Spravato Therapy: What to Know This Summer

If you’ve been researching Spravato therapy, you’re likely someone who has spent a long time looking for relief and is now ready to explore a different approach. Spravato (esketamine) nasal spray is FDA-approved for treatment-resistant depression in adults, and for many patients, learning about this option comes after months of trying standard antidepressants without meaningful improvement. Dr. Roshni Karnani is a board-certified neurologist who provides clinically grounded guidance to help patients understand whether this treatment is right for them. This page is here to give you the clear, honest information you need before taking that next step. If you’re located in New York City, Westchester, or the surrounding area, we encourage you to call our practice and start the conversation.

What Is Spravato and How Does It Work?

Spravato is the brand name for esketamine, a nasal spray derived from ketamine that acts on NMDA receptors in the brain. Unlike traditional antidepressants, which primarily target serotonin or norepinephrine pathways and can take weeks to produce effects, esketamine works through a distinct glutamate-based mechanism. Research suggests this difference in mechanism may help patients who have not responded adequately to two or more oral antidepressants.

FDA Approval and REMS Requirements

Spravato is FDA-approved for treatment-resistant depression in adults and for major depressive disorder with acute suicidal ideation or behavior. Because of its potential for misuse and the possibility of sedation or dissociation following administration, the FDA requires all treatment centers to be certified through a program called REMS (Risk Evaluation and Mitigation Strategy). This means Spravato cannot be dispensed for home use. It must be administered and monitored in a certified clinical setting, and patients are observed for at least two hours after each dose.

Our practice is a REMS-certified treatment center, one of relatively few in the Westchester and New York City area authorized to administer Spravato. This certification reflects a commitment to patient safety protocols that go beyond standard outpatient care. Patients who are also managing complex neurological conditions, such as those seen by our migraine treatment specialists in NYC, may benefit from this integrated approach to neurological and mood-related care.

 

Spravato Therapy: Candidacy and the Treatment Process

Not every patient with depression is a candidate for Spravato. Understanding who may benefit, and what the treatment experience involves, is a critical part of making an informed decision.

Who May Be a Candidate

Spravato is generally considered for adults who have tried and not responded sufficiently to at least two different antidepressant medications. A thorough evaluation by a qualified provider is necessary to determine candidacy. Factors such as medical history, current medications, and the presence of any neurological conditions are all considered during the assessment process. Patients managing conditions such as epilepsy or other neurological diagnoses may require additional evaluation before proceeding.

What to Expect During Treatment

Treatment sessions are conducted in a supervised clinical environment. Patients self-administer the nasal spray under direct medical supervision. Sessions are typically scheduled twice weekly for the first four weeks, then weekly, then every one to two weeks as a maintenance phase. During each session, patients remain in the office for at least two hours while staff monitors for any adverse effects, including dizziness, nausea, or transient dissociation. Patients are required to arrange transportation home, as driving after a session is not permitted.

Some patients report noticing a difference within the first few weeks; others may need to complete the full induction phase before evaluating response. Our team works closely with each patient to monitor progress and adjust the treatment schedule accordingly.

Integrating Spravato With Broader Neurological Care

One dimension of Spravato therapy that is often overlooked is how it fits within a broader neurological health picture. Depression does not exist in isolation. It frequently co-occurs with neurological conditions, and managing both effectively requires a provider with deep expertise across specialties.

The Intersection of Neurology and Mood Disorders

Research suggests that depression is significantly more common among individuals living with conditions such as multiple sclerosis, Parkinson’s disease, chronic migraine, and neuropathy. Addressing mood as part of a comprehensive neurological care plan may support better overall outcomes. For patients already receiving care for conditions such as multiple sclerosis or neuropathy, integrating Spravato therapy under the same roof can simplify coordination and reduce the burden of managing multiple providers.

TMS as a Complementary Option

In addition to Spravato, our practice also offers Transcranial Magnetic Stimulation (TMS), another advanced therapy for treatment-resistant depression. TMS uses targeted magnetic pulses to stimulate specific regions of the brain associated with mood regulation. For patients who may not be candidates for Spravato, or who are considering all available options, TMS may represent a valuable alternative. Your provider can help determine which approach, or which combination, may be most appropriate based on your clinical history. 

Why Choose Our Practice in New York, NY?

Dr. Roshni Karnani is a neurologist board-certified by the American Board of Psychiatry and Neurology, with expertise that enables the delivery of both Spravato and TMS services within a single neurology practice. Recognized as a Castle Connolly Top Doctor and honored by New York Magazine, Dr. Karnani brings extensive experience in treatment-resistant depression alongside her broader expertise in movement disorders, epilepsy, multiple sclerosis, migraine, and dementia care.

Patients are seen at three locations serving the greater New York area: Rye Brook, Yonkers, and New York City. Dr. Karnani also speaks Spanish, a meaningful differentiator for Spanish-speaking patients seeking compassionate, accessible neurological care. Our practice is one of the relatively few REMS-certified Spravato treatment centers in the Westchester and NYC region. 

Frequently Asked Questions About Spravato Therapy

How is Spravato different from oral antidepressants?

Spravato works through a glutamate-based mechanism targeting NMDA receptors, which is distinct from most oral antidepressants that primarily affect serotonin or norepinephrine systems. This difference may explain why some patients who have not responded to standard antidepressants report improvement with esketamine. It is not a replacement for oral antidepressants but is typically used alongside them. 

Is Spravato covered by insurance?

Coverage for Spravato varies by insurance plan. Many major insurers do cover it for patients who meet FDA-approved criteria, including documented treatment-resistant depression. Prior authorization is typically required. Our team can assist with the insurance verification process. For questions about payment and coverage options, patients are encouraged to review our payment and insurance information page or call our office directly.

Can I drive myself home after a Spravato session?

No. Because Spravato may cause sedation, dizziness, or dissociation during and after administration, driving after a treatment session is not permitted. This is a formal requirement under the REMS program. Patients must arrange for a responsible adult to drive them home or use a rideshare service. Planning transportation in advance is an important part of preparing for each appointment. Our staff can discuss logistics with you during the intake process.

How many sessions are typically needed before noticing a response?

The standard induction schedule involves twice-weekly sessions for the first four weeks, followed by a maintenance phase. Some patients report noticing a difference during the induction period, while others benefit from completing the full initial course before evaluating response. Dr. Karnani monitors each patient closely throughout the process and adjusts the schedule based on clinical response and tolerability. There is no universal timeline that applies to every patient.