Spravato · Compounded ketamine · Screening first
Spravato and ketamine, with the safety talk first.
Spravato is esketamine nasal spray. It's administered in a certified healthcare setting, never sent home with you, and every dosing visit includes monitoring afterward.
How it works
A different mechanism than standard antidepressants.
Most antidepressants work through serotonin and related systems, and they take weeks to show their hand. Esketamine works on the brain's glutamate system, which is part of why it's studied and prescribed for depression that hasn't responded to the standard route.
For treatment-resistant depression in adults, Spravato is FDA-approved for use together with an oral antidepressant. It isn't a replacement for your existing treatment plan. It's an addition, considered when the standard plan alone hasn't been enough.
The schedule, roughly
Dosing visits are more frequent at the start of treatment and typically space out over time. The exact cadence is set by your treatment plan and reviewed as you go.
Every dosing visit includes in-clinic monitoring afterward, so plan for the appointment to take a couple of hours, plus your ride home.
The safety realities, up front
These rules are the treatment working as designed.
Monitored dosing
After each dose you stay in the clinic for monitoring, which watches for sedation, dissociation, blood pressure changes, nausea, and dizziness. You leave when you're clinically stable.
No driving until tomorrow
You cannot drive or operate machinery until the next day, after restful sleep. Plan transportation for every dosing visit, every time.
Certified setting only
Dosing for Spravato happens under a federal safety program (REMS). Compounded ketamine follows the same house rules. It's dosed in office, monitored, and never sent home.
A dosing visit, start to finish
You'll know the shape of the visit before your first one.
You check in, your blood pressure gets a baseline, and you self-administer the nasal spray under clinical observation. Then comes the monitored stretch, a quiet space, staff checking on you, blood pressure rechecked. Common effects during that window include dissociation (a dreamlike, detached feeling), dizziness, sleepiness, and nausea, and they typically taper the same day.
When you're clinically stable, you head home with your ride. Many patients keep the rest of the day low-key on dosing days.
Who it's for
After standard treatment hasn't been enough.
Candidates typically have depression that has not adequately improved with standard treatment, can attend monitored sessions, and can arrange transportation afterward. Blood pressure and relevant medical history are part of screening, because esketamine can raise blood pressure transiently.
Eligibility is decided at consultation, not by a website. The FDA-approved option is Spravato, the esketamine nasal spray. The practice also offers compounded intranasal ketamine, an off-label option covered plainly below.
Now offered · Compounded ketamine
Compounded intranasal ketamine, without the insurance maze.
The practice now offers compounded ketamine as an intranasal treatment, run the way Spravato visits run. It's dosed here in the office, monitored afterward, never sent home with you. The medication comes from a compounding pharmacy rather than a drug manufacturer, which is part of what makes the simpler pricing possible.
Said plainly, compounded ketamine is not FDA-approved for depression, and prescribing it for depression is off-label. Off-label does not mean casual. The same screening, the same monitoring, and the same no-driving rule apply, and the consultation covers which option fits your history better and why.
Self-pay, stated up front
$2,500 per course of six treatments
No prior authorization, no benefits verification, no denials to appeal. The price is set before you start.
The insurance route is still Spravato. Plans that cover it usually require prior authorization, and costs depend on your benefits.
Book a consultation →Spravato or compounded
Two routes, one standard.
The consultation
What gets reviewed.
The visit covers your diagnosis, medication history, medical screening, and REMS education, then lands on what fits, whether that's Spravato, compounded ketamine, TMS, medication changes, therapy, referral, or a higher level of care. You'll leave knowing the recommendation and the reasoning behind it.
If Spravato is the recommendation, the next steps are benefits verification and prior authorization, since most plans that cover it require both. TMS is the other advanced option for treatment-resistant depression, and the consultation compares them against your history when both are on the table.
Common questions
How long does a dosing visit take?
Plan for a couple of hours. The dose itself is quick, and the monitored observation afterward is most of the visit. You leave when you're clinically stable, with your ride.
What does Spravato feel like?
Common effects during the monitored window include dissociation, dizziness, sleepiness, and nausea. They're watched in clinic and typically taper the same day. Everyone's experience differs, which is one reason the monitoring exists.
Do I stop my current antidepressant?
No. Spravato is approved for use together with an oral antidepressant. What continues and what changes is decided at consultation, with your prescriber.
Is Spravato the same as ketamine therapy?
They're related but not identical. Spravato is the FDA-approved esketamine nasal spray, given under the REMS safety program. The practice also offers compounded intranasal ketamine, which is off-label for depression and follows the same in-office dosing, monitoring, and no-driving rules.
Does insurance cover Spravato?
Plans that cover it usually require prior authorization and documentation of medical necessity. Coverage is not guaranteed until benefits are verified, so share your plan details at booking.
Can I drive myself home afterward?
No. After a dosing visit you cannot drive or operate machinery until the next day, after restful sleep. Arrange a ride for every dosing visit.
Is compounded ketamine FDA-approved?
No. Compounded ketamine is not FDA-approved for depression, and prescribing it for depression is off-label. Spravato is the FDA-approved intranasal treatment. Screening, in-office monitoring, and the no-driving rule apply either way.
What does compounded ketamine cost?
Self-pay is $2,500 for a course of six in-office treatments, with no insurance authorization involved. Spravato is the insurance route, and its cost depends on your specific plan and benefits.
Talk it through with a clinician.
A consultation covers eligibility, safety, logistics, and coverage before anything is scheduled.
This page is educational and does not guarantee eligibility, access, insurance coverage, or a specific treatment outcome.