SPRAVATO® (esketamine) became the first nasal spray medication approved by the U.S. Food and Drug Administration specifically for treatment-resistant depression in 2019, marking a meaningful shift in what was available to patients who had exhausted standard antidepressant options (Janssen Pharmaceuticals, 2019). Most New Jersey patients searching for information about it have already been through a long treatment history. They want practical answers about what the treatment involves, where to get it, and what to expect, not a general overview of depression. This blog is written for those patients.
How SPRAVATO® Is Different from Standard Antidepressants
Standard antidepressants, primarily selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), work by increasing the availability of specific neurotransmitters in the brain. They are effective for many patients. For others, they are not, and the reasons have less to do with treatment compliance than with the underlying biology of the depression itself.
SPRAVATO® works through a different pathway entirely. Esketamine acts on the glutamate system, which is the brain’s primary excitatory neurotransmitter network (National Institutes of Health). This system plays a central role in synaptic function and the brain’s ability to form and strengthen neural connections. For patients whose depression has not responded to repeated serotonin-based treatments, this distinction is clinically significant: it means SPRAVATO® is not simply another medication in the same class. It is addressing a different set of biological mechanisms.
This is also why SPRAVATO® can produce noticeable symptom relief within 24 hours to a few days for some patients, whereas standard antidepressants typically require six to eight weeks to reach a therapeutic effect. The mechanism operates differently and produces a different clinical timeline. Results vary by individual, and not every patient with treatment-resistant depression responds to SPRAVATO® at the same rate or to the same degree.
FDA Approval and What It Means for Patients
SPRAVATO® received FDA approval in 2019 as the first medication of its kind for treatment-resistant depression, available exclusively through certified healthcare settings (Janssen Pharmaceuticals, 2019). In 2024, it received an additional approval as the first and only monotherapy for adults with TRD, meaning it can now be prescribed as a standalone treatment rather than only alongside an oral antidepressant (Johnson and Johnson, 2025).
This monotherapy approval matters for practical reasons. Some patients with treatment-resistant depression have histories of poor tolerability to oral antidepressants, or have tried so many that continuing one alongside SPRAVATO® is not clinically warranted. The approval gives clinicians and patients more flexibility in structuring a treatment plan that fits the actual history rather than forcing an antidepressant into the protocol for regulatory rather than clinical reasons.
The REMS (Risk Evaluation and Mitigation Strategy) program attached to SPRAVATO® means that it can only be administered at certified clinical sites. Psychotherapy Care Center is a certified SPRAVATO® REMS treatment center, which means our clinical staff are trained in the specific protocols required for safe administration and ongoing monitoring. This is not a medication patients take at home. Every session takes place in our clinic under qualified healthcare supervision.
Who Qualifies for SPRAVATO® Treatment
SPRAVATO® is FDA-approved for adults with treatment-resistant depression, defined as inadequate response to at least two antidepressants at adequate doses for adequate duration, and for adults with major depressive disorder who are experiencing active suicidal ideation with intent or plan. Not every patient who inquires about SPRAVATO® will be an appropriate candidate, and determining candidacy requires a thorough evaluation of your psychiatric and medical history.
Factors that affect candidacy include current medications, cardiovascular history, history of substance use, dissociative disorder history, and several other medical and psychiatric considerations. The pre-treatment evaluation exists to protect patients, not to create barriers. We work through this process carefully with every patient and give honest answers about whether SPRAVATO® is the right fit for their specific situation.
We serve patients from across New Jersey at our Jersey City and Union City locations. Patients traveling from other parts of the state for SPRAVATO® treatment, including from areas such as Paramus, Toms River, Monmouth County, and Central NJ, are welcome to contact us to discuss the logistics of beginning a treatment course and whether telehealth can support any components of the evaluation and monitoring process.
What Treatment Looks Like at Our Clinics
A SPRAVATO® session at Psychotherapy Care Center follows a consistent structure. You arrive and settle into a comfortable, quiet space designated for treatment. Under the guidance of our staff, you self-administer the nasal spray. For the next two hours, we monitor your blood pressure and overall status before clearing you to leave. You must have a designated driver for every session, as driving after treatment is not safe or permitted. Most patients report feeling back to their normal baseline after a full night of sleep.
The frequency of sessions during the induction phase and the maintenance phase that follows is determined by your clinical team based on your response and the established treatment protocol. Maintenance sessions are designed to sustain the benefit achieved during induction and reduce the risk of relapse over time. Your team will discuss the schedule with you before treatment begins so that you can plan accordingly.
Throughout the treatment course, SPRAVATO® is integrated with your broader care at Psychotherapy Care Center. That may include traditional psychotherapy, comprehensive medication management, or other modalities depending on your full clinical picture. We do not treat SPRAVATO® as a standalone program disconnected from the rest of your psychiatric care. The goal is a coherent, coordinated plan. We encourage you to discuss all aspects of your treatment with your provider and to raise questions at any point in the process.
Insurance Coverage and Cost in New Jersey
SPRAVATO® has broader insurance coverage than many patients expect. Because it carries FDA approval and a substantial clinical evidence base, it is covered by a meaningful range of major insurers when specific criteria are met. Psychotherapy Care Center accepts Aetna, AmeriHealth, Anthem, BlueCross BlueShield, Cigna/Evernorth, Medicare, Medicaid, Optum, Oxford Health Plans, UMR, United Healthcare, and others.
Coverage depends on your specific plan and whether clinical eligibility criteria are met. We handle insurance verification before your first treatment session so that you know what to expect on the financial side before any commitment is made. If coverage is a concern, call us and we will check your benefits as part of the initial intake process. We would rather have that conversation early and give you accurate information than have cost become a reason patients put off care they are already qualified for.
Frequently Asked Questions
Is SPRAVATO® the same as ketamine infusion therapy? SPRAVATO® (esketamine) is a derivative of ketamine and works through a related mechanism, but it is a distinct FDA-approved medication formulated specifically for depression in the form of a nasal spray. It is administered in a certified clinical setting under healthcare supervision. Psychotherapy Care Center offers SPRAVATO® nasal spray treatment. We do not offer intravenous ketamine infusion therapy.
How many SPRAVATO® sessions will I need? The protocol involves an induction phase followed by a maintenance phase, with the specific schedule determined by your clinical team and your response to treatment. Results vary by individual. Your clinician will reassess your progress regularly and adjust accordingly.
Do I need a referral to start a SPRAVATO® evaluation? No referral is required to contact us. You can call, email, or submit a request through our website. From there, we will schedule an evaluation to determine whether SPRAVATO® is appropriate for your history and health status.
Can I drive myself home after a session? No. Driving after a SPRAVATO® session is not permitted. Every patient must have a designated driver or arranged transportation for each appointment. This is a REMS program requirement.
What happens if SPRAVATO® does not work for me? Not every patient with treatment-resistant depression responds to SPRAVATO®, and that determination is made through the treatment course, not before it begins. If SPRAVATO® is not producing the response your clinical team is looking for, we will discuss what other options are available based on your full history. We do not consider a non-response to be the end of the road.
Key Takeaways
- SPRAVATO® (esketamine) is FDA-approved for treatment-resistant depression and works through the glutamate system, a different mechanism than standard SSRIs and SNRIs.
- In 2024, SPRAVATO® received approval as the first and only monotherapy for TRD, meaning it can now be used as a standalone treatment rather than only alongside an oral antidepressant.
- Psychotherapy Care Center is a certified SPRAVATO® REMS treatment center serving patients from Jersey City, Union City, and across New Jersey.
- Every session is conducted in-clinic with a minimum two-hour observation period. Patients must have a driver home following each session.
- SPRAVATO® is covered by many major insurance plans, and we verify coverage before treatment begins.
Conclusion
If you have been through multiple antidepressants without finding relief, SPRAVATO® may represent an option your current treatment history points toward. Getting an evaluation is the first step. At Psychotherapy Care Center, we see patients from across New Jersey at our Jersey City and Union City clinics, and we take the time to assess whether SPRAVATO® is the right fit before recommending it. Call us at (201) 604-0377, submit an appointment request through our website, or email us at info@pccmh.com. We respond within 24 hours.
References
Janssen Pharmaceuticals. (2019). Janssen announces U.S. FDA approval of SPRAVATO™ (esketamine) CIII nasal spray for adults with treatment-resistant depression. https://www.jnj.com/media-center/press-releases/janssen-announces-u-s-fda-approval-of-spravatotm-esketamine-ciii-nasal-spray-for-adults-with-treatment-resistant-depression-trd-who-have-cycled-through-multiple-treatments-without-relief
Johnson and Johnson. (2025). SPRAVATO® (esketamine) approved in the U.S. as the first and only monotherapy for adults with treatment-resistant depression. https://www.jnj.com/media-center/press-releases/spravato-esketamine-approved-in-the-u-s-as-the-first-and-only-monotherapy-for-adults-with-treatment-resistant-depression
National Institutes of Health. (n.d.). Glutamate. https://www.ncbi.nlm.nih.gov/books/NBK62187/
Medical Disclaimer: The information in this blog is for educational purposes only and does not constitute medical advice. SPRAVATO® (esketamine) treatment should only be pursued under the supervision of a licensed psychiatric provider familiar with your full medical and psychiatric history, and only at a certified REMS treatment center. Results vary by individual, and not every patient is a candidate for SPRAVATO®. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline, or go to your nearest emergency room.
