Treatment-resistant depression — defined as major depressive disorder that has not responded adequately to at least two antidepressant medications of appropriate dose and duration — affects an estimated 30 percent of all patients diagnosed with major depression in the United States, representing millions of people whose illness has continued despite following their providers’ recommendations. For patients in the greater Richmond and South Chesterfield area who find themselves in this category, the arrival of SPRAVATO® (esketamine) as an FDA-approved treatment represents a meaningful clinical development that our team at Infuse RVA is trained and certified to offer. Our goal with this post is to give you the specific, honest information you need to decide whether SPRAVATO® warrants a conversation with our team.
What Is SPRAVATO® and Who Is It Approved For?
Spravato (Esketamine) Treatment is an FDA-approved nasal spray formulation of esketamine — a compound derived from ketamine — designed specifically for adults with treatment-resistant depression (TRD) and, in a separate FDA approval, for adults with major depressive disorder with acute suicidal ideation or behavior (MDD with ASIB). The FDA approvals were granted in 2019 and are based on clinical trials demonstrating statistically significant reductions in depressive symptoms compared to placebo in patients who had not responded to prior antidepressant treatment. It is important to be precise: SPRAVATO® is FDA-approved for TRD and MDD with ASIB only. It is not approved for general depression in patients who have not experienced prior treatment failure, and our team at Infuse RVA adheres strictly to these clinical and regulatory boundaries.
How SPRAVATO® Works Differently Than Conventional Antidepressants
SPRAVATO® operates through a fundamentally different mechanism than conventional antidepressants. Standard antidepressants — SSRIs, SNRIs, TCAs, and MAOIs — primarily modulate the monoamine neurotransmitter systems (serotonin, norepinephrine, dopamine). Their antidepressant effects typically require four to eight weeks to develop and are mediated by downstream neuroadaptive changes that take time to unfold. SPRAVATO® acts on NMDA receptors in the glutamatergic system, the brain’s primary excitatory signaling network. This mechanism produces more rapid antidepressant effects — many patients begin to notice meaningful symptom changes within the first one to two treatment sessions. The speed of response is not incidental: for patients who have spent years waiting for medications to work, experiencing relief within days can itself be a critical turning point in their relationship with treatment.
To understand how esketamine compares to related approaches, our blog post on Ketamine & Esketamine For Unipolar Depression explores the shared and distinct mechanisms of both compounds in depth.
What to Expect During a SPRAVATO® Session at Infuse RVA
At Infuse RVA, SPRAVATO® is administered under the FDA-required REMS (Risk Evaluation and Mitigation Strategy) program, which mandates that the drug be given in a certified healthcare setting under direct medical supervision. Patients self-administer the nasal spray under our team’s guidance, then remain in our South Chesterfield facility for a mandatory two-hour monitoring period. During this time, our team monitors for potential side effects including dissociation, dizziness, nausea, and blood pressure changes. These effects are generally temporary and resolve within the monitoring window, but their management requires clinical presence — which is why SPRAVATO® cannot be prescribed for home use. Patients must arrange transportation home after each session and should plan not to drive or operate heavy machinery for the remainder of the treatment day.
SPRAVATO® and Your Oral Antidepressant Regimen
SPRAVATO® is designed to be used alongside an oral antidepressant, not as a standalone medication. The FDA approval studies all included concurrent oral antidepressant therapy, and our clinical protocol at Infuse RVA reflects this requirement. We work closely with each SPRAVATO® patient’s prescribing provider, or manage medications ourselves through our own care coordination, to ensure their oral antidepressant regimen is appropriate and well-matched to their history. The combination of a novel-mechanism drug like SPRAVATO® with a carefully chosen oral antidepressant often produces synergistic effects that neither would achieve alone.
Navigating Insurance and Prior Authorization
One barrier to SPRAVATO® treatment we encounter frequently is the insurance prior authorization process. Because SPRAVATO® is FDA-approved specifically for treatment-resistant depression, most commercial insurers and Medicare require documentation that the patient has tried and failed to achieve adequate relief from at least two prior antidepressants. This requirement aligns with the clinical definition of TRD, but gathering and organizing that documentation can feel burdensome. Our team at Infuse RVA has experience navigating the prior authorization process and works with patients to compile the clinical history required for approval efficiently. We want the bureaucratic hurdle to be our problem to manage, not yours.
Understanding Dissociation During SPRAVATO® Sessions
A second barrier is the realistic concern about dissociative effects during sessions. SPRAVATO® produces transient dissociation in most patients — an altered perceptual state that some patients find disorienting and others find neutral or even interesting. This effect is temporary, does not persist beyond the monitoring period, and is managed by our clinical team throughout each session. We spend time before the first session explaining exactly what dissociation feels like and how to work with it rather than against it. For the vast majority of our SPRAVATO® patients, the dissociative experience becomes less pronounced with successive sessions as familiarity increases. Discuss your concerns about this aspect of the treatment with our team — we believe informed patients have better experiences, and we do not rush this conversation. Results vary by individual, and every patient’s experience with SPRAVATO® is different.
Frequently Asked Questions About SPRAVATO® at Infuse RVA
What Makes Someone Eligible for SPRAVATO® at Infuse RVA?
SPRAVATO® is FDA-approved for adults with treatment-resistant depression (defined as inadequate response to at least two prior antidepressants of adequate dose and duration) and for adults with major depressive disorder with acute suicidal ideation or behavior. Our team conducts a thorough clinical evaluation to confirm eligibility and ensure SPRAVATO® is clinically appropriate for your individual situation.
Can I Receive SPRAVATO® If I’m Already Taking Antidepressants?
Yes — SPRAVATO® is designed to be used alongside an oral antidepressant, not as a replacement for one. Our team will review your current medications and coordinate with your prescriber as needed to ensure compatibility and optimize your overall regimen.
How Long Does a SPRAVATO® Treatment Course Last?
The standard protocol involves twice-weekly sessions during the first four weeks (induction phase), followed by weekly sessions for weeks five through eight, and then biweekly or monthly maintenance sessions based on your response. Our team reviews your progress and adjusts the maintenance schedule over time.
What Is the Dissociation Like During a SPRAVATO® Session?
Dissociation from SPRAVATO® typically involves a sense of altered perception, mild derealization, and sometimes unusual visual or sensory experiences. These effects are temporary, begin during the administration period, and resolve within the two-hour monitoring window. Our clinical team is present throughout each session to support your experience and monitor your safety.
Does Infuse RVA Accept Insurance for SPRAVATO®?
Yes. SPRAVATO® is covered by most major commercial insurers and Medicare for eligible patients with documented treatment-resistant depression. Our team handles prior authorization and will give you a clear picture of your coverage before treatment begins. Contact our South Chesterfield office for specifics.
Key Takeaways
- SPRAVATO® is FDA-approved for treatment-resistant depression and MDD with acute suicidal ideation or behavior — not for general depression
- It operates through glutamate NMDA receptor blockade, producing antidepressant effects faster than conventional oral medications
- Sessions are administered in our certified facility under medical supervision with a two-hour monitoring period; patients need a driver
- SPRAVATO® must be used alongside an oral antidepressant per FDA protocols
- Results vary by individual; our team conducts a thorough evaluation before recommending SPRAVATO®
Is SPRAVATO® the Next Step in Your Care?
If you have tried multiple antidepressants and have not found the relief you need, SPRAVATO® may represent the most significant clinical option that hasn’t yet been part of your care. At Infuse RVA in South Chesterfield, our team evaluates each patient honestly and thoroughly before recommending any treatment — because we believe the right treatment for the right patient is the only kind of care worth offering. To learn more or take the next step, schedule a consultation with our South Chesterfield team today.
References
U.S. Food and Drug Administration. NDA 211243 approval letter: SPRAVATO (esketamine) nasal spray. March 5, 2019. https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2019/211243Orig1s000ltr.pdf
National Institute of Mental Health. Depression. https://www.nimh.nih.gov/health/topics/depression
Janssen Pharmaceuticals. SPRAVATO® (esketamine) Prescribing Information. https://www.spravatohcp.com/
Ionescu DF, Papakostas GI, Holt DJ. Pharmacotherapies for treatment-resistant depression: how antipsychotics fit in the rapidly evolving therapeutic landscape. American Journal of Psychiatry. 2023;180(3):190–205. https://doi.org/10.1176/appi.ajp.20230025
About Infuse RVA
At InfuseRVA Ketamine & Wellness in South Chesterfield, VA, our team works specifically with patients in the greater Richmond area who have not found adequate relief through conventional treatment — those whose depression, PTSD, anxiety, or chronic pain persists despite prior medication and therapy trials. We evaluate each patient individually before recommending any treatment approach, with IV ketamine infusion therapy and SPRAVATO® (esketamine) available for patients who meet criteria for treatment-resistant depression following a thorough clinical review. Our care is built around both the physical and emotional dimensions of mental health: we take the whole patient seriously, from unexplained physical symptoms to the longer history that brought them to our door.
Medical Disclaimer
This content is provided by Infuse RVA for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. SPRAVATO® is a prescription medication and must be administered under direct medical supervision in a certified healthcare facility. Only a qualified medical provider can determine whether SPRAVATO® is appropriate for your specific situation. Results vary by individual, and no outcomes are guaranteed. Please discuss all treatment options with your provider before making any decisions about your care.
