Treatment-resistant depression (TRD) is a complex and challenging condition that warrants careful consideration. When depressive symptoms endure despite multiple attempts with traditional antidepressants, it can severely impede an individual’s ability to lead a fulfilling life. 

TRD is not a sign of personal failure but rather an indication that the standard treatment approaches may not be effectively addressing the underlying causes of depression. In such cases, exploring alternative treatments, such as Spravato, becomes imperative to offer new avenues for relief and recovery.  

What is Spravato?

Spravato is a relatively new medication approved by the FDA in 2019 for the treatment of TRD. It is closely related to ketamine. Unlike traditional antidepressants, Spravato is delivered through a nasal spray, making it an accessible and convenient treatment option. Spravato works differently than other antidepressants by acting on certain neurotransmitters in the brain. 

Let’s explore how does Spravato work:

  1. NMDA Receptor Modulation

Spravato works by targeting and modulating a specific receptor in the brain called the N-methyl-D-aspartate (NMDA) receptor. This receptor plays a crucial role in the regulation of mood, cognition, and pain perception. By binding to the NMDA receptors, Spravato helps regulate the release of certain neurotransmitters in the brain, including glutamate. 

  1. Enhanced Glutamate Signaling

Glutamate is the most abundant excitatory neurotransmitter in the brain. It acts as a chemical messenger, facilitating communication between neurons. In individuals with depression, there is evidence of reduced glutamate signaling. Spravato’s mechanism of action involves increasing glutamate release and enhancing overall glutamate signaling, potentially leading to mood improvement. 

  1. Synaptic Plasticity and Neuroplasticity

One theory regarding the therapeutic effect of Spravato involves synaptic plasticity and neuroplasticity. Synaptic plasticity refers to the brain’s ability to form new connections and strengthen existing ones. Neuroplasticity, on the other hand, is the brain’s ability to reorganize itself and create new pathways. 

By modulating the NMDA receptor and enhancing glutamate signaling, Spravato may promote synaptic and neuroplasticity. This can facilitate the formation of new neural connections and potentially counteract the negative impact of depression on brain circuitry. 

When is Spravato Right for My Depression Treatment?

When considering Spravato as part of depression treatment, several factors come into play. Determining when Spravato is the right choice involves assessing individual circumstances and treatment needs. Here are key considerations:

  1. When traditional antidepressants fail: If you have tried two or more antidepressant medications without success, it might be time to consider Spravato. This medication is specifically designed for individuals who have not responded adequately to other treatments. 
  1. Severe symptoms: If your depression symptoms are severe, including feelings of hopelessness, suicidal thoughts, or an inability to function normally, Spravato may be a viable option. Its fast-acting properties can provide relief when time plays a critical role in your recovery. 
  1. Rapid relief: Unlike traditional antidepressants that may take several weeks to show any effect, Spravato can provide rapid relief. Many individuals report experiencing a significant reduction in depressive symptoms within hours or days after using the nasal spray. 
  1. Enhanced therapy efficacy: Spravato is administered under the supervision of a healthcare professional in a controlled setting. It is typically used in combination with oral antidepressants and therapy sessions, amplifying the efficacy of your overall treatment plan. 
  1. History of treatment discontinuation: If you have previously discontinued antidepressant treatment due to severe side effects or unsatisfactory results, Spravato could be a viable alternative. Its unique mechanism of action may offer a fresh approach to managing your depression symptoms. 
  1. Consultation with a healthcare professional: Ultimately, the decision to use Spravato should be made in consultation with a qualified healthcare professional. They will evaluate your medical history, previous treatment attempts, severity of symptoms, and potential risks associated with Spravato to determine whether it is the most suitable option for you. 

What Does Spravato Feel Like?

Experiencing Spravato, like any medication, can vary from person to person. As an esketamine nasal spray designed to address treatment-resistant depression, the sensations associated with Spravato can be unique. Individuals who have undergone Spravato treatment commonly report a sense of dissociation or detachment from their surroundings during the administration. 

Some may describe a feeling of euphoria or light-headedness, while others might notice changes in perception. It’s essential to understand that these effects are temporary and typically dissipate shortly after the treatment session concludes. Importantly, the subjective experience of Spravato is part of its therapeutic process, influencing the brain’s neurotransmitters to alleviate depressive symptoms. 

However, individual responses can vary, and it’s crucial to discuss any concerns or sensations experienced during Spravato sessions with your healthcare provider to ensure a personalized and effective treatment approach.

Spravato VS Ketamine

When comparing Spravato and traditional ketamine, it’s crucial to recognize their shared origin while understanding key distinctions. Both medications involve the use of ketamine, but Spravato is a specific formulation of esketamine, a component of ketamine. 

Spravato is administered as a nasal spray, offering a more controlled and convenient method compared to traditional ketamine, which is typically administered intravenously.

Spravato VS Ketamine





Nasal spray

Intravenous infusion


Self-administered under supervision

Requires clinical setting

Onset of Action

Rapid, within hours

Rapid, within minutes

Frequency of Sessions

Regular schedule as prescribed

Varies, often multiple sessions


More convenient for at-home use under supervision

Requires clinical visits

Regulatory Approval

FDA-approved for treatment-resistant depression

Off-label use for depression, approved for anesthesia and pain management


Varies, insurance coverage may apply

May involve higher clinic costs

Spravato VS Infusion

Spravato and ketamine infusions are both emerging treatments for depression, yet they differ in administration and application. Spravato utilizes a nasal spray format, providing a self-administered option under healthcare supervision. On the other hand, ketamine infusions involve the intravenous delivery of ketamine in a controlled clinical setting.

Spravato VS Infusion



Ketamine Infusion


Nasal spray for self-administration

Intravenous infusion by medical professionals

Treatment Setting

Clinic or at-home under supervision

Clinical setting under professional supervision

Duration of Session

Shorter sessions

Longer infusion sessions


Regular healthcare supervision

Continuous monitoring during infusion

Treatment Response

Variable, patient-dependent

Variable, patient-dependent


More flexible due to self-administration option

Less flexibility, requires clinic visits

Risk Profile

Generally well-tolerated with potential side effects

Side effects may vary, closely monitored in clinical settings

Spravato VS TMS

When considering treatment options for depression, both Spravato and Transcranial Magnetic Stimulation (TMS) offer distinct approaches.




Mechanism of Action

Modulates glutamate system

Non-invasive magnetic stimulation


Nasal spray

External magnetic coil application

Treatment Setting

Clinical supervision

Office-based, outpatient

Onset of Action

Rapid, within hours

Gradual, over weeks of sessions

Frequency of Sessions

Regular schedule as prescribed

Typically daily sessions for several weeks

Side Effects

Potential side effects, closely monitored

Generally well-tolerated, mild scalp discomfort possible

Treatment Response

Variable, patient-dependent

Gradual improvement over sessions


Varies, insurance coverage may apply

Costs may vary, insurance coverage possible

Choosing between Spravato and TMS depends on factors like individual treatment history, preferences, and the nature of the depression. A comprehensive discussion with healthcare professionals is essential to determine the most suitable approach for addressing depressive symptoms effectively.

How Long Does Spravato Last?

The duration of Spravato’s effects can vary from person to person, and it’s influenced by factors such as individual response, dosage, and the frequency of administration. 

Generally, the acute effects of a single Spravato session may last for a few hours. However, the therapeutic impact on depressive symptoms is often achieved through a series of sessions over an extended period. The frequency of Spravato sessions is typically determined by a healthcare professional based on the individual’s response to treatment. 

It’s essential to follow the prescribed treatment plan to maximize the potential benefits of Spravato. While some individuals may experience a rapid and sustained improvement in their depressive symptoms, others may require ongoing maintenance sessions to sustain the positive effects over the long term. 

The duration of Spravato’s efficacy underscores the importance of regular communication with healthcare providers to tailor the treatment plan to each individual’s unique needs and optimize long-term outcomes.

Final Thoughts

When traditional antidepressant treatments prove ineffective or intolerable, it may be time to consider alternative options such as Spravato. As a nasal spray medication that offers rapid relief from treatment-resistant depression symptoms, Spravato has shown promise in providing a fresh perspective on depression treatment. 

However, it’s essential to consult with a healthcare professional who can assess your unique circumstances and guide you toward the most suitable treatment plan. Remember, there is always hope, and with the support of medical professionals, you can explore all available options for managing your depression effectively.