Spravato for depression that hasn't responded to other treatment
Mindflow MD is a certified SPRAVATO® (esketamine) treatment center for adults with treatment-resistant depression. Every dose is taken here, and a clinician monitors you for at least two hours before you go home.
No referral needed. Patients and families can call us at [PHONE].
What Spravato is, and who it's for
SPRAVATO® (esketamine) is a prescription nasal spray approved by the FDA for adults with treatment-resistant depression: major depression that hasn't improved enough after at least two antidepressants, each taken at a proper dose for long enough. It can be used on its own or together with an oral antidepressant.
It works differently from most antidepressants, acting on glutamate, one of the brain's main chemical messengers. It is also approved, alongside an oral antidepressant, for adults with major depression who are having acute suicidal thoughts or behavior.
It may be worth discussing if
- You're 18 or older and have been diagnosed with major depression
- You've tried two or more antidepressants without enough improvement
- You can visit the clinic regularly for the first two months and arrange a ride home each time
Spravato isn't used if you have
- An aneurysm or other aneurysmal blood vessel disease, in the brain, chest, abdomen, arms or legs
- An arteriovenous malformation (AVM)
- A history of bleeding in the brain
- An allergy to esketamine, ketamine or the spray's other ingredients
Your evaluation also looks at blood pressure, heart health, pregnancy plans, substance use history and current medications.
What a treatment day looks like
Plan on about three hours at the clinic. Most of that time you're resting while our clinical staff keep watch.
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Check in
We check your blood pressure and ask how you've been feeling since your last visit.
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Take your dose
You use the nasal spray yourself while a clinician watches. Each device is two sprays, one in each nostril, with five minutes between devices.
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Rest and monitoring
You stay with us for at least two hours. Staff recheck your blood pressure and watch for sleepiness, feeling disconnected, or changes in breathing.
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Go home with a ride
A clinician confirms you're ready to leave. Someone else drives you: no driving or operating machinery until the next day, after a night's sleep.
Before each visit
- Don't eat for 2 hours beforehand, and don't drink anything for 30 minutes beforehand. This helps with nausea.
- If you use a steroid or decongestant nasal spray, use it at least an hour before your appointment.
- Arrange your ride home.
- Bring headphones or something calming for the rest period.
Your first two months
Visits start often, then space out. That's 12 sessions over the first eight weeks, after which your clinician sets the schedule based on how you're responding.
At the four-week mark, your clinician reviews with you whether Spravato is helping enough to continue.
Insurance and cost
Spravato is covered by many commercial insurance plans and by Medicare, usually after prior authorization. Coverage can fall under your medical benefit, your pharmacy benefit or both, so what you pay varies by plan.
Before your first session, our team checks your benefits, submits the prior authorization and tells you what to expect to pay.
If you have commercial insurance, you may also qualify for the manufacturer's savings program for the medication. We'll help you enroll.
Referring a patient
We work with psychiatrists, primary care physicians, therapists, intensive outpatient programs and hospital discharge teams. You stay part of your patient's care, and we keep you informed throughout treatment.
What to send
- Patient name, date of birth and phone number
- Front and back of the insurance card
- Diagnosis and current medications
- Antidepressant trials, with dose, duration and response
- Recent clinical notes, if available
What happens next
- We contact your patient to schedule an evaluation.
- We verify benefits and handle the prior authorization.
- We share the evaluation outcome and treatment plan with you.
- We send progress updates, including the four-week review.
Common questions
Is Spravato the same as ketamine?
They're closely related. Esketamine is one form of the ketamine molecule. Spravato is the FDA-approved nasal spray version for depression, and it's only available through certified treatment centers like ours. Ketamine infusions for depression are a different treatment and aren't FDA-approved for that use.
Do I need to stop my current antidepressant?
Not necessarily. Spravato can be used on its own or alongside an oral antidepressant. Your prescriber will decide what's right for you.
How will I feel during a session?
Common effects include feeling disconnected from yourself or your surroundings, dizziness, nausea, sleepiness, a spinning sensation, numbness, anxiety, feeling drunk and a temporary rise in blood pressure. These usually ease during the monitoring period, which is one reason you stay with us for at least two hours.
Can I drive myself home?
No. You'll need someone to drive you. Don't drive or operate machinery until the next day, after a restful night's sleep.
How soon will I know if it's working?
We track how you're doing at every visit. After the first four weeks, your clinician reviews your progress with you to decide whether to continue.
Can I take Spravato at home?
No. Spravato is never dispensed for home use. Every dose is taken at a certified treatment center under supervision.
Can I use Spravato if I'm pregnant or planning to be?
Spravato may harm an unborn baby and isn't recommended during pregnancy. Tell us if you're pregnant, planning a pregnancy or breastfeeding so we can talk through your options.
Do I need a referral?
No. You can contact us directly, or your psychiatrist, therapist or primary care physician can refer you. Some insurance plans have their own referral requirements, and we'll check yours.
Important safety information
SPRAVATO® has a boxed warning, the FDA's most serious type of warning.
Sedation, dissociation and breathing
Spravato can cause sleepiness, fainting, dissociation (feeling disconnected from yourself, your thoughts, feelings or surroundings) and slowed or shallow breathing. You'll be monitored by a healthcare provider for at least two hours after each dose.
Abuse and misuse
Spravato is a federally controlled substance (CIII) and can be misused. Your provider will check for signs of abuse and misuse before and during treatment.
Suicidal thoughts and behaviors
Antidepressants may increase suicidal thoughts and actions in some people 24 and younger, especially in the first few months of treatment or when the dose changes. Spravato is not approved for children. Watch for new or sudden changes in mood, behavior, thoughts or feelings, and call your provider right away if they happen.
Restricted program
Because of these risks, Spravato is only available through a restricted program called the SPRAVATO® REMS, and only at certified healthcare settings.
Other serious risks include increased blood pressure, problems with thinking and judgment, harm to an unborn baby, and bladder problems. The most common side effects include dissociation, dizziness, nausea, sleepiness, a spinning sensation, decreased feeling or sensitivity, anxiety, lack of energy, increased blood pressure, vomiting and feeling drunk.
This is not the complete safety information. Read the full Prescribing Information, including the Boxed Warning, and learn about the SPRAVATO® REMS program.