Treatment-resistant depression in adults
For adults with major depressive disorder who have not responded adequately to an appropriate course of oral antidepressant treatment, used together with an oral antidepressant.
For Eligible Adult Patients
SPRAVATO® Treatment in a Certified Healthcare Setting
K. Johns Medical offers evaluation, insurance-support coordination, and supervised SPRAVATO treatment for eligible adult patients.
Video
A short look at SPRAVATO treatment
A 20-second overview of what a supervised treatment visit looks like at our office. Turn on sound for narration.
This video is general education only. It is not medical advice, and it does not replace the full prescribing information or a clinical evaluation. Treatment room imagery is illustrative.
The Basics
What is SPRAVATO®?
SPRAVATO® (esketamine) is a prescription nasal-spray medication used together with an oral antidepressant. It is administered under the direct supervision of a healthcare professional in a certified treatment setting.
Patients spray the medication themselves, but they do so in the clinic, with the care team present. The medication is not dispensed for use at home. After administration, patients are monitored for at least two hours before a discharge assessment is completed.
SPRAVATO is not a cure for depression, and it is not appropriate for everyone. Whether it may be an option is determined through a complete clinical assessment.
Eligibility
Who may be considered?
Eligibility requires a complete clinical assessment by a qualified healthcare professional. The current FDA-approved indications for adults are listed below.
Depressive symptoms with acute suicidal ideation or behavior
When clinically appropriate and consistent with the current FDA-approved indication, for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior, used together with an oral antidepressant. SPRAVATO does not replace hospitalization when hospitalization is clinically indicated.
Eligibility, insurance approval, symptom improvement, and any particular treatment schedule cannot be guaranteed. Some patients will not be candidates for this treatment, and alternative options can be discussed during your consultation.
Process
The SPRAVATO treatment process
From first consultation to ongoing treatment visits, each step is designed around safety and clear communication.
- 1
Initial clinical consultation
A dedicated appointment to discuss your depression history, previous treatments, and whether SPRAVATO may be an option worth exploring.
- 2
Review of psychiatric and medical history
Prior diagnoses, hospitalizations, treatment response, and medical conditions are reviewed, including conditions that may affect safety.
- 3
Medication review
All current prescriptions, over-the-counter products, and supplements are reviewed, including those that may interact with treatment.
- 4
Safety assessment
A clinical safety assessment is completed, including risk review and discussion of the required monitoring and transportation arrangements.
- 5
Insurance verification and prior authorization
Benefits are verified and prior authorization is submitted when required. Requirements vary by plan, and approval cannot be promised.
- 6
SPRAVATO REMS enrollment and verification
Patients, the prescriber, and the treatment setting must be enrolled and verified through the SPRAVATO REMS program before treatment can begin.
- 7
Scheduled treatment visit
Treatment visits are scheduled in advance with enough time for administration, the required observation period, and discharge assessment.
- 8
Supervised self-administration
The patient self-administers the nasal spray under the direct supervision of a healthcare professional in the certified treatment setting.
- 9
Monitoring for at least two hours
After administration, the care team monitors the patient for at least two hours before any discharge assessment is completed.
- 10
Clinical discharge assessment
The patient may leave only after the treating healthcare professional determines that discharge is appropriate.
- 11
Required transportation arrangements
Patients must arrange safe transportation home and may not drive themselves after a treatment visit.
Treatment Day
What happens on treatment day?
Knowing what to expect makes treatment visits easier. Your care team will give you specific instructions before each appointment.
Before your visit
- You receive preparation instructions before the visit
- Eating and drinking restrictions may apply
- Certain nasal medications may require timing instructions
- Blood pressure is assessed before administration
- Transportation home must be arranged in advance
During and after administration
- You self-administer SPRAVATO under direct supervision
- The care team monitors blood pressure, oxygen saturation, alertness, sedation, dissociation, respiratory status, and overall clinical stability
- Monitoring continues for at least two hours
- You may leave only after the treating healthcare professional determines that discharge is appropriate
- You must not drive, operate machinery, or engage in hazardous activities until the next day after a restful sleep, consistent with prescribing instructions
Safety
Risks and safety monitoring
SPRAVATO has known risks. They are discussed with you in detail before treatment begins, and monitoring is built into every visit.
Sedation
Feeling very sleepy or drowsy during and after administration.
Dissociation
A temporary sense of disconnection from yourself, your surroundings, time, or your body.
Dizziness
Lightheadedness or unsteadiness, particularly when standing.
Nausea
Upset stomach or vomiting during or after the treatment visit.
Increased blood pressure
Blood pressure can rise after administration, which is why it is checked before treatment and monitored afterward.
Respiratory depression
Slowed or shallow breathing has been reported and is one reason clinical monitoring is required.
Impaired attention, judgment, and reaction time
Thinking and reaction speed can be affected for the rest of the treatment day.
Abuse and misuse potential
Esketamine is a controlled substance with potential for abuse and misuse, which is part of why it is dispensed only in certified settings.
Worsening mood or suicidal thoughts
Some patients experience worsening depression or suicidal thoughts. These require immediate clinical evaluation — call 911 or go to the nearest emergency department if you are unsafe.
This page is a general summary and is not a complete list of risks or a substitute for the full prescribing information and medication guide, which your care team will review with you.
SPRAVATO REMS requirements
SPRAVATO is available only through a restricted program called the SPRAVATO REMS (Risk Evaluation and Mitigation Strategy). Under this program, the medication must be administered in a certified healthcare setting, patients must be enrolled, and the required observation period must be completed before discharge. The medication is never dispensed for home use.
Insurance and access
Coverage and prior-authorization requirements vary by insurance plan and can change. Our team will review the available documentation and work with you, your insurer, and the specialty pharmacy when applicable. We cannot promise that a plan will approve treatment or cover a particular number of visits. Questions about cost and self-pay options can be discussed with the office directly.
Referrals
Consultations and referrals
Records and clinical documents are accepted by fax or secure means arranged with our staff. Please do not send medical records through this website or by ordinary email.
Patient consultation request
Patients interested in SPRAVATO can complete the consultation request form on this website. It is delivered securely to the office, and staff will call to confirm your consultation appointment.
Referring-provider inquiry
Referring clinicians may contact the office by telephone to discuss a patient's suitability and the referral process.
Records submission
Clinical documentation must be submitted by fax to 757-530-8350 or secure means arranged with our staff. Medical records cannot be uploaded through this website.
FAQ
SPRAVATO frequently asked questions
Request a SPRAVATO consultation
Complete the consultation request form on this website. The office will call to confirm your appointment. Eligibility is determined only after a complete clinical assessment.