SPRAVATO® (Esketamine) Treatment for Treatment-Resistant Depression in Chesapeake, VA
SPRAVATO® is designed to provide rapid relief for those who haven’t found success with other treatments. It helps ease persistent symptoms, enabling you to reconnect with the people and activities that matter most. Many clients report noticeable improvements after just a few sessions.
What is SPRAVATO®?
SPRAVATO® (esketamine) is a nasal spray medication derived from ketamine. It is FDA-approved for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior, used along with an oral antidepressant.
It works on the NMDA receptor in the brain — a different mechanism from standard antidepressants. SPRAVATO® has not been shown to prevent suicide or to reduce suicidal ideation or behavior, and it does not replace hospitalization when clinically needed.
Who is SPRAVATO® for?
It is for adults with treatment-resistant depression who haven’t responded adequately to at least two antidepressants.
Adults with major depressive disorder who have depressive symptoms with acute suicidal ideation or behavior, treated along with an oral antidepressant.
SPRAVATO® has extra safeguards to ensure it’s right for you.
We’re here to guide you every step of the way.
Step 1
Initial Evaluation
Meet with one of our providers to discuss your mental health history, current symptoms, and treatment goals. During this step, your provider will determine if you meet the criteria for SPRAVATO®, which includes having treatment-resistant depression (TRD) or major depressive disorder (MDD) with acute suicidal ideation or behavior, and a lack of adequate response to at least two prior antidepressant medications. Additionally, any medical conditions, medications, or contraindications will be reviewed to ensure SPRAVATO® is safe for you.
Step 2
Insurance Authorization
TRIP support staff will work with your insurance company to confirm coverage and obtain prior authorization for eligible SPRAVATO® treatment. SPRAVATO® assistance programs may also help with insurance navigation and financial support.
Step 3
Baseline Assessments
Further assessments may be conducted to establish a baseline of your symptoms and mental health status. Your physical health will also be assessed, as certain conditions may affect your ability to use SPRAVATO®.
Step 4
Treatment Initiation
SPRAVATO® must be administered in a certified healthcare facility under medical supervision. During your initial visit, you'll self-administer the nasal spray under the guidance of a healthcare provider and remain in the facility for at least two hours for monitoring to ensure there are no adverse side effects. Common effects like dizziness, dissociation, or sedation will be observed, and appropriate measures taken if needed.
Step 5
Ongoing Treatment Schedule
SPRAVATO® is usually administered twice weekly for the first four weeks during the induction phase. After this initial phase, sessions are typically reduced to once weekly, and then potentially to once every two weeks, based on your response and provider recommendations. SPRAVATO® is always used in conjunction with an oral antidepressant.
Step 6
Follow-Up Care
You’ll have scheduled follow-ups with your provider to track your progress, adjust dosages, and ensure the treatment is effective. Your provider will help you determine the appropriate duration of SPRAVATO® treatment and discuss how it fits into your broader mental health plan, including therapy, lifestyle changes, or other medications.
Our team of providers are here to ensure your best path forward
Justin Ray
Justin T. Ray, PMHNP-BC, is a highly experienced psychiatric nurse practitioner and founder of South Chesapeake Psychiatry and Transforming Minds Interventional Psychiatry in Chesapeake, Virginia. A retired Navy veteran, he is known for his innovative approach to mental health care and dedication to improving the lives of individuals with complex psychiatric needs.
Amanda Snow
Amanda is a Psychiatric Mental Health Nurse Practitioner Board Certified (PMHNP-BC). She has over eight years experience as a PMHNP-BC and twenty-five years experience in mental health. Amanda is a Retired Navy Nurse.
Alysha Cunningham
I am a board-certified Psychiatric Mental Health Practitioner that provides comprehensive and holistic medication management and therapeutic interventions for clients experiencing psychiatric distress. My primary goal is to provide care that is specifically tailored to your needs and goals and create an environment where you feel understood and supported.
Take back your life, one step at a time.
To explore whether TRIP / SPRAVATO® treatment is the right fit, contact our office to begin the eligibility and insurance review process.
Questions we hear often
Find answers to common questions about SPRAVATO® and what to expect.
SPRAVATO® (esketamine) is a nasal spray medication derived from ketamine. It is FDA-approved for adults with treatment-resistant depression (TRD) and for depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior, used along with an oral antidepressant. SPRAVATO® has not been shown to prevent suicide or to reduce suicidal ideation or behavior.
Spravato targets the NMDA receptor in the brain, promoting rapid improvement in depression symptoms by enhancing synaptic connections and restoring neural function.
SPRAVATO® is for adults with treatment-resistant depression — generally an inadequate response to at least two oral antidepressants — and for adults with MDD who have depressive symptoms with acute suicidal ideation or behavior, used together with an oral antidepressant. It is not a substitute for hospitalization when clinically needed.
Spravato is a nasal spray administered in a certified healthcare setting under supervision. Clients remain on-site for observation after administration.
Treatment begins with twice-weekly sessions for the first four weeks, then tapers to weekly or biweekly maintenance sessions based on individual needs.
Sessions typically last about 2-3 hours, including administration, observation, and recovery time.
Many individuals report improvements within hours or days, though full effects may take a few sessions.
Common side effects include dizziness, dissociation, nausea, drowsiness, increased blood pressure, or headaches. Most are temporary and subside after the session.
Response varies by individual. If Spravato is not effective, your provider will explore other treatment options.
No, clients must arrange transportation as they cannot drive until the following day.
While esketamine is a controlled substance, the risk of misuse is low due to the supervised administration and controlled dosing.
Spravato is not recommended for individuals with certain medical conditions, such as aneurysms, a history of substance abuse, or uncontrolled high blood pressure.
Yes, Spravato is typically used alongside an oral antidepressant and therapy for a comprehensive approach to treatment.
You’ll self-administer the nasal spray under supervision, then relax in a calm environment for observation. Providers monitor your response and vital signs.
Some clients experience dissociation or feelings of detachment, which typically resolve within the observation period.
Spravato is not recommended during pregnancy or breastfeeding. Discuss risks and alternatives with your provider.
Cost, insurance, and eligibility
SPRAVATO® Cost and Insurance Questions
Does insurance cover SPRAVATO®, and what will I actually pay?
Most commercial plans, Medicare, and many Medicaid plans cover SPRAVATO® for adults who meet the FDA criteria for treatment-resistant depression, but almost all of them require prior authorization first. TRIP is in-network with nearly every major plan; the one exception is TRICARE, which TRIP does not participate in, so TRICARE beneficiaries should call us first to discuss options. Your out-of-pocket cost depends on your deductible, copay or coinsurance, and whether the medication is billed under your medical or pharmacy benefit. Before your first session, TRIP verifies your benefits and tells you what to expect so there are no surprises.
What does prior authorization involve, and who handles it?
Insurers typically ask for documentation that you have major depressive disorder, that you have had an inadequate response to at least two antidepressants at adequate doses and durations, and that you will continue an oral antidepressant during treatment. Our team gathers the records, submits the request, and follows up with the insurer—you do not need to chase it. Approvals often take one to two weeks; if a request is denied, we can appeal with additional documentation.
Why does SPRAVATO® have to be given in a certified clinic, and is there copay help?
SPRAVATO® is only available through the FDA’s REMS program, which means it is administered in a certified treatment center like TRIP, with monitoring for at least two hours after each dose—it is never dispensed for home use. The manufacturer’s SPRAVATO withMe program offers a savings card that can substantially reduce the per-treatment cost for eligible clients with commercial insurance; our staff can help you check eligibility and enroll before you start.
I already see a psychiatric provider elsewhere. Can I still get SPRAVATO® through TRIP?
Yes. You can keep your existing prescriber or therapist and come to TRIP only for SPRAVATO® sessions. With your permission we coordinate with your current provider on your oral antidepressant and your progress. If you do not have a prescriber, South Chesapeake Psychiatry can provide the psychiatric evaluation and medication management alongside treatment.
Ready to see whether SPRAVATO® may be right for you?
Start with TRIP’s eligibility and insurance review.
