Roughly 30 percent of people with major depressive disorder do not reach remission even after two adequate antidepressant trials — a reality that challenges both patients and the providers trying to help them. SPRAVATO® is one of the few treatments to receive FDA approval specifically for this population, and yet many Houston-area patients who would qualify have never been offered it. At our Bellaire practice, we have made it a priority to ensure that every patient who might benefit from SPRAVATO® understands what it is, how it works, and what to realistically expect.
What Is SPRAVATO® and How Is It Different From IV Ketamine?
SPRAVATO® is the brand name for esketamine nasal spray, a medication developed from one of the chemical components of ketamine. It is important to understand that SPRAVATO® is a distinct drug from IV ketamine — it is administered differently, has its own FDA approval history, and operates under a specific Risk Evaluation and Mitigation Strategy, or REMS, program that the FDA requires for its use. SPRAVATO® is FDA-approved for two indications: treatment-resistant depression (TRD) in adults who have not responded adequately to at least two different antidepressants, and major depressive disorder with acute suicidal ideation or behavior (MDD with ASIB). This makes it one of the most precisely targeted approvals in modern psychiatric pharmacology. Because of the REMS program requirements, SPRAVATO® must be administered in a certified healthcare setting and patients must be monitored for at least two hours after each dose — it is not a medication patients take home.
The SPRAVATO® Treatment Experience in Bellaire, TX
At Dr. Prashad’s Bellaire office, the SPRAVATO® experience is designed around both clinical rigor and patient comfort. On the day of your session, you arrive at the office, self-administer the nasal spray under our supervision, and then rest in a monitored environment while the medication takes effect. The monitoring period is non-negotiable per REMS requirements, but many patients find it surprisingly manageable — we create a calm setting with dimmed lighting and a comfortable reclining space. After the monitoring period, patients must arrange transportation home, as SPRAVATO® affects cognition and reaction time in the hours following administration.
The dosing schedule for SPRAVATO® begins with an induction phase: twice-weekly administration for the first four weeks. This is followed by a maintenance phase, initially once weekly for the next four weeks, and then once weekly or once every two weeks thereafter, depending on how a patient is responding. This graduated schedule is grounded in the clinical trial data submitted to the FDA and reflects the time it takes for the glutamatergic and neuroplastic mechanisms to produce sustained benefit. We coordinate the SPRAVATO® schedule carefully alongside any oral antidepressants a patient is taking, as SPRAVATO® is generally used in combination with an oral antidepressant rather than as a standalone treatment.
Insurance, Cost, and Practical Considerations
Insurance coverage is one of the most meaningful distinctions between SPRAVATO® and IV ketamine treatment. Because SPRAVATO® carries FDA approval for TRD, it has a legitimate pathway for coverage under many commercial insurance plans and some Medicare Part D programs. The insurance landscape is complex — coverage depends on your specific plan, prior authorization requirements, and documentation of prior treatment failures — but our clinical and administrative team is experienced in navigating these processes. We assist patients with prior authorization paperwork and can help clarify what documentation is needed to build the strongest possible case for coverage. This is one reason some patients for whom both SPRAVATO® and IV ketamine might be appropriate ultimately pursue SPRAVATO® first.
One barrier we encounter frequently is a patient’s concern about whether SPRAVATO® is “strong enough” compared to IV ketamine. This is a reasonable question grounded in an understandable misperception. SPRAVATO® is not a diluted or lesser form of treatment — it is a distinct, rigorously studied, FDA-approved therapy with its own mechanism and clinical evidence base. Clinical trial data shows antidepressant effects typically observed within days of beginning treatment, and many patients in the pivotal trials experienced significant and durable improvement. To understand more about how this medication works at the neurological level, our post on how SPRAVATO® works for treatment-resistant depression provides a detailed overview. Results vary by individual, and we always discuss the full range of outcomes observed in the research with patients before they commit to a treatment plan.
A second barrier — and one that carries real weight for many patients — is the time commitment involved. Twice-weekly visits during the induction phase, each lasting at least two hours, can feel incompatible with work schedules, childcare responsibilities, or simply the fatigue that accompanies a depressive episode. We take this concern seriously. Our scheduling team works with patients to find appointment times that minimize disruption to their daily obligations, and we often find that patients who initially worried about the time investment describe the monitored rest period, once they experience it, as unexpectedly restorative. We encourage patients to discuss scheduling concerns openly with us before assuming SPRAVATO® is not logistically feasible.
SPRAVATO® is not the right choice for every patient with treatment-resistant depression, and our evaluation process is designed to help clarify which path makes the most sense for each individual. Patients with certain cardiovascular conditions, a history of psychosis, or specific contraindications may not be candidates, and we review all of this carefully during the initial consultation. For patients who are not SPRAVATO® candidates or who have already tried it, understanding the full landscape of treatment-resistant depression options — including IV ketamine and Deep TMS (FDA-cleared) — is an important part of the conversation. The path that fits your situation is one we take seriously, and we encourage patients to bring their full history and their questions to that first appointment.
Frequently Asked Questions
Is SPRAVATO® the same as ketamine?
No. SPRAVATO® is esketamine, one of the chemical components of the ketamine molecule, but it is a distinct FDA-approved drug administered as a nasal spray in a certified clinical setting. IV ketamine, by contrast, is used off-label for psychiatric conditions and is not FDA-approved for depression. While both act on the glutamate system, their administration routes, regulatory status, insurance pathways, and clinical protocols differ meaningfully.
Will my insurance cover SPRAVATO®?
Many commercial insurance plans and some Medicare programs cover SPRAVATO® for patients who meet clinical criteria, including documentation of at least two prior inadequate antidepressant trials. Coverage is not automatic — prior authorization is typically required — but our team has significant experience assisting patients through this process. We recommend discussing your specific plan during the consultation so we can guide you through what documentation will be needed.
How long does a SPRAVATO® treatment session take?
Each session involves self-administering the nasal spray under clinical supervision followed by a mandatory two-hour monitoring period per the FDA’s REMS program requirements. You should plan for at least two and a half to three hours total for each appointment, including intake and discharge. You will need a designated driver or transportation service home.
How soon will I notice effects from SPRAVATO®?
Many patients in clinical trials began noticing antidepressant effects within days of their first or second session. The induction phase of twice-weekly dosing over four weeks is designed to build and consolidate these early gains. Results vary by individual, and some patients require the full induction period before experiencing meaningful relief. We monitor your progress closely and adjust accordingly.
Can I use SPRAVATO® alongside my current antidepressant?
Yes — SPRAVATO® is typically prescribed in combination with an oral antidepressant. It is not generally used as a standalone treatment. Dr. Prashad reviews your current medication regimen as part of the initial evaluation and coordinates the SPRAVATO® protocol with your existing psychiatric care.
Key Takeaways
- SPRAVATO® is FDA-approved specifically for treatment-resistant depression (TRD) and MDD with acute suicidal ideation or behavior — two distinct and precise clinical indications.
- SPRAVATO® is a different drug from IV ketamine and must be administered in a certified healthcare setting under REMS protocol requirements.
- Unlike IV ketamine, SPRAVATO® has insurance coverage pathways for qualifying patients, and our team assists with prior authorization.
- The treatment schedule involves twice-weekly sessions for the first four weeks, followed by a maintenance phase — a time commitment worth discussing openly before beginning.
- Results vary by individual; Dr. Prashad evaluates each patient’s full history to determine whether SPRAVATO® or another treatment approach is the best fit.
If you have been living with treatment-resistant depression and have not yet explored SPRAVATO®, we encourage you to schedule a consultation at our Bellaire office. Dr. Prashad will review your history, your current medications, and your goals with the same attention she brings to every patient — and she will give you an honest, clear-eyed picture of what SPRAVATO® might mean for you specifically. Discuss with your provider all available options, and let us help you determine whether this FDA-approved treatment belongs in your care plan.
References
U.S. Food and Drug Administration — SPRAVATO® Approval: https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trials-snapshots-spravato
American Psychiatric Association: https://www.psychiatry.org/patients-families/depression/what-is-depression
National Institute of Mental Health — Treatment-Resistant Depression: https://www.nimh.nih.gov/health/topics/depression
JAMA Psychiatry — Esketamine Clinical Trials: https://jamanetwork.com/journals/jamapsychiatry
SPRAVATO® REMS Program: https://www.spravatorems.com/
About Dr. Sandhya Prashad
Dr. Sandhya Prashad, MD, is a board-certified psychiatrist who has been treating patients in the Houston area since 2011, specializing in treatment-resistant depression and interventional psychiatric care. She has personally administered over 9,000 treatments for patients whose depression has not responded to traditional antidepressants, developing deep expertise in the neurobiological factors—including seasonal triggers, environmental stressors, and genetic predisposition—that shape treatment response. Dr. Prashad’s practice offers IV ketamine therapy, SPRAVATO® (esketamine), and comprehensive psychiatric evaluation, with a commitment to finding a path forward even for the most complex and long-standing cases.
Medical Disclaimer
The information provided in this article is intended for educational purposes only and does not constitute medical advice. It is not a substitute for professional psychiatric evaluation, diagnosis, or treatment. Results vary by individual, and not all patients will respond the same way to SPRAVATO®. Always discuss your treatment options with a qualified medical provider before making any changes to your care plan. If you are experiencing a psychiatric emergency or thoughts of self-harm, please call 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room immediately.