FDA approved · Treatment-resistant depression · Insurance accepted
Spravato (esketamine)
Spravato is an FDA approved nasal spray for treatment-resistant depression — the first of its kind to be approved as a monotherapy. It works on a different pathway than traditional antidepressants and can produce measurable improvements in depressive symptoms as early as 24 hours after the first dose.
- Multidisciplinary teamNeurology, psychiatry & care coordination
- Insurance acceptedMedicare, Tricare, most major plans
- Virtual visitsTelehealth for qualifying services
- 2 locationsLong Island and Westchester, NY
- 500+ patientsTrusted by families since 2018
What is Spravato?
Spravato (esketamine) is a nasal spray developed by Janssen Pharmaceuticals and approved by the FDA for treatment-resistant depression. It is derived from ketamine and works by blocking NMDA (N-methyl-D-aspartate) receptors in the brain — a mechanism completely different from traditional antidepressants, which primarily target serotonin, norepinephrine, or dopamine systems.
Because of this distinct mechanism, Spravato can work for patients whose depression has not responded to multiple antidepressant medications. Clinical trials demonstrated improvements in depressive symptoms as early as 24 hours after the first dose, making it particularly valuable when a rapid response is clinically important.
Spravato is administered as a nasal spray in a certified healthcare setting. It is not a take-home medication. Each session is supervised by a licensed provider, and patients are monitored for a minimum of two hours after administration before being released.
Key facts about Spravato
- FDA approved (NDA 211243) — first approved March 2019
- Approved as monotherapy for TRD — January 2025
- Works on NMDA receptors — different from all antidepressants
- Symptom improvement as early as 24 hours after first dose
- Administered in-office under clinical supervision
- Patients monitored minimum 2 hours after each dose
- Cannot drive on the day of treatment
- Covered by Medicare and most commercial insurance
- REMS certified treatment site required
FDA approval history
Spravato has received three FDA approvals. The most recent — January 2025 — expanded its use as a standalone treatment for treatment-resistant depression, making it the only FDA approved antidepressant monotherapy of its kind.
FDA Approved
March 5, 2019
Treatment-Resistant Depression (TRD)
In conjunction with an oral antidepressant, for adults who have not responded to two or more adequate antidepressant treatments.
FDA Approved
August 3, 2020
Major Depressive Disorder with Acute Suicidal Ideation or Behavior
For the rapid reduction of depressive symptoms in adults with MDD and active suicidal ideation, in conjunction with an oral antidepressant.
FDA Approved
January 21, 2025
TRD as Monotherapy
Expanded approval: Spravato can now be used without a concurrent oral antidepressant for adults with treatment-resistant depression — the first FDA approved monotherapy for TRD.
Who is Spravato for?
Adults diagnosed with Treatment-Resistant Depression (failed 2 or more adequate antidepressant trials)
Adults with MDD with acute suicidal ideation or behavior requiring rapid symptom relief
Patients who cannot tolerate the side effects of oral antidepressants
Patients seeking a monotherapy option (no concurrent antidepressant required — 2025 approval)
Patients who have responded to ketamine infusions and want an FDA approved alternative
Patients who need faster onset than traditional antidepressants can provide
What happens during a Spravato session?
Spravato is not a take-home medication. Every session takes place in our office under clinical supervision. Here is what to expect from evaluation through your first treatment.
Evaluation
A comprehensive psychiatric evaluation confirms you meet criteria for treatment-resistant depression or MDD with suicidal ideation. Prior treatment history and medication records are reviewed.
Insurance verification
Our team verifies your coverage and handles prior authorization. Spravato is covered by Medicare and most commercial plans when TRD criteria are met.
Arrange transportation
You must arrange for someone to drive you home on each treatment day. You cannot drive or operate heavy machinery on the day of each session due to the risk of sedation and dissociation.
In-office administration
You self-administer the nasal spray under the direct supervision of a licensed healthcare provider. Susan Mogan, PMHNP, supervises all Spravato treatments at Cognifica Health.
Two-hour observation
You remain in our office for a minimum of two hours after administration while a provider monitors for dissociation, blood pressure changes, and sedation. Most patients rest comfortably during this time.
Maintenance planning
The induction phase is twice weekly for four weeks. Your provider then transitions you to a maintenance schedule based on your clinical response — typically once weekly, then biweekly.
How is Spravato delivered at Cognifica Health?
All Spravato treatments at Cognifica Health are supervised by Susan Mogan, PMHNP, under the oversight of Dr. John Abrahams, MD. Our office is a REMS certified Spravato treatment site, which is a federal requirement for any practice administering this medication.
Before your first session, you will complete a full psychiatric evaluation to confirm candidacy. Our team handles prior authorization with your insurance carrier so you understand your coverage before treatment begins.
Insurance & locations
Spravato is covered by Medicare and most commercial insurance plans when treatment-resistant depression criteria are met. Our team verifies and handles prior authorization before your first session.
- Aquebogue, NY — (631) 388 7624
- West Harrison, NY — (914) 948 3008
About the Spravato REMS Program
Because Spravato carries risks of sedation, dissociation, respiratory depression, and potential for misuse, the FDA requires it to be available only through a restricted Risk Evaluation and Mitigation Strategy (REMS) program. This means it can only be administered at certified healthcare facilities, and patients must be monitored on-site for a minimum of two hours after each dose. Cognifica Health is a REMS certified Spravato treatment site.
Frequently asked questions
Book a Spravato consultation
Fill out the form below and our team will contact you within one business day to discuss your treatment options and verify your insurance coverage.
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Medically reviewed by Dr. Susan Mogan, PMHNP, DNP, Board certified Psychiatric Mental Health Nurse Practitioner
Last reviewed: March 2026
Sources and References
- FDA NDA 211243 — Spravato (esketamine) Approval History
- FDA Approval: Spravato as Monotherapy for TRD (January 2025) — J&J Press Release
- FDA Expands Approval of Intranasal Esketamine — UTHealth McGovern Medical School (January 2025)
- SUSTAIN-1: Long-term efficacy of esketamine nasal spray — New England Journal of Medicine
- NIMH: Depression — Treatment Options
- Spravato Prescribing Information (Janssen)
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Questions about Spravato treatment?
Call (631) 388 7624