Another way forward, with the same team beside you.
Spravato® is an FDA-approved nasal spray for adults with treatment-resistant depression. We give it in our certified clinic, and your care plan does not change hands to get it.
In-person in Louisville · Consultations by telehealth across Kentucky
What Spravato® actually is
A prescription nasal spray for adults with treatment-resistant depression, meaning depression that has not improved after two or more antidepressants at an adequate dose and duration. It is also approved for adults with major depressive disorder who are experiencing acute suicidal thoughts or behavior.
Where most antidepressants work on serotonin, esketamine acts on the brain's glutamate system through the NMDA receptor. A different mechanism, which is why it can help when the usual medications have not.
You self-administer the spray yourself, here, with a member of our team in the room. It is never dispensed for you to take home.
Two ways people qualify
Most patients arrive through one of these. If you are unsure which fits, that is exactly what the consultation is for.
Treatment-resistant depression
You may be a candidate if:
You are 18 or older
Moderate to severe major depressive disorder, confirmed on a standardized scale such as the PHQ-9
At least two antidepressants tried at an adequate dose and duration without meaningful improvement
Medical and psychiatric clearance for Spravato®
You can stay on-site for about two hours after each dose
Most people who come to us for Spravato® qualify through this pathway. If two medications have not worked, it is worth a conversation.
MDD with acute suicidal thoughts
A short-term option while you stabilize:
Major depressive disorder with current suicidal thoughts or behavior
Spravato® forms part of a broader safety and care plan. It does not replace hospitalization when that is what is needed
Medical and psychiatric clearance for Spravato®
Transportation home after each session
It starts as a conversation, not a form.
When Spravato® is not the right fit
It may not be appropriate with aneurysmal vascular disease, an arteriovenous malformation, a history of intracerebral hemorrhage, or other conditions where a rise in blood pressure would be dangerous. It is also not recommended during pregnancy or breastfeeding, or alongside an untreated substance use disorder. We would rather tell you at the consultation than after you have rearranged your life around a schedule.
Spravato® is a stage, not a standalone
Plenty of clinics will dose you and send you on your way. Spravato® works best inside a plan, and here the plan already exists before you walk in.
Listen first
We start with your full treatment history: what you tried, at what dose, for how long, and what actually happened. That history is also exactly what your insurer needs to authorize treatment, so nothing gets asked twice.
Understand the whole picture
Sleep, stress, hormones and pharmacogenomic testing all inform whether Spravato® is the right next step, or whether something simpler was missed along the way.
Map a clear path
You see the full schedule before you start: how many visits, across how many weeks, what we are watching for at each stage, and what happens if it is not working.
Guide, don't hand off
Your therapist, your prescriber and your Spravato® team are the same team. Nobody gets re-explained to. Nothing falls between two offices.
Track and adjust
We measure symptoms at intervals rather than going on impressions, and we space out or stop treatment when the data says to.
The goal was never indefinite maintenance by default. It is stabilization, and then a plan you can actually sustain.
What the day actually looks like
Nobody tells you the small things, so here they are. About two to two-and-a-half hours, door to door, most of it spent sitting somewhere quiet while we keep an eye on you.
Eat lightly
Nothing to eat for two hours before, and nothing to drink for the last thirty minutes.
Take your medications
Everything you normally take, at the normal time, unless your prescriber has told you otherwise.
Leave these out
No alcohol, cannabis or recreational drugs. No other nasal spray in the two hours beforehand.
Bring what settles you
Headphones, a blanket, an eye mask. Anything that makes two quiet hours easier.
Dress in layers
The rooms run cool and you will be sitting a while.
Arrange your ride
A responsible adult or a rideshare. You cannot drive yourself home, not even the next block.
Bring ID and your card
Photo ID and your insurance card, every visit, not only the first.
Say something if today is off
A cold, a bad night, a change in medication. Tell us at check in rather than pushing through.
Check in
We welcome you, confirm your details and take your blood pressure.
See your provider
A short conversation before dosing. How the last session went, how today feels, anything you want to ask.
The dose itself
You spray it yourself, with us in the room. This part is over in a few minutes.
Rest
You settle somewhere comfortable and we monitor you throughout. Most people listen to something. Some sleep.
Snack and water
Provided, once you are ready for it. Your blood pressure is checked again here.
Home
When your vitals and your provider both clear you, your ride takes you home. Plan on resting the remainder of the day.
About two to two-and-a-half hours, door to door. Bring less than you think you need and more than you think you will read.
However you like to spend two quiet hours
That is the standard course. Your prescriber sets the real pace and adjusts it based on how you respond, which is the whole reason we measure rather than guess.
Insurance authorizes Spravato® a block of sessions at a time. We track where you are against that block and start the renewal before you reach the end of it, so the schedule does not stall waiting on paperwork.
What we tell everyone before they start
Spravato® carries an FDA boxed warning, and it is given under a restricted program. We would rather you read that here, calmly, than find it somewhere else and wonder why we did not mention it.
It is never dispensed to you
Spravato® is not a prescription you fill at a pharmacy and take home. It is sent to a certified clinic and given there. No bottle leaves with you, which also means it cannot be lost, shared or taken incorrectly.
The clinic has to be certified
Not every practice can offer it. The setting, the staff and the monitoring are all part of what the FDA approved, not optional extras.
You are enrolled before the first dose
Every patient is registered in the manufacturer's safety program. We handle that paperwork before you start.
Two hours of monitoring is the rule
It is a requirement of the program, not a scheduling preference. Blood pressure at intervals, and a person checking on you throughout.
Dissociation
A sense of distance from your body, your surroundings or time. It is the effect people find strangest and it is expected.
Dizziness or a floating feeling
Usually strongest in the first forty minutes.
Nausea
Occasionally vomiting. Tell us and we can help.
Sleepiness
Many people doze. That is fine.
A rise in blood pressure
Which peaks around forty minutes and is the main reason we take readings.
A numb or reduced sense of touch
Temporary, and it fades before discharge.
A headache that runs into the next day
Anxiety that does not settle after the session
Feeling unsteady or drunk after you get home
Any new or worsening thoughts of harming yourself
Pain when urinating, or trouble passing urine
Anything that frightened you, even if it sounds small
Nothing on that list is too small to mention. We would rather hear something twice than not at all, and it is often the detail you almost left out that changes what we do next.
A boxed warning is the strongest warning the FDA issues. Spravato® carries one covering three things. Here is what it says, and what each part means for how your treatment is run.
Sedation and dissociation
You may feel sleepy and disconnected. This is why you are watched for two hours and why you cannot drive yourself home.
Potential for abuse and misuse
Esketamine is related to ketamine. Giving it under supervision, and never sending it home, is how that risk is managed.
Suicidal thoughts and behaviors
Antidepressants can increase suicidal thinking in people aged twenty four and younger. Spravato® is not approved for anyone under eighteen. Tell us about any change in mood, and we will ask you about it too.
No driving until the next day
And then only after a full night of sleep. This includes the evening of your appointment, however clear you feel.
Nothing you have to sign
Leave decisions, contracts and difficult conversations for tomorrow.
Someone around, if you can
Not required after the first few sessions, but most people prefer it early on.
None of this is a reason to avoid treatment. It is the reason treatment is given the way it is.
Spravato® (esketamine) is a registered trademark of Janssen Pharmaceuticals. This page is written to help you prepare for a conversation with your prescriber and is not a substitute for the FDA approved prescribing information or the Medication Guide, both of which you will be given before your first dose. Individual results vary and no outcome is implied or guaranteed. If you are pregnant, planning to become pregnant or breastfeeding, tell your prescriber before starting. If you are having thoughts of harming yourself, call or text 988 at any time.
The questions people actually ask
Mostly about money, timing and what happens if it does not work. Those are the right things to ask, so they are answered first.
No. You can contact us directly and we will book the consultation. If you already have a prescriber or therapist elsewhere, we will ask permission to speak with them, because their history of what you have tried is the fastest route to an authorization.
The consultation is usually within a week or two. The first dose comes after that, once your insurance has authorized it, which is the step that sets the real timeline.
No, and you should not stop anything without talking to us first. Spravato® is approved to be used alongside an oral antidepressant, not instead of one. If your current medication needs adjusting, that is a decision your prescriber makes with you.
Most of the major plans we work with do cover it for treatment resistant depression, subject to prior authorization. Coverage depends on your plan and your documented history, which is why the consultation collects that history properly the first time.
We will give you a written estimate before you commit to anything, covering the medication, the observation period and the visit itself. Nobody starts treatment here without knowing what it costs.
We track where you are against the approved block of sessions and start the renewal before you reach the end of it. If a renewal is ever declined, we will tell you immediately and talk through the options rather than quietly rescheduling you.
Some people notice a shift within the first week or two, which is faster than most oral antidepressants. Others take longer. We measure at set intervals rather than asking you to guess, so the answer for you comes from your own numbers.
Then we stop, and we say so. There is a point in the course where the data tells us whether this is helping, and if it is not, continuing is not in your interest. That conversation is part of the plan from the beginning, not a failure.
Tell us and we will reschedule. Missing one does not undo your progress. Repeated gaps do affect how well the course works and can complicate the authorization, so we would rather move a session than lose it.
Yes, and we would encourage it. If you would rather do therapy here so everything sits with one team, that is available too. Either way, the two halves need to be talking to each other.
You cannot drive afterwards, so the day of a session is not a normal working day. Most people book sessions later in the day or take the afternoon. By the following morning, after a full night of sleep, most are back to normal.
If the question you have is not here, it is probably a good one. Ask it on the consultation call and you will get a straight answer.
Begin your care journey →One conversation, and you will know more than you do now
You do not have to decide anything on that call. You will find out whether Spravato® is a reasonable next step for you, what it would cost, and how long it would take to start.
Most consultations are booked within two weeks
A call, or a form
Ten minutes. We ask what you have tried and what has been going on, and you ask us anything.
A consultation
With a prescriber, not a coordinator. This is where we decide together whether Spravato® is the right next step, or whether something else is.
We handle the authorisation
We assemble your history and submit it. You will know the outcome as soon as we do.
Whatever you decide, you will leave that call with a clearer picture than you came in with. That on its own is worth ten minutes.