In continuing our mission to increase access to the latest treatments for mental health, Ketamine Clinics Los Angeles is offering patients Spravato treatment, the first FDA-approved nasal spray for depression. This new tool was made possible by the incredible success of intravenous infusions of ketamine for depression in the last 22 years. There are some important differences between the two treatments. One key consideration in our decision to offer Spravato is the fact that it can be covered by insurance, at least a significant portion of the costs, whereas IV infusions are typically not. Many patients with a good PPO plan can get some money back for their out of pocket costs for IV ketamine after filing a claim with their insurer depending upon their health insurance company, policy, deductible status, and other considerations. Helping patients identify affordable options is always a high priority at KCLA, and we are even more focused on those options that are most likely to produce the desired relief for the longest period of time.
Depression is the leading cause of disability world-wide and its impact is only worsening. More than one-third of those who suffer from depression remain treatment-resistant. Ketamine Clinics Los Angeles (KCLA) is dedicated to using all available tools to assist patients in living the life they deserve, one of peace and happiness. As with any treatment, there are pros and cons and important considerations to take into account before choosing the best option for you. At KCLA, we are committed to educating patients on the latest and most effective treatment options available and guiding them through the process so they are not only making an informed decision but also able to become their own best advocates. This page reviews key information about dosing, protocol, efficacy, comparisons to IV ketamine, scheduling, and some other general logistics surrounding Spravato for depression and other mental health conditions. This page is not intended to be an in depth analysis, but a general overview to assist patients and those who care for them in determining the right treatment.
About Spravato (Esketamine) Treatment
Spravato is a prescription medication for treatment-resistant depression, and the first of its kind to be administered through a nasal spray. Unlike many other prescriptions for depression, it must be administered in an approved clinic and under the direct observation of clinicians. Its active ingredient is esketamine, or S-ketamine, which differs from traditional ketamine—and traditional IV ketamine infusions —in a number of ways.
Initial differences can be found in their structural properties. IV infusions of ketamine utilize a racemic mixture of ketamine, which is a 50/50 mix of two mirror-image molecules (think a “right handed” version and a “left handed” version). Esketamine is a chemical chain composed of just one of the two molecules that make up racemic ketamine. This small but important structural difference enabled this medication to be patented, which motivated the many millions of dollars that went into acquiring FDA approval (and a manufacturer patent) for this variation of a proven compound. Racemic ketamine is off-patent since it was first approved by the FDA more than 50 years ago in 1970.
Spravato S-ketamine nasal spray is currently approved by the FDA for patients who have been diagnosed with treatment-resistant depression or major depressive disorder with suicidal ideation or behaviors. It is not at this time approved for the treatment of anxiety, PTSD, OCD, pain, or other conditions.
Individuals must be prescribed Spravato by a board-certified psychiatrist, and they must follow a set regimen for treatment, generally starting with two treatments a week for four weeks. Patients must meet other criteria, such as having tried and failed at least two adequate trials of other antidepressant medications and they must start a new course of treatment on an oral antidepressant medication. Spravato is self-administered by the patient, however it can only be used under the direct supervision of a healthcare provider in an approved facility.
Spravato Effectiveness in Treating Depression
Clinical results for Spravato show some positive benefit, though its important to remember that the treatment protocol requires that a new antidepressant be started at the same time as Spravato. This makes it difficult to determine causality of modality. Spravato and medication is shown as more beneficial than placebo nasal spray and medication in this year-long study. We do not have any data that illustrates if Spravato alone is better than placebo.
Spravato is absorbed into the bloodstream through the nasal cavity. This route of administration (ROA) significantly reduces the bioavailability of the medicine, or the percentage of the medicine that’s able to access the circulation and target organs. When ketamine is administered intravenously, 100% of the medicine is available for the body to use. The bioavailability of esketamine nasal spray is approximately 48%. Intravenous ROA also allows for a highly personalized dose and experience at each treatment, whereas Spravato is administered in only two set dosages, 56mg or 84mg.
Similar to IV Ketamine Infusion Therapy, Spravato has been found to offer fast-acting results, with many patients experiencing reduced depressive symptoms within hours to days of initial treatment. By contrast, most traditional antidepressants take weeks or months before an effect is noticed. This can make a huge difference for patients who are suffering from major depressive symptoms and suicidal ideations or behaviors and need relief ASAP.
Notably, results may take longer to achieve with Spravato as the treatment course is 16 weeks as opposed to the standard 2-3 weeks of IV ketamine. In the aforementioned study, participants received Spravato twice a week for 4 weeks, then once a week for 4 weeks, and then weekly or every other week for the remaining 8 weeks.
Is Spravato Right For Me?
Possible Spravato Side Effects
Side effects are possible with any medication. Some side effects to be aware of with Spravato include nausea, lethargy, trouble focusing, and dissociation (an “out of body” feeling). Because of the potential side effects, patients are monitored for two hours after each esketamine treatment, and should not plan to drive themselves home or operate any heavy machinery until the following day.
There is a potential for misuse of Spravato, particularly among patients with a history of substance use disorder. This is more pronounced than some other ROAs due to the bolus or lump dose of Spravato, versus a slow, gradual infusion. Taking Spravato in a controlled, clinical setting under the oversight of a healthcare provider helps minimize this risk, as does the highly regimented dosage schedule.
Is Spravato Covered by Insurance?
We do not currently accept insurance for Spravato but are working on making that possible. Full or partial reimbursement for Spravato esketamine nasal spray treatment may be available through your insurance provider if you are treated by a clinic that is in network with your insurer. If your insurance does not cover any of the cost of treatment, you may be eligible for a lower cost through Janssen, the manufacturer of Spravato.
Try Esketamine for Depression
KCLA is glad to be making more treatments available to those in need with the addition of Spravato nasal spray and encourage those who are interested to contact us for an initial consultation with one of our in-house psychiatrists.
At Ketamine Clinics Los Angeles, we are committed to providing patients with safe and effective treatments for a wide range of mental health disorders. Whether you choose Spravato or ketamine infusion treatments, you can expect supportive care from a highly-trained clinical staff, in a state-of-the-art facility, and long-term care and support to ensure that you are getting your needs met.
We have been providing the gold-standard in ketamine treatment in Los Angeles for nearly a decade, and have administered more than 14,000 ketamine infusions to our patients. We maintain an industry leading success rate with 83% of our IV infusion patients achieving relief from depression and other mood disorders.
If you are struggling with treatment-resistant depression or major depressive disorder with suicidal ideations or actions, please know that help is available. Contact us today to speak with compassionate, board-certified clinicians and learn about esketamine treatment, ketamine for depression, and other innovations in mental health.
Lauren – Mother of PTSD and depression patient
I saw my son once again.
Although all the medical treatment Matt has received was valuable in some way, the only time in 16 years I saw the person who is my son once again quietly emerge, was after the ketamine infusions.
Allen – Engineer
My successes have been phenomenal.
I have cut down on my Effexor to 75 Mg per day. I have eliminated lithium from my regiment and haven’t needed ambien for about month now to sleep. My klonopin I’ve reduced to once every other day. The infusions really helped my depression and chronic pain in my neck. My depression has never been better and I am cutting down on my other medications with great success. Thank you, thank you Dr. Mandel!
Katharine – Registered Nurse
When I found Ketamine Clinics of Los Angeles,
When I found Ketamine Clinics of Los Angeles and began to research the treatment, I felt my spirits lift. I felt hope. From the moment I called their office, I knew I was in good hands. As someone who works in healthcare, I couldn’t believe how kind and attentive Dr. Mandel and his entire staff were. I know they really care about me. The treatment is the only thing in more than 30 years that has produced such rapid and dramatic improvement in my mood.
Keith – Lawyer
My doctor recommended that I try ketamine
My doctor recommended that I try ketamine at this time because he considers that there is now enough clinical information to make an informed decision about its effectiveness and side effects, and specifically recommended Dr. Mandel, who even with a glowing recommendation from someone for whom I have tremendous respect, vastly exceeded all of my expectations.
Alex – Teacher
Dr. Mandel has truly made my unlivable life, livable again.
Dr. Mandel has truly made my unlivable life, livable again. My ability to get out of bed early and or nearly right as I wake up has significantly improved. I’m able to keep up with my incredibly hectic schedule. My overall mood is high and lethargy is low. My social anxiety is at an all time low, and I haven’t had a panic attack since my first infusion.