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What Patients Need to Know Before, During, and After Treatment
At Nervana Medical, we offer SPRAVATO® (esketamine) as an evidence-based option for adults struggling with treatment-resistant depression (TRD) and, in certain cases, major depressive disorder (MDD) with suicidal thoughts or behaviors. This therapy is always provided in conjunction with strict medical supervision in our REMS certified clinic. If you are considering SPRAVATO® treatment in Sandy, Utah, understanding how it works and what to expect can help you feel informed, prepared, and supported throughout your care.
What Is SPRAVATO® (Esketamine)?
SPRAVATO® is an FDA-approved prescription nasal spray containing esketamine, a Schedule III controlled substance. Esketamine is the S-enantiomer of ketamine and works differently from traditional antidepressants by targeting glutamate pathways in the brain, which are involved in mood regulation and neuroplasticity.
SPRAVATO® is approved for:
- Adults with treatment-resistant depression (TRD)
- Adults with major depressive disorder (MDD) with acute suicidal thoughts or behaviors, when used with an oral antidepressant
Is SPRAVATO® the Same as Ketamine Infusions?
No. While SPRAVATO® and ketamine are related, they are not the same treatment.
Unlike ketamine infusions, SPRAVATO® is FDA-approved specifically for depression and is only available through certified clinics under a Risk Evaluation and Mitigation Strategy (REMS). Esketamine received FDA approval in 2019 for the treatment of adults with treatment-resistant depression, defined as an inadequate response to at least two prior adequate antidepressant trials. It is also FDA-approved for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior, when used in conjunction with an oral antidepressant.
In contrast, racemic ketamine remains an off-label treatment for depression. While it is FDA-approved for use as a general anesthetic and supported by substantial clinical evidence and guidelines, including those from the U.S. Department of Veterans Affairs and Department of Defense, it has not received FDA approval for psychiatric indications.
What Happens During a SPRAVATO® Consultation?
Your initial consultation at Nervana Medical includes:
- A detailed review of your medical and mental health history
- Discussion of treatment goals and prior antidepressant trials
- Evaluation of whether SPRAVATO® is clinically appropriate
- Initiation of insurance verification and prior authorization, when applicable
This visit ensures SPRAVATO® is both safe and appropriate for your individual situation.
How Is SPRAVATO® Administered?
SPRAVATO® is self-administered under medical supervision using a nasal spray device. Treatments take place in our certified clinic.
A typical dosing schedule includes:
- Twice weekly treatments for the first four weeks
- Weekly or every-other-week treatments during maintenance, based on response
After each dose, patients are monitored in-clinic for at least two hours to ensure safety.
Required Safety Monitoring
Because SPRAVATO® can cause sedation, dissociation, temporary increases in blood pressure, and respiratory effects, close monitoring is required.
During treatment visits, our medical team monitors:
- Blood pressure
- Level of alertness
- Physical comfort
- Emotional well-being
Patients are only discharged once the provider determines it is safe to do so.
Can Patients Drive After SPRAVATO® Treatment?
No. Patients cannot drive or operate machinery on the day of treatment.
You must arrange transportation home, and you should not resume driving or other potentially hazardous activities until the next day after a restful sleep.
Common Side Effects of SPRAVATO®
Common side effects may include:
- Dissociation or a sense of detachment
- Dizziness or lightheadedness
- Sleepiness or fatigue
- Nausea or vomiting
- Headache
- Anxiety
- Temporary increases in blood pressure
These effects typically occur shortly after dosing and usually resolve the same day.
Medical Conditions That Require Careful Evaluation
SPRAVATO® may not be appropriate for everyone. Special consideration is required for patients with:
- Uncontrolled high blood pressure
- Heart, brain, or vascular conditions (such as prior stroke or aneurysm)
- History of psychosis
- Pregnancy or breastfeeding
- Substance use disorders
Your provider will carefully evaluate risks and benefits before recommending treatment.
Insurance Coverage for SPRAVATO®
Many commercial insurance plans, Medicare, and Medicaid provide coverage for SPRAVATO® when medical necessity criteria are met. Coverage varies by plan, and out-of-pocket costs depend on individual benefits.
Our team assists with prior authorization and insurance navigation whenever possible.
What Is the SPRAVATO® REMS Program?
SPRAVATO® is available only through a federally required Risk Evaluation and Mitigation Strategy (REMS). This program ensures:
- Certified treatment locations
- Trained healthcare providers
- In-clinic administration and monitoring
- Patient enrollment and safety oversight
Patients cannot take SPRAVATO® home or self-administer outside the clinic.
What If a Patient Misses a Dose?
If treatment sessions are missed and symptoms remain stable, patients typically continue their current dosing schedule.
If depressive symptoms worsen during maintenance therapy, providers may recommend returning to a more frequent dosing schedule based on clinical judgment.
Does SPRAVATO® Prevent Suicide?
SPRAVATO® has not been shown to prevent suicide. While it may reduce depressive symptoms in some patients, it does not replace comprehensive psychiatric care or hospitalization when clinically indicated.
Ongoing monitoring, therapy, and safety planning remain essential.
SPRAVATO® Patient Pre-Treatment Instructions
Before each treatment:
- Do not eat solid food for 2 hours
- Do not drink liquids for 30 minutes
- Avoid alcohol on treatment days
- Take prescribed medications unless instructed otherwise
- Inform your provider of new medications or health changes
- Arrange transportation home
SPRAVATO® Post-Treatment Instructions
After treatment:
- Do not drive, work, or make important decisions the same day
- Avoid alcohol and strenuous activity
- Rest for the remainder of the day
- Resume eating once nausea resolves
- Contact the clinic for concerning symptoms, including worsening depression or suicidal thoughts
SPRAVATO® Care at Nervana Medical
SPRAVATO® works best when combined with:
- An oral antidepressant
- Therapy or integration support
- Consistent follow-up care
- Healthy sleep, nutrition, and lifestyle habits
At Nervana Medical in Sandy, Utah, we are committed to providing safe, compliant, and compassionate SPRAVATO® care within a structured medical setting.
If you are interested in learning whether SPRAVATO® may be right for you, we encourage you to schedule a consultation with our team.