Spravato (esketamine) is an FDA-approved nasal spray for adults with treatment-resistant depression, and for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior. It is taken in the office, never at home, with about two hours of monitoring after each dose. At MindMorph it is given in person at the Lakewood, CO office (opening December 1, 2026) by a psychiatric nurse practitioner, and it is the ketamine-related treatment that insurance most often covers.
Integrative Psychiatry InstituteCertified Psychedelic-Assisted Therapy Provider (opens in a new tab)Masha's psychedelic-assisted therapy training through the Integrative Psychiatry Institute shapes how we prepare you for each session and how we talk about it afterward. Read about ketamine therapy
What Spravato is approved for
The FDA label lists two indications, and the wording here follows the label because the difference matters:
- Treatment-resistant depression (TRD) in adults, as monotherapy or in conjunction with an oral antidepressant
- Depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior, in conjunction with an oral antidepressant
The label also carries a limitation that deserves to be said plainly: the effectiveness of Spravato in preventing suicide or in reducing suicidal ideation or behavior has not been demonstrated. It treats depressive symptoms; it is not an emergency intervention, and anyone in immediate danger needs emergency care first.
Since 2025 Spravato has been approved for use on its own (monotherapy) for TRD, so an oral antidepressant is no longer required in every case. Whether you continue one is a decision we make together based on your history.
How esketamine works
Esketamine is a derivative of ketamine. It acts on the brain's glutamate system, through the NMDA receptor, rather than on serotonin the way SSRIs do. Research links that pathway to neuroplasticity, the forming of new neural connections, which is one reason some people notice a change within days rather than weeks. Not everyone does; some respond gradually, and some do not respond. Results cannot be guaranteed.
What a Spravato session looks like
| Step | What happens | Time |
|---|---|---|
| Pre-treatment review | Symptom check-in, blood pressure, goals for the session, any questions | About 15 minutes |
| Administration | You self-administer the nasal spray with the clinician present and observing | A few minutes |
| Monitoring | You rest in a reclining chair with an eye mask and headphones if you like; blood pressure, oxygen, and level of awareness are checked at intervals | At least 2 hours |
| Integration and recovery | Quiet reflection, water, a short conversation about what came up, then discharge once you are clear to leave | Until you are steady |
Plan to skip food for two hours before the appointment and liquids for 30 minutes, which lowers the chance of nausea. Someone needs to drive you home. You should not drive, operate machinery, or make important decisions until the next day, after a restful night's sleep.
How a course runs
Treatment usually begins with two sessions a week for the first four weeks, then once a week, then once a week or every two weeks depending on how you respond. Each session includes about two hours of monitoring after the dose in the office, so the early weeks are a real commitment of time. Most people continue an oral antidepressant, and therapy, mindfulness, nutrition, and sleep work fill the days between doses so that whatever shifts has somewhere to land.
Spravato compared with ketamine-assisted psychotherapy
| Spravato (esketamine) | Ketamine-assisted psychotherapy | |
|---|---|---|
| FDA status | Approved for TRD and for MDD with acute suicidal ideation or behavior | Off-label (ketamine is not FDA-approved for any psychiatric disorder) |
| Form | Nasal spray | Sublingual troche |
| Setting | Certified office under a federal safety program (REMS), two-hour monitoring | Supervised in the office within a therapy course |
| Cadence | Twice weekly, then weekly, then weekly or every two weeks | Individualized series, then integration and any maintenance |
| Insurance | Often covered with prior authorization | Usually self-pay with a superbill |
If you are weighing the two, read the ketamine therapy page as well; the consultation is where we decide which, if either, fits.
Safety and side effects
The most common effects are temporary: dissociation (feeling detached from your body or surroundings), sedation, dizziness, nausea, and a rise in blood pressure during the monitoring window. These typically fade before you leave. Because of the sedation and dissociation, and because esketamine can be misused, the FDA permits Spravato only in certified healthcare settings with an onsite prescriber and monitoring equipment, and the medication is never dispensed to take home. Uncontrolled high blood pressure, certain vascular conditions, and a history of substance misuse are among the things reviewed before you start. The label also warns about suicidal thoughts and behaviors in young adults taking antidepressants, which is one reason symptoms are tracked closely throughout.
Cost and insurance
Many insurance plans help cover Spravato for approved diagnoses, usually after prior authorization. MindMorph verifies benefits and handles the authorization paperwork before the first dose; the current in-network lists for Colorado and Oregon and the self-pay rates for evaluation and follow-up visits are on the insurance and payment page. Coverage cannot be guaranteed; MindMorph tells you what to expect before you commit.
The integrative layers around Spravato
Depending on your evaluation, the plan around the doses may include genetic and lab testing, nutrition and supplement guidance, movement and yoga, breathwork and mindfulness training, and sleep and circadian support. A dose can open a window; these are what you do with it.
Conditions Spravato may help address
- Treatment-resistant depression: adults whose depression has not responded adequately to at least two antidepressants
- Major depressive disorder with acute suicidal ideation or behavior: used to treat depressive symptoms while fuller care is put in place
Why people choose MindMorph for Spravato
Every session is supervised in person by the same board-certified psychiatric nurse practitioner who manages your medication, so the person monitoring you is the person who knows your history. MindMorph helps with benefit verification, prior authorization, and claims. The treatment room is quiet, private, and trauma-informed, one patient at a time, and therapy, mindfulness, and lifestyle care stay in the same plan rather than going out to a referral elsewhere.
Location and booking
Spravato treatments are provided in person only at the MindMorph office, 215 Union Blvd, Suite 125, Lakewood, CO 80228 (in-person appointments from December 1, 2026). Spravato is not available by telehealth, including for Oregon patients, though evaluation and follow-up visits can be by video. Book a complimentary consultation or call (720) 504-2181.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline) or call 911. This practice does not provide emergency services.
Watch
All videos-
Length 0:43
From Psychedelic Integration Therapy Transformation
A real shift after psychedelic-assisted therapy, whether the work involved Spravato, ketamine, or another approach, is what I reflect on in this 43-second clip filmed for the site. What stays with me is how often people arrive feeling stuck and hopeless, sometimes at the very…
-
Length 1:15
From Psychedelic Integration Therapy Freedom from Patterns
The change I see most often in the people I work with is a kind of freedom: the freedom to respond rather than react, and freedom from patterns they have carried for a very long time. In this 75-second clip filmed for the site I describe how it shows up: stepping out of the loops that…
-
Length 1:13
From Psychedelic Integration Therapy Integration Is Key
The biggest misconception I hear about psilocybin work, and psychedelic work in general, is that the medicine itself is the key to healing. In this 73-second clip filmed for the site I say the experience plays a part, but the real work is the preparation beforehand and the integration that…
-
Length 0:22
From Therapy & Counseling Hyper-independence is often praised
Never needing anyone is a trait that gets rewarded everywhere, and a story can hide inside it. Self-reliance that formed because relying on someone once went badly looks like strength from the outside and often feels like exhaustion from the inside. The clip, 22 seconds, questions the praise.
-
Length 0:23
From Therapy & Counseling Let's talk about anger
Anger as information: what it protects and what it asks for. Anger is the emotion people most often apologize for in a first appointment. The clip's premise is that it is a messenger with a job, usually standing in front of something more vulnerable, and that the useful question is what it is…
-
Length 0:21
From Therapy & Counseling Let's talk about bottling up emotions
Where pressed-down feelings actually go, and what release can look like. Bottling up is a skill most people learned because expressing feelings once cost too much. The body keeps the ledger: a jaw that never unclenches, a chest that braces before hard conversations, a stomach that answers the phone…
Questions
Spravato is a prescription esketamine nasal spray, FDA-approved for treatment-resistant depression in adults and for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior. It acts on the brain's glutamate system rather than serotonin, and is taken only in a certified healthcare setting with monitoring.
Often, yes. Many insurance plans help cover Spravato for the approved diagnoses, usually after prior authorization. MindMorph verifies your benefits and handles the authorization before the first session. Coverage depends on your plan and cannot be guaranteed; the in-network lists for Colorado and Oregon are on the insurance page.
Yes. Esketamine is a Schedule III controlled substance, and Spravato is available only through a federal safety program (REMS) that restricts it to certified healthcare settings. You self-administer the spray in the office under direct observation, you are monitored for at least two hours, and the medication is never dispensed to take home.
It can produce dissociation: a sense of detachment from your body or surroundings, along with drowsiness or dizziness. That effect is expected, peaks within the first hour, and usually fades before you leave. You rest in a reclining chair, blood pressure and alertness are checked, and you do not drive until the next day.
Treatment usually starts at two sessions a week for four weeks, then once a week, then once a week or every two weeks depending on your response and goals. Each visit includes about two hours of monitoring in the office. Frequency is reviewed with you throughout; some patients respond within the first few sessions, others improve gradually.
No. Spravato is given only in person, under observation, at the Lakewood, Colorado office, which opens December 1, 2026; the FDA does not permit it outside a certified setting. Oregon patients can do their evaluation and follow-up visits by secure video, but each dose requires a trip to Lakewood. Ketamine-assisted psychotherapy dosing is in person as well.