Treatment-resistant depression is defined clinically as the failure to achieve adequate response after at least two antidepressant trials of adequate dose and duration — a threshold that an estimated 30 percent of people with major depressive disorder meet. SPRAVATO® (esketamine) nasal spray is the first drug in its class to receive FDA approval specifically for this population, representing a genuine advance in what the regulatory process recognizes as clinically valid for these patients. At Minnesota Ketamine & Wellness Institute, SPRAVATO® is our primary recommended treatment for patients who meet TRD criteria — it is FDA-approved, covered by most major insurance plans for eligible patients, and administered in our certified clinic under direct clinical supervision.
What Makes SPRAVATO® Different from IV Ketamine
SPRAVATO® is not the same as IV ketamine, and clarity on that distinction matters. SPRAVATO® is esketamine — the S-enantiomer of ketamine — delivered as a self-administered nasal spray in a certified healthcare setting under direct clinical supervision. IV ketamine is racemic ketamine, delivered intravenously. Both compounds act on NMDA receptors in the glutamate system, but their pharmacokinetic profiles, regulatory status, and approved clinical indications differ. SPRAVATO® holds FDA approval for two specific indications: treatment-resistant depression (TRD) in adults who have not responded to at least two antidepressants, and major depressive disorder with acute suicidal ideation or behavior (MDD with ASIB). IV ketamine’s psychiatric uses remain off-label. We never conflate the two at our institute, and we explain these differences during every intake evaluation.
The FDA approval of SPRAVATO® was based on Phase III clinical trials conducted by Janssen Pharmaceuticals, which demonstrated statistically significant improvement in depressive symptom scores compared to placebo at the primary endpoint. Because SPRAVATO® carries a risk of sedation, dissociation, and potential for misuse, the FDA requires its distribution and use under the SPRAVATO® Risk Evaluation and Mitigation Strategy, or REMS program. This means SPRAVATO® can only be administered in certified healthcare settings, patients must remain on-site for at least two hours of observation following each dose, and settings must document adherence to the monitoring protocol. Minnesota Ketamine & Wellness Institute is a SPRAVATO® certified provider, and Christy Hatcher, MSN, APRN, CRNA ensures that the clinical environment meets every REMS requirement. To learn more about the history of ketamine and how it evolved into today’s approved treatments, our blog provides a helpful overview.
Why a CRNA-Led Practice Matters for SPRAVATO® Care
Christy’s background as a nurse anesthetist is directly relevant here. A CRNA’s training centers on pharmacokinetics, airway management, hemodynamic monitoring, and the management of sedative and dissociative agents — precisely the competencies most relevant to safe SPRAVATO® administration. Her years of clinical experience in anesthesia care translate directly into the level of pharmacological oversight that SPRAVATO® treatment demands. Patients who have had SPRAVATO® administered in less specialized settings sometimes tell us they did not feel adequately monitored; our protocol is designed to prevent that concern from arising. You can learn more about Christy and the full clinical team on our Meet the Team page.
Insurance Access and the VA Contract
One barrier we address regularly is insurance coverage. Because SPRAVATO® is FDA-approved, it is covered by most major insurance plans for eligible patients — this is a meaningful distinction from IV ketamine, whose psychiatric uses are off-label and therefore unlikely to be reimbursed. Prior authorization requirements, formulary placement, and diagnosis documentation all affect whether a specific patient’s claim will be approved, and we work with patients to navigate that process, gather the necessary documentation of prior medication failures, and communicate with insurers on their behalf where possible. We encourage every patient to contact their insurance provider before their first appointment to understand their specific benefit and out-of-pocket obligations, and to discuss with your provider what documentation of prior treatment history will strengthen the authorization request.
For veterans, our institute holds a VA Community Care Network (VCA) contract. The VA will refer eligible veterans to us and covers the cost of ketamine infusions through that contract. Veterans managing treatment-resistant depression alongside other service-related conditions should discuss with their provider and VA care coordinator whether the VCA pathway applies to their situation and which treatment modality — SPRAVATO® or IV ketamine — best fits their clinical picture. For a broader look at the cost of ketamine therapy in Minnesota, including insurance and coverage considerations, our dedicated resource covers the topic in depth.
What to Expect During a SPRAVATO® Session
A second barrier is uncertainty about what to expect during a session. SPRAVATO® produces dissociative effects — perceptual shifts in vision, time perception, and bodily awareness — that can be unfamiliar and occasionally unsettling for first-time patients. At our institute, we prepare patients thoroughly before the first dose. We explain the likely experience, the two-hour monitoring window, and what our clinical staff will be doing throughout. Our multidisciplinary team includes therapists who are Somatic Psychedelic Facilitators and Certified Clinical Trauma Professionals, which means that if emotional material emerges during or after a session, skilled support is available. Integration therapy — making sense of what surfaces during SPRAVATO® sessions — is an option we actively encourage for patients who want to deepen the therapeutic value of each dose.
SPRAVATO® is typically prescribed as a twice-weekly induction phase for the first four weeks, followed by a weekly maintenance phase, and then every-one-to-two-weeks ongoing dosing depending on response and clinical judgment. The treating provider determines the dosing schedule, and patients must not drive or operate heavy machinery on the day of each dose. Every SPRAVATO® session at our institute is supervised from administration through the full monitoring period, and Christy or another qualified provider reviews each session before the patient is discharged. Results vary by individual, and some patients experience more pronounced or durable benefit than others. The goal of our program is to provide the conditions most likely to support a meaningful response while maintaining the highest standards of clinical safety.
Patients sometimes ask whether SPRAVATO® can be used alongside existing antidepressants. The approved indication for TRD includes use as an adjunct to oral antidepressants, not as a replacement. Patients typically continue their current antidepressant while adding SPRAVATO®, though medication management decisions are always individualized. We offer Medication Management services in Minneapolis at our institute, and our team can coordinate with existing prescribers to ensure that SPRAVATO® is integrated appropriately into a patient’s overall treatment plan.
Frequently Asked Questions
Is SPRAVATO® covered by insurance? Because SPRAVATO® is FDA-approved for treatment-resistant depression, it is covered by most major insurance plans for eligible patients — a meaningful advantage over IV ketamine. Coverage depends on your specific plan, formulary, and whether prior authorization criteria are met. We encourage patients to contact their insurer directly and to discuss documentation requirements with your provider before beginning treatment.
How is SPRAVATO® different from regular ketamine? SPRAVATO® is esketamine — the S-enantiomer of ketamine — delivered as a nasal spray in a certified healthcare facility under clinical supervision. IV ketamine is a different formulation, administered differently, and its psychiatric uses are off-label. SPRAVATO® is FDA-approved for two specific indications; IV ketamine is not FDA-approved for psychiatric conditions. They are distinct drugs with different regulatory pathways.
Why do I have to stay at the clinic for two hours after each dose? The SPRAVATO® REMS program requires a minimum two-hour observation period after each dose because of the risks of dissociation, sedation, and elevated blood pressure that SPRAVATO® can produce. The monitoring period ensures that these effects have resolved sufficiently before you leave, and our clinical team assesses your status throughout. You cannot drive on the day you receive SPRAVATO®.
Can SPRAVATO® be used for anxiety or PTSD? SPRAVATO® is FDA-approved only for treatment-resistant depression and major depressive disorder with acute suicidal ideation or behavior. Use for other conditions would be off-label. Discuss with your provider whether your specific diagnosis and clinical history make SPRAVATO® an appropriate option. If you are interested in how ketamine approaches apply to PTSD specifically, our resource on what PTSD treatment involves offers a useful starting point.
What happens if SPRAVATO® doesn’t work for me? Non-response or partial response to SPRAVATO® does not mean all options are exhausted. Our team can explore IV ketamine therapy, ketamine-assisted psychotherapy, medication adjustments through our Medication Management service, or a combined approach. Results vary by individual, and finding the right combination often requires patience and close collaboration with your provider.
Key Takeaways
- SPRAVATO® is esketamine nasal spray, FDA-approved for treatment-resistant depression — a distinct drug and pathway from IV ketamine
- SPRAVATO® is covered by most major insurance plans for eligible patients, making it our primary recommended option for those who meet TRD criteria
- Administration requires a certified healthcare setting, direct supervision, and a mandatory two-hour monitoring period under the SPRAVATO® REMS program
- Veterans referred through the VA Community Care Network (VCA contract) may have access to ketamine infusions at our institute with VA coverage — discuss with your provider which modality applies to your situation
- Results vary by individual; discuss all treatment options and documentation requirements with your provider
For patients who have not found adequate relief from antidepressants, SPRAVATO® offers an FDA-approved option that works through a different mechanism and can be administered safely in our certified Minneapolis clinic. If you or someone you care for meets the criteria for treatment-resistant depression, we encourage you to schedule a consultation with Minnesota Ketamine & Wellness Institute. Our team will review your treatment history, explain what SPRAVATO® involves, and help you determine whether this is the right next step.
References
Janssen Pharmaceuticals (SPRAVATO® Prescribing Information) — https://www.spravato.com/
U.S. Food and Drug Administration — https://www.fda.gov/drugs/drug-safety-and-availability/fda-approves-new-nasal-spray-medication-treatment-resistant-depression
National Institute of Mental Health — https://www.nimh.nih.gov/health/topics/depression
American Psychiatric Association — https://www.psychiatry.org/patients-families/depression/what-is-depression
About Christy Hatcher, MSN, APRN, CRNA
Christy Hatcher, MSN, APRN, CRNA is the owner and lead provider at Minnesota Ketamine & Wellness Institute. She specializes in ketamine infusions as an alternative or adjunct treatment for depression, anxiety, PTSD, and suicidal ideation. The Institute offers a multidisciplinary team with over 40 years of combined experience in mental health and anesthesia services, including therapists who are Certified Clinical Trauma Professionals, Somatic Psychedelic Facilitators, and licensed clinical social workers certified in psychedelic-assisted therapy. The clinic integrates ketamine-assisted psychotherapy (KAP) and integration therapy alongside infusion services, holds a VA Community Care Network (VCA) contract for eligible veterans, and offers SPRAVATO® as its primary FDA-approved, insurance-covered option for treatment-resistant depression.
Medical Disclaimer
The content of this article is provided by Minnesota Ketamine & Wellness Institute for educational purposes only and does not constitute medical advice, diagnosis, or treatment. SPRAVATO® is FDA-approved for treatment-resistant depression and MDD with acute suicidal ideation only. Individual results vary. Always discuss treatment options, risks, and benefits with a qualified healthcare provider before making any medical decisions.