When you have tried antidepressant after antidepressant and still feel stuck, it is easy to lose hope. Spravato (esketamine) offers a different option. It is an FDA-approved nasal spray for treatment-resistant depression that works on a different brain pathway than traditional antidepressants, and for some people, it brings relief when nothing else has.
Psychiatric Pathways in Bloomington is a certified Spravato treatment center led by Brenna Christie, FNP-C, PMHNP-BC. We provide Spravato in a calm, closely monitored setting as part of comprehensive psychiatric care for adults across the Twin Cities, with medication management and IV ketamine therapy available under the same care team. Spravato is often covered by insurance.
If you are having thoughts of suicide or feel unsafe, call or text 988 (the Suicide & Crisis Lifeline) or call 911 if there is immediate danger.
Spravato is a prescription nasal spray made from esketamine, a form of ketamine. It is FDA-approved for adults with:
Spravato is not approved for other conditions, and it is not a replacement for emergency care. Because of risks including sedation, dissociation, respiratory depression, and misuse, it is only available at certified treatment centers under a safety program called the Spravato REMS, and every dose is given under direct supervision.
Most antidepressants work on serotonin, norepinephrine, or dopamine. Spravato works on glutamate, the brain’s most abundant chemical messenger, which plays a key role in learning, mood, and how brain cells communicate. This is thought to help the brain form new connections that chronic stress and depression have weakened, which may explain why Spravato can help people who have not responded to traditional antidepressants.
Spravato can also work quickly. In the clinical study that led to its approval as a standalone treatment, patients taking Spravato showed improvement over placebo as early as 24 hours, and 22.5% of Spravato patients reached remission at four weeks, compared with 7.6% on placebo. Individual results vary.
Spravato may be a good fit if you:
Spravato is not right for everyone. People with certain blood vessel conditions, such as an aneurysm or a history of bleeding in the brain, should not use it. It also requires extra caution for people with uncontrolled high blood pressure, certain heart or lung conditions, a history of substance use disorder, psychosis, or bipolar disorder, and it is not recommended during pregnancy or breastfeeding. Your evaluation will cover all of this.
Spravato typically starts with two treatments a week for the first four weeks, then once a week for the next four weeks. After that, treatments continue weekly or every other week depending on how you respond. We track your progress with structured check-ins and adjust your plan as you go.
Spravato is FDA-approved for depression. But depression rarely shows up alone. It often occurs alongside PTSD, anxiety, OCD, and other conditions, which is why many people with these diagnoses ask about Spravato. Here is how it fits with each condition we treat.
| Condition | Is Spravato FDA-approved for it? | When Spravato may be considered |
| Depression | Yes, for treatment-resistant depression and for major depression with suicidal thoughts or actions | Depression has not improved after at least two antidepressants |
| PTSD | No | PTSD occurs alongside treatment-resistant depression |
| Anxiety | No | Anxiety occurs alongside treatment-resistant depression |
| OCD | No | OCD occurs alongside treatment-resistant depression |
| Bipolar disorder | No | Not a standard treatment; case-by-case review only |
| Prescription drug addiction | No | Not an addiction treatment; extra caution required |
Depression is what Spravato is approved to treat. For adults with treatment-resistant depression, it can be used on its own or with an oral antidepressant. For adults with major depression who are experiencing suicidal thoughts or actions, it is used together with an oral antidepressant as part of close, comprehensive care. Postpartum depression is a form of major depression, so Spravato may be considered when it has not responded to standard treatment, though it has not been studied specifically after childbirth and breastfeeding is not recommended during treatment. Learn more about depression treatment.
Spravato is not approved to treat PTSD on its own. However, depression is one of the most common conditions to accompany PTSD, and when that depression has not responded to at least two antidepressants, Spravato may be an appropriate option. Some patients find that easing depression makes it easier to engage in trauma-focused therapy. Learn more about PTSD treatment.
Spravato is not approved for anxiety disorders on their own, and anxiety or restlessness can be a temporary side effect of treatment. For people whose anxiety occurs alongside treatment-resistant depression, Spravato may be considered as part of a broader plan that also treats the anxiety directly. Learn more about anxiety treatment.
Spravato is not approved for OCD. Depression is common among people with OCD, and when it has not improved with standard antidepressants, Spravato may be considered for the depression, alongside OCD-specific care such as SSRIs and Exposure and Response Prevention (ERP) therapy. Learn more about OCD treatment.
Spravato is approved for major depressive disorder, not bipolar disorder, and people with bipolar disorder were generally not included in the studies that led to its approval. Because treatments for depression can sometimes trigger mania in people with bipolar disorder, Spravato is not a standard bipolar treatment. If you have bipolar depression that has not responded to treatment, we will review your history carefully and discuss whether IV ketamine alongside a mood stabilizer, Spravato, or another approach is the safest fit. Learn more about bipolar disorder treatment.
Spravato is not a treatment for addiction. Like ketamine, esketamine carries a risk of misuse, and its label calls for extra caution in people with a history of substance use disorder. In some cases, a person who is stable in recovery and has treatment-resistant depression may be evaluated for Spravato, with careful review and close monitoring. For addiction itself, we focus on psychiatric care for co-occurring conditions and coordination with addiction treatment. Learn more about prescription drug addiction treatment.
Spravato and IV ketamine both work on the glutamate system, and we offer both. The right choice depends on your diagnosis, history, insurance, and preferences.
We will help you weigh the options during your consultation.
The most common side effects include dissociation (feeling disconnected or detached), dizziness, nausea, sleepiness, headache, a temporary rise in blood pressure, and anxiety. They usually begin shortly after a dose and resolve the same day. Every dose is given in our office, and you are monitored for at least two hours before you go home.
Spravato carries a boxed warning for sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors in younger adults, as all antidepressants do. Spravato has not been shown to prevent suicide, and it does not replace hospital care when that is needed. These risks are why it is only given in certified centers with close supervision, and why a careful evaluation comes first.
Because Spravato is FDA-approved, it is often covered by insurance. Psychiatric Pathways is in-network with Optum (including UnitedHealthcare, Medica, and UMR), Aetna, and Humana. Many plans require prior authorization, and our team can help you navigate that process. HSA and FSA payments are accepted. The manufacturer also offers a savings program that may lower out-of-pocket costs for eligible patients with commercial insurance. Visit our insurance page for details.
Brenna Christie is dual board certified as both a Family Nurse Practitioner and a Psychiatric-Mental Health Nurse Practitioner, and a member of the American Society of Ketamine Physicians, Psychotherapists and Practitioners (ASKP3). Her practice focuses on adults whose depression and mood symptoms have not improved with traditional treatment alone.
Our clinic is located at 3601 Minnesota Dr #510 in Bloomington, serving adults throughout the Twin Cities, including Minneapolis, Edina, Richfield, Eden Prairie, and surrounding communities. Spravato treatments take place in person at our office. Many medication management follow-up visits can be held by telehealth.
Spravato is a nasal spray made from esketamine, one part of the ketamine molecule. It is FDA-approved for treatment-resistant depression and often covered by insurance. IV ketamine is given by infusion, is used off-label, and is usually self-pay.
Some people notice improvement within days. In clinical trials, improvement over placebo was seen as early as 24 hours for some patients. Others need several weeks of treatment to respond.
Not necessarily. Spravato can be used on its own or together with an oral antidepressant for treatment-resistant depression. We will decide together what makes sense for you.
No. You cannot drive or operate machinery until the next day after a restful night’s sleep, so you will need a ride home.
Plan for about two to two and a half hours, including check-in, the dose, and at least two hours of monitoring.
Esketamine has potential for misuse, which is why it is only given in certified clinics under supervision and never sent home with patients. Your provider will review your history before starting treatment.
Spravato is approved for depression, not these conditions on their own. It may be considered when PTSD, anxiety, or OCD occurs alongside depression that has not responded to at least two antidepressants.
Spravato is not approved for bipolar disorder and is not a standard treatment for it. We are happy to discuss your options, including IV ketamine alongside a mood stabilizer.
Spravato is not recommended during pregnancy or breastfeeding. We will talk through safer alternatives with you.
Call us or book a free consultation online. We will review your history, explain your options, and help you check your insurance coverage.
If depression has not responded to treatment, Spravato may offer a new path forward. At Psychiatric Pathways, Brenna Christie and our team are here to help you find out if it is right for you.
Call (952) 592-5421 or schedule your free consultation today.
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