People who hear about Spravato for the first time often picture a prescription they pick up at a pharmacy. It does not work that way, and knowing the routine in advance can make it easier for a veteran, or anyone, to decide whether to ask about it.
Who it is for
Spravato is the brand name for esketamine nasal spray. The FDA has approved it, taken together with an oral antidepressant, for two uses in adults: treatment-resistant depression, and depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. It is not a pill and it is not taken at home. Under a federal safety program called the Spravato REMS, the spray is used only in a certified healthcare setting, under supervision, and the patient stays to be monitored for at least two hours afterward. Patients are told not to drive or operate machinery until the next day after a restful sleep.
Just as plainly, the label says what it is not. It has not been shown to prevent suicide or to reduce suicidal thoughts or behavior, and using it does not replace a hospital stay when one is needed. Common side effects include dissociation, dizziness, nausea, sleepiness and a temporary rise in blood pressure, which is part of why the monitoring period exists. Whether it fits a particular person is a decision for that person and a clinician, and no clinic can promise a result.
A typical visit
Exact schedules vary by clinic and by the prescriber's plan, but certified offices tend to follow a similar pattern. The patient checks in and has blood pressure taken. Under staff supervision, the patient uses the nasal spray device. Then comes the monitoring period, at least two hours, in a quiet room where staff check on the patient and repeat vital signs. Some people feel sleepy or detached for part of that time. Before leaving, staff confirm the patient is ready to go, and someone else drives.
Treatment usually involves more frequent visits at first, then fewer over time, as decided by the prescriber. Patients continue taking an oral antidepressant throughout.
What it cannot do
The treatment is not an emergency service. A person who is thinking about suicide right now needs immediate help, not an appointment. That means calling or texting 988, and for veterans and service members pressing 1 for the Veterans Crisis Line or texting 838255, or calling 911.
Getting started
The first step is usually a conversation with a clinician who reviews which treatments have been tried. Some certified clinics, including Brain Recovery Centers in Chesterfield, Missouri, offer a free consultation to talk through whether it is a reasonable option and how insurance or VA community care may apply. A consultation does not commit anyone to treatment, and no clinic can guarantee a result.
If you or someone you know is thinking about suicide, call or text 988, the Suicide and Crisis Lifeline, any time. Veterans and service members can press 1 after dialing 988, or text 838255, to reach the Veterans Crisis Line. In an emergency, call 911.