treatment resistant depression

Spravato (esketamine)

Spravato (esketamine) is a new and pioneering breakthrough in the treatment of severe depression.

This new medication works in the brain to treat depression in a novel way that is quite distinct from all our other current treatments for depression.

Spravato (esketamine) works in the glutamate neurotransmitter system in the brain and not on the serotonin or norepinephrine systems (like the SSRI antidepressants such as Lexapro, Zoloft, Prozac and Trintellix or SNRI antidepressants such as Effexor or Cymbalta). It stimulates the key NMDA receptor in the brain and by this unique means it may produce a rapid relief of depression, sometimes in as little as 24 to 48 hours. A full course of treatment ordinarily still requires 6-8 weeks of treatment and maintenance treatment with Spravato will usually be needed after that for most patients

Because of these unique features Spravato (esketamine) offers new hope for patients who are suffering with treatment resistant depression. If you are in this category of severe depression you are certainly not alone. About 1/3 or more of patients with major depression follow such a treatment resistant course whereby many antidepressant medication treatments over time have just not worked. It is estimated that at least 5 million people in the US suffer from this pernicious type of depression. In the Spravato (esketamine) studies patients had not responded to at least two or more antidepressant medications in their current episode of depression.

If you are in that category of depression, where antidepressants haven’t worked for you despite several attempts then Spravato (esketamine) is a novel and promising option.


Frequently Asked Questions (FAQs)

1. What should I do first if I am interested in this treatment option?

Please call your insurance company and ask if treatment with Spravato (esketamine) is covered.

The manufacturer of Spravato (Janssen) also provides assistance for patients in determining insurance coverage and may also be able to provide some financial support for your treatment.

Please call the Janssen CarePath Program at 844-777-2828

2. What is the next step if I have insurance coverage for Spravato?

If you are covered then please call our practice at 856-375-2406 to make an appointment.

Bernadette will schedule you for a 90 minute evaluation with Dr. O’Reardon just as soon as possible to assess your case and determine whether Spravato (esketamine) is the next best treatment for your case of TRD and also what other treatment options should be considered for you in that regard.

3. What is the next step after my evaluation by Dr. O’Reardon?

Your first treatment session for administration of the intranasal treatment with Spravato will be scheduled promptly if Spravato (esketamine) is the right treatment for you.

4. What happens at the office during my visits for Spravato (esketamine) treatment?

Each visit to the office for treatment will take about two and a half hours.

First your dose of Spravato is administered in the doctor’s office.

Next there is a 2 hour safety monitoring period. During this time your BP will be monitored. You will also be checked for any sedation and presence of any dissociative symptoms (feeling strange, disconnected transiently) or any other side effects.

After 2 hours, if you are stable then you will then be discharged home. You will need somebody to drive you home after the treatment.

5. What are the common side effects with Spravato (esketamine?)

These include transient sedation, a possible rise in your blood pressure and feelings of dissociation (such feeling strange, disconnected or change in sense of time). These side effects may typically be present for the first 2 hours after taking the nasal spray of ketamine. For this reason you are monitored in the doctor’s office for a period of 2 hours after your dose of Spravato (esketamine). Such side effects if they occur typically go away the same day.

During this time your blood pressure will be checked periodically and you will be assessed for the presence of any specific side effects. After 2 hours the doctor will assess you clinically to make sure you are safe to be discharged home.

6. How often are the treatments?

For the first 4 weeks you come in twice per week, each time for a two and a half hour visit.

In the second month your visits are now once per week.

After that treatments for long term maintenance with Spravato (esketamine) might be once per week or twice per month depending on your clinical course.

7. How is payment for this treatment handled at this practice?

This practice does not contract with any commercial insurance or with Medicare.
Therefore, you pay for the treatment at the time of service and claim back from your insurance company whatever they are willing to provide for out of network treatment in your case. There is no reimbursement directly from Medicare as I am not a Medicare provider.

You will need to check with any secondary insurance you have in addition to Medicare whether they will provide you with any reimbursement in this circumstance

8. What is the cost of the treatment?

The initial evaluation for 90 minutes is $350.

Some or all of this may be covered by your insurance. Medicare does not reimburse in this circumstance and please check with any secondary insurance you have in addition to Medicare if they will reimburse you or not.

Each visit for Spravato (esketamine) treatment costs $250.

Payment is due at the time of service.


You will be provided with a receipt that has all the information you need to seek reimbursement from your insurance company

9. Will I be covered for Spravato (esketamine) treatment if I have bipolar depression?

Unfortunately, the answer here is no. The reason for this is that the FDA approval is only for major depression based on the research that has been done to date. Insurance companies will not pay for any treatments that are not FDA approved as it treats such treatments as “off label”.

10. Can I take Spravato (esketamine) at home?

This is prohibited by the FDA as ketamine has the potential to be abused and therefore lead to addiction. Therefore, administration is solely at the doctor’s office.