Why Choose SPRAVATO Therapy: Benefits and Results

For adults in New York, NY living with treatment-resistant depression, finding effective relief can feel like an exhausting search. Spravato (esketamine) has emerged as a clinically meaningful option for patients who have not responded adequately to traditional antidepressants, offering a different mechanism and a faster path to symptom improvement than many oral antidepressant medications.

This guide covers how Spravato works, who may benefit, what the treatment process involves, what clinical evidence shows about remission rates and outcomes, and how Chester Neurology approaches care for patients managing this complex condition. Whether you are researching options for yourself or a loved one, this resource is designed to give you a clear, honest foundation for informed conversations with your healthcare provider.

If you would like to discuss your options with a specialist, contact Chester Neurology at (914) 816-1941.

What Is Spravato and How Does It Work?

Spravato is an FDA-approved nasal spray containing esketamine, a compound derived from ketamine, used in conjunction with an oral antidepressant to address treatment-resistant depression in adults. Unlike traditional antidepressants, which primarily target serotonin, norepinephrine, or dopamine pathways, Spravato works on glutamate receptors in the brain. This distinct mechanism is one reason it can provide relief in patients for whom multiple antidepressants have not been effective.

Spravato vs. Ketamine Therapy

Patients often ask how Spravato differs from ketamine therapy. While both involve esketamine or ketamine compounds, Spravato is administered as an esketamine nasal spray in a certified clinical setting under medical supervision. Intravenous ketamine therapy is also used for depression in some settings, but Spravato is the only FDA-approved esketamine formulation specifically indicated for treatment-resistant depression and for adults with major depressive disorder accompanied by acute suicidal ideation or behavior. The nasal spray delivery method and structured REMS program help ensure consistent administration and monitoring.

Rapid Onset of Action

One of the most clinically significant aspects of Spravato is its rapid onset. Many patients begin to notice some decrease in depression symptoms within hours to days of their first dose, which is notably faster than most oral antidepressant medications, which typically require weeks before meaningful improvement occurs. For patients with severe depressive symptoms or suicidal ideation, this speed can be an important consideration.

Understanding Treatment-Resistant Depression

Treatment-resistant depression (TRD) is generally defined as major depressive disorder in which a patient has not experienced an adequate response to at least two different antidepressants taken at appropriate doses and durations. It is more common than many people realize. Research suggests that approximately one-third of adults diagnosed with major depressive disorder may meet criteria for treatment-resistant depression (TRD) at some point during their illness.

For patients and their loved ones, TRD can be particularly difficult. Depression symptoms, including persistent low mood, loss of interest, fatigue, cognitive difficulties, and, in serious cases, suicidal thoughts, continue to affect daily functioning despite repeated treatment attempts. The emotional toll of trying multiple medications without sustained improvement can itself become a barrier to continued engagement with care.

Why Traditional Antidepressants May Not Be Enough

Traditional antidepressants, including SSRIs and SNRIs, are effective for many patients. However, for those with an inadequate response, continuing to cycle through similar oral antidepressant medications without addressing underlying neurobiological differences may not reduce depression symptoms meaningfully. Treating treatment-resistant depression often requires approaches that work through different pathways, which is precisely where Spravato’s mechanism targeting glutamate receptors offers a clinical distinction.

Key Benefits of Spravato for Depression

Understanding the potential benefits of Spravato helps patients and their loved ones make more informed decisions alongside their healthcare providers. The following represent the most clinically documented advantages based on available evidence and FDA review data.

Rapid Relief for Severe Symptoms

Providing quick relief for patients with significant depression severity is one of Spravato’s most important clinical attributes. For adults experiencing acute suicidal ideation, the FDA has specifically approved Spravato for use in this population, recognizing the clinical need for treatments that can provide rapid relief when traditional medications are not acting quickly enough.

A Different Mechanism Than Oral Antidepressants

Because Spravato works differently in the brain than standard antidepressants, it can benefit patients who have not responded to multiple oral antidepressant regimens. It represents a different biological approach for patients whose brain chemistry has shown inadequate response to other treatments.

Used Alongside Oral Antidepressants

Spravato is not intended as a standalone replacement for oral antidepressant therapy. It is used in combination with an ongoing oral antidepressant as part of a comprehensive treatment plan. This combination approach has demonstrated the ability to reduce depression symptoms more effectively than either approach alone in patients with treatment-resistant depression.

Continued Improvement Over Time

While some patients notice improvement relatively early, continued improvement is observed across the full treatment course. The induction phase, typically twice-weekly dosing, transitions into a maintenance phase with less frequent dosing as symptoms stabilize. Many patients experience continued improvement in depressive symptoms as the maintenance phase progresses.

What to Expect During Spravato Treatment Sessions

Spravato is classified as a schedule III controlled substance and is administered exclusively in certified clinical settings under the FDA’s REMS (Risk Evaluation and Mitigation Strategy) program. This means patients do not take Spravato home; every session occurs in a monitored medical environment.

The Treatment Session Process

During treatment sessions, a healthcare provider administers the nasal spray under supervision. Patients remain in the clinical setting for a mandatory observation period of at least two hours after dosing. This observation window allows staff to monitor for dissociative symptoms, blood pressure changes, and other potential side effects that may occur during or after administration. Patients should arrange for someone to drive them home, as operating a vehicle after Spravato treatment is not permitted on the day of each session.

Dosing Schedule Overview

The standard Spravato dosing schedule begins with an induction phase of twice-weekly treatment sessions for the first four weeks. Dosing then transitions to once-weekly sessions during weeks five through eight, followed by a maintenance phase of once-weekly or once every two weeks, based on clinical response. The specific dosing schedule for each patient is determined by their provider based on symptom response and individual factors.

Clinical Results and Remission Rates

Clinical trials supporting the FDA approval of Spravato demonstrated meaningful outcomes for adults with treatment-resistant depression. Patients experienced statistically significant reductions in depression severity compared to placebo groups, with many patients achieving remission or substantial symptom improvement over the course of treatment.

Spravato for Suicidal Ideation

For adults with major depressive disorder accompanied by acute suicidal ideation or behavior, clinical trials demonstrated that Spravato could provide rapid relief compared to standard of care alone. This is a separate FDA-approved indication, and the ability to decrease suicidal thoughts in a clinically meaningful timeframe represents a significant benefit for patients in acute distress and their loved ones.

Potential Side Effects and Safety Considerations

As with any medical treatment, Spravato carries potential side effects and requires careful patient screening. Understanding these considerations is an important part of an informed decision-making process.

Common Side Effects

The most commonly reported side effects include dissociative symptoms (such as feelings of detachment or perceptual changes), dizziness, nausea, sedation, and increases in blood pressure during and shortly after administration. These effects are typically monitored closely during the required post-dose observation period. Blood pressure monitoring is a standard component of every Spravato session.

Who Is a Good Candidate for Spravato?

Determining whether Spravato is a good candidate match for a specific patient requires a comprehensive evaluation by a qualified provider. Generally, adults who may benefit from Spravato include those who have been diagnosed with treatment-resistant depression after an inadequate response to at least two antidepressants, and adults with major depressive disorder experiencing acute suicidal ideation requiring rapid intervention.

Patients with co-occurring anxiety disorders, including social anxiety disorder, may present with more complex symptom profiles, and those mental health conditions will be factored into a thorough candidacy evaluation. Similarly, individuals with a history of trauma or other contributing mental health factors will need a comprehensive assessment to determine whether Spravato is an appropriate component of their broader care plan.

Spravato is not indicated as a treatment for anxiety symptoms alone or for anxiety disorders in the absence of a qualifying depressive condition. Adults who have found success with traditional antidepressants for other mental health conditions but are now facing treatment-resistant depression may still qualify based on their current clinical status.

Who Should Use Caution

Spravato is not appropriate for every patient. Individuals with a history of certain cardiovascular conditions, a personal or family history of psychosis, active substance use disorder, or specific vascular conditions may not be suitable candidates. Patients with a history of aneurysmal vascular disease or who are pregnant should not receive Spravato. A thorough medical evaluation is essential before beginning treatment. Your provider will review your complete medical history to assess whether Spravato is appropriate within your overall treatment plan.

Why Choose Chester Neurology for Spravato in New York

When seeking Spravato treatment in the New York, NY area, the experience and qualifications of your provider matter significantly. Chester Neurology is a REMS-certified Spravato treatment center, one of a relatively small number of practices certified to administer this therapy in the greater Westchester and New York City region. This certification reflects a rigorous compliance standard required by the FDA for all Spravato providers.

Dr. Roshni Karnani leads patient care at Chester Neurology with credentials from the American Board of Psychiatry and Neurology, a certification that is uncommon and directly relevant to the neurological and psychiatric dimensions of treating treatment-resistant depression. Dr. Karnani completed her neurology residency at Westchester Medical Center and her undergraduate education at Barnard College, Columbia University. She is also recognized as a Castle Connolly Top Doctor and has received recognition from New York Magazine’s physician list.

Chester Neurology serves patients across New York City, Rye Brook, Yonkers, and surrounding communities.

Have questions beyond what this guide covers? Dr. Karnani can provide personalized guidance based on your individual situation. Contact Chester Neurology online or call (914) 816-1941 to schedule a consultation.

Frequently Asked Questions About Spravato Therapy

How long does it typically take to see improvement after starting Spravato?

Some patients begin to notice a decrease in depression symptoms within the first one to two weeks of the induction phase, though individual timelines vary. Most patients experience more consistent results as treatment continues through the full induction and maintenance phases. Your provider will monitor your response closely and adjust the treatment plan as needed.

Does insurance cover Spravato treatment?

Insurance coverage for Spravato varies by plan and insurer. Because Spravato is FDA-approved for treatment resistant depression and for major depressive disorder with acute suicidal ideation, many insurance plans do provide coverage, particularly when prior authorization requirements are met and documentation of inadequate response to prior antidepressants is in place. Our team can assist with coverage questions during your consultation.

Can Spravato be used if I am currently taking an oral antidepressant?

Yes, Spravato is specifically designed to be used in combination with an oral antidepressant, not as a replacement for one. Your provider will evaluate your current medications and overall treatment plan to determine whether Spravato is an appropriate addition to your existing regimen.

Is there a difference between Spravato and IV ketamine therapy for depression?

Both Spravato and ketamine therapy involve related compounds and act on glutamate receptors in the brain, but they differ in formulation, delivery method, approval status, and clinical setting. Spravato is the only FDA-approved esketamine nasal spray specifically indicated for treatment-resistant depression and for adults with acute suicidal ideation. IV ketamine therapy is used off-label in some settings. Your provider can help you understand which approach may be most appropriate for your situation.

What happens if Spravato stops being effective over time?

Some patients may experience a decrease in symptom improvement over time, which is why ongoing monitoring and regular provider check-ins are a core part of the treatment process. If response decreases, your provider may adjust dosing, revisit the maintenance phase schedule, or consider complementary approaches as part of a revised treatment plan.

Are there lifestyle factors that can affect how well Spravato works?

General mental and physical wellness practices,  including consistent sleep, reduced alcohol use, and engagement with psychotherapy where appropriate, may support the overall effectiveness of depression treatment. Your provider can offer individualized guidance on supportive lifestyle factors as part of your comprehensive care plan.

Can Spravato help with depressive symptoms related to trauma?

Spravato is FDA-approved specifically for treatment-resistant depression and major depressive disorder with acute suicidal ideation. While trauma is frequently a contributing factor in depressive symptoms, the presence of trauma-related history does not automatically qualify or disqualify a patient. A thorough evaluation by your provider will determine whether Spravato fits within your broader treatment plan given your complete clinical picture.

Taking the Next Step Toward Relief

Living with treatment-resistant depression or watching a loved one struggle is one of the most challenging experiences a person can face. Spravato represents a meaningful, FDA-approved option for adults in New York, NY who have not found adequate relief through traditional antidepressants, offering a distinct biological mechanism, the potential for rapid relief, and a structured clinical pathway toward remission.

At Chester Neurology, Dr. Roshni Karnani provides expert, compassionate evaluation for patients considering Spravato and other advanced therapies for complex depression. As a REMS-certified treatment center, our practice is equipped to guide you through every stage of care. Contact Chester Neurology at (914) 816-1941 or schedule a consultation online to begin the conversation.