What Is SPRAVATO?
SPRAVATO is the brand name for esketamine, a prescription nasal spray approved by the FDA in 2019 for adults with treatment-resistant depression, and in 2020 for depression with suicidal thoughts or actions. It is the first antidepressant in more than 30 years to work through a new mechanism, and it is the only ketamine-based treatment for depression that is FDA-approved and covered by most insurance plans.
Because SPRAVATO can cause temporary dissociation and sedation, the FDA requires that it be given only at a certified clinic under a safety program called REMS. You self-administer the spray in our office, then rest under observation for two hours before someone drives you home. You cannot fill it at a pharmacy or take it at home.
At Georgia Behavioral Health in Norcross, SPRAVATO treatment is directed by Dr. Neha Khurana, MD, a board-certified psychiatrist and Atlanta Magazine Top Doctor for General Psychiatry in 2025 and 2026. Our office is a certified SPRAVATO treatment center and is LegitScript certified. We treat patients from Norcross, Peachtree Corners, Duluth, Suwanee, Johns Creek, Lawrenceville and the greater Gwinnett County area.
Watch: SPRAVATO at Georgia Behavioral Health
A short look at what a SPRAVATO visit is like at our Norcross office.
How Does SPRAVATO Work?
Most antidepressants act on serotonin, norepinephrine, or dopamine, and they take four to eight weeks to build up an effect. About a third of patients never get adequate relief from them. Esketamine works on a different system entirely: glutamate, the brain's most abundant chemical messenger.
Esketamine blocks a receptor called NMDA. That triggers a surge of glutamate signaling and a rapid increase in the growth factors that help brain cells form new connections. In depression, especially long-standing depression driven by chronic stress, those connections in the prefrontal cortex have been lost. SPRAVATO helps the brain rebuild them, which is why patients can feel a shift within hours to days of the first doses instead of waiting weeks.
This is the same reason SPRAVATO can work when several antidepressants have not. It does not depend on the serotonin system at all. Read more about why antidepressants stop working.
In the pivotal TRANSFORM-2 trial, patients with treatment-resistant depression who added SPRAVATO to a new oral antidepressant were significantly more likely to respond at four weeks than those who added placebo, with some patients showing improvement within 24 hours of the first dose.
Source: Popova et al., American Journal of Psychiatry, 2019
Image source: Adobe Stock (Asset ID: AdobeStock_221688877)
Who Is a Candidate for SPRAVATO?
SPRAVATO is FDA-approved for adults with:
Treatment-Resistant Depression
Major depressive disorder that has not responded adequately to at least two different antidepressants taken at a proper dose for a proper length of time.
Learn about our TRD ClinicDepression With Suicidal Thoughts
Major depressive disorder with acute suicidal ideation or behavior, where rapid symptom relief matters most. Used alongside an oral antidepressant.
Learn about depression careYou may be a good fit if you have tried two or more antidepressants without adequate relief, if your depression returns each time a medication stops working, or if you need faster relief than a new pill can offer. SPRAVATO is usually taken together with an oral antidepressant, and it can be combined with talk therapy or TMS as part of a broader plan.
Who Should Not Use SPRAVATO
SPRAVATO raises blood pressure for a short time after each dose, so it is not appropriate for everyone. During your evaluation we screen carefully for:
- Aneurysmal vascular disease, arteriovenous malformation, or a history of bleeding in the brain
- Uncontrolled high blood pressure or unstable heart disease
- Pregnancy or breastfeeding
- A history of psychosis, or a current substance use disorder that is not in treatment
- Allergy to esketamine or ketamine
Most other medical conditions and medications do not rule SPRAVATO out, but they are part of the conversation. A full psychiatric evaluation comes first, every time.
The SPRAVATO Treatment Process: What to Expect
Initial Screening
A brief phone or virtual conversation to review your symptoms, the antidepressants you have tried, and your insurance so we can tell you quickly whether SPRAVATO is worth pursuing.
Psychiatric Evaluation
Dr. Khurana or a member of her team completes a full evaluation, confirms the diagnosis, checks blood pressure and medical history, and reviews other options such as TMS or IV ketamine.
Insurance Authorization and REMS Enrollment
Our office submits the prior authorization and enrolls you in the SPRAVATO REMS safety program. Most approvals come back within one to two weeks.
Treatment Day
Do not eat for two hours or drink for 30 minutes before your visit. We check your blood pressure, you self-administer the nasal spray in a quiet, comfortable room, and you rest for about two hours while staff monitor you. Most patients bring headphones or simply close their eyes.
Ride Home
You cannot drive until the next day after a full night's sleep. Arrange a ride, or we can help you plan for one.
Ongoing Care
We track your symptoms with standardized scales at every visit and adjust the schedule as you improve. Many patients taper to every other week and then to maintenance visits as needed.
Treatment Schedule
SPRAVATO follows a set schedule that your insurer also expects to see:
- Weeks 1 to 4 (induction): two visits per week, usually 56 mg or 84 mg per dose
- Weeks 5 to 8: one visit per week
- Week 9 onward (maintenance): one visit every week or every two weeks, based on how you are doing
Each visit takes about two and a half hours including check-in, dosing, and observation. Because the benefit builds over the first month, completing the induction phase matters. Stopping early is the most common reason SPRAVATO falls short.
How Effective Is SPRAVATO?
Across the clinical trial program that led to approval, roughly half to two-thirds of patients with treatment-resistant depression responded to SPRAVATO plus an oral antidepressant within four weeks, and a meaningful share reached full remission. Just as important, patients who continued treatment after getting better were far less likely to relapse than those who stopped.
In the SUSTAIN-1 maintenance study, patients in stable remission who continued SPRAVATO had a 51 percent lower risk of relapse than those switched to placebo. For patients who were stable responders but not yet in remission, the reduction was 70 percent.
Source: Daly et al., JAMA Psychiatry, 2019
Most patients notice something within the first one to two weeks. Sleep, energy, and the heaviness of low mood often lift first. The full effect builds over the four-week induction. If you have not improved by the end of induction, we reassess and discuss alternatives rather than continuing indefinitely.
Image source: Adobe Stock (Asset ID: AdobeStock_129682464)
SPRAVATO Side Effects and Safety
The most common side effects happen during the two-hour observation window and resolve before you leave:
- Dissociation, a temporary feeling of being detached from your surroundings or your body. This is the effect patients ask about most. It peaks around 40 minutes after dosing and fades within two hours.
- Dizziness, vertigo, or feeling sedated
- Nausea, which is why we ask you not to eat beforehand. Anti-nausea medication is available.
- A temporary rise in blood pressure, which we measure before and after every dose
- Numbness, headache, or a strange taste
Because of the sedation and dissociation, you cannot drive, operate machinery, or make important decisions until the next day. SPRAVATO is a Schedule III controlled substance and the REMS program exists to make sure every dose is given and observed by trained staff. Esketamine has not been shown to be habit-forming at the doses and frequency used for depression, and it is never dispensed for home use.
SPRAVATO Cost and Insurance Coverage in Georgia
Most major commercial plans, including Aetna, Anthem Blue Cross Blue Shield, Cigna, UnitedHealthcare and Humana, as well as Medicare, cover SPRAVATO for treatment-resistant depression with prior authorization. Plans typically require documentation that you have tried at least two antidepressants without adequate relief. There are two costs to be aware of: the medication itself and the in-office monitoring, which are usually billed separately.
Our office verifies your benefits, submits the prior authorization, and handles REMS enrollment before your first visit, so you know your expected out-of-pocket cost in advance. Patients with commercial insurance may also qualify for the manufacturer's savings program, which can lower the medication copay substantially. We can walk you through it during your consultation.
Call (678) 861-6463 and we will check your specific policy.
SPRAVATO vs. IV Ketamine vs. TMS
GBH offers all three of the leading interventional treatments for treatment-resistant depression. Many patients are candidates for more than one, and some use them in sequence. Here is how they compare.
| SPRAVATO (esketamine) | IV Ketamine | TMS Therapy | |
|---|---|---|---|
| FDA status | FDA-approved for treatment-resistant depression and depression with suicidal thoughts | FDA-approved anesthetic, used off-label for depression | FDA-cleared for depression, OCD, anxious depression |
| How it is given | Nasal spray, self-administered under supervision | Intravenous infusion | Magnetic coil on the scalp |
| Visit length | About 2.5 hours including observation | About 2 hours including infusion and monitoring | 20 to 40 minutes |
| Course | Twice weekly for 4 weeks, then weekly, then every 1 to 2 weeks | Typically 6 infusions over 2 to 3 weeks | 5 days a week for about 6 weeks |
| Sedation or dissociation | Likely. No driving that day. | Common. No driving that day. | None. You drive yourself. |
| Insurance | Usually covered with prior authorization | Not typically covered | Usually covered |
| Speed of response | Hours to days | Hours to days | Gradual, usually weeks 3 to 4 |
Not sure which is right for you? Read our full comparison of TMS therapy vs. SPRAVATO, or book an evaluation and we will walk through the options together. Some patients start SPRAVATO for fast relief while a TMS course builds, or use IV ketamine while waiting for SPRAVATO authorization.
Ready to Find Out If SPRAVATO Is Right for You?
A consultation with our TRD Clinic team takes about an hour and gives you a clear answer on candidacy, insurance, and timing. Serving Norcross, Peachtree Corners, Duluth, Suwanee, Johns Creek and greater Gwinnett County.
Book a SPRAVATO ConsultationWhy Choose Georgia Behavioral Health for SPRAVATO in Norcross
- Certified SPRAVATO treatment center. We are enrolled in the SPRAVATO REMS program and LegitScript certified, meeting the highest standards of compliance and patient safety.
- Psychiatrist-led care. Every SPRAVATO patient is evaluated and followed by a board-certified psychiatrist. Dr. Khurana is an Atlanta Magazine Top Doctor for General Psychiatry in 2025 and 2026.
- A full TRD Clinic under one roof. SPRAVATO, TMS, IV ketamine, medication management, EMDR and talk therapy are all offered here, so your plan is built around you rather than around the one tool a clinic happens to have.
- Insurance and REMS handled for you. We run benefits, prior authorization, and REMS enrollment before your first dose.
- A calm, private treatment room. Two hours of observation should feel restful, not clinical. Our office is at 4720 Peachtree Industrial Blvd, Suite 4101 in Norcross, with parking on site.
- Care in English, Korean and Spanish. 한국어 진료 가능합니다. Se habla español.
SPRAVATO Resources and Research
From the GBH Blog
→ TMS Therapy vs SPRAVATO: Which Is Right for You? → What Is Treatment-Resistant Depression? Answers to the Questions Patients Are Actually Asking → Why Antidepressants Stop Working → Men's Mental Health and Treatment-Resistant Depression → The Link Between Chronic Stress and Treatment-Resistant DepressionReferring a Patient for SPRAVATO?
Download our TRD Clinic Referral Guide. We co-manage with referring therapists and physicians and send progress updates throughout treatment.