Spravato is the brand name for esketamine, a nasal spray that is closely related to ketamine. In 2019 the FDA approved it for treatment-resistant depression, meaning depression that has not responded to at least two standard antidepressants. It is also approved for adults with major depression who are having suicidal thoughts. It is not a first thing you try. It is a serious tool for people who have already been through the usual steps and are still struggling.
What makes it different is how it works. Most antidepressants act slowly on serotonin over weeks. Esketamine works on a separate brain system, the glutamate pathway, and some people notice a shift in mood within days. It is always used alongside an oral antidepressant, not on its own. If you have also seen clinics advertising ketamine infusions, our guide on ketamine therapy versus Spravato explains why the two are related but covered very differently by insurance.
After each dose you are monitored in the clinic for at least two hours, and you cannot drive for the rest of the day. Plan for a ride home.
Who Spravato is actually for
Spravato is meant for adults whose depression has stuck around despite honest attempts at other treatment. In plain terms, you are more likely to be a candidate if:
- You have tried two or more antidepressants at real doses for a real length of time and still feel depressed.
- Your low mood is interfering with work, relationships, or your ability to function day to day.
- You are willing to come into a clinic regularly during the first weeks and stay for monitoring.
It is not for everyone. Certain heart and blood pressure conditions, a history of some kinds of substance problems, and other factors can make it a poor fit. That is exactly what an evaluation is for.
What a visit is really like
You take the spray yourself, under supervision, in the clinic. Then you sit in a calm, monitored space for at least two hours while the effects pass. Some people feel dizzy, foggy, or a floaty, dissociated sensation during that window. It fades. Because of these effects, federal rules require the medicine to be given only in a certified clinic, and you are not allowed to drive until the next day.
The schedule
A typical course begins with twice-weekly sessions for the first four weeks. If it is helping, visits usually drop to once a week, and later to once every one or two weeks. Your clinician adjusts this based on how you respond, not a fixed formula.
Spravato helps a meaningful share of people who had run out of hope, and it does little for others. No one can promise you a result. What a good clinic can promise is a careful evaluation, real monitoring, and honesty about whether it is worth trying in your case.
Cost and insurance in Missouri
This is the question that stops people, so here is the plain version. Spravato is a covered benefit under many insurance plans when you meet the criteria, but it almost always requires prior authorization. That means your provider has to document that you have already tried other antidepressants. Coverage and out-of-pocket cost depend on your specific plan.
Missouri's Medicaid program, MO HealthNet, is accepted at some local clinics for these treatments. The most reliable way to know your real cost is to have a clinic that offers Spravato check your benefits directly before you start. They do this all the time.
The point of Spravato is not to replace everything you have tried. It is to add a different kind of tool when the usual ones have not been enough.
How to find it here
Spravato can only be given at a certified clinic, so you cannot get it from a regular pharmacy or take it at home. When you call around the St. Louis metro, ask directly whether a clinic is a certified Spravato provider, whether a doctor supervises treatment, and whether they will verify your insurance up front. If your own doctor is not sure where to send you, you are allowed to contact a specialty clinic yourself and ask for an evaluation.