Ketamine treatment for depression in the form the FDA actually approved. Spravato is an esketamine nasal spray for treatment-resistant depression in adults, given in our West Hartford, Connecticut office with a clinician present for every session.
Monitored on site after every dose, as the REMS program requires
FDA approvedFor treatment-resistant depression in adults, as monotherapy or with an oral antidepressant
You never dose aloneSelf-administered nasal spray with a clinician present
Two-hour monitoringRequired at every session before you are discharged
Benefits verified firstWe file the prior authorization before you are scheduled
Ketamine treatment for depression in Connecticut, explained
People search for ketamine treatment for depression. What is actually approved for depression, covered by insurance, and delivered under federal safety rules is esketamine, sold as Spravato®. Here is the difference in plain terms.
Spravato® (esketamine)
Approved, supervised, billable
Esketamine is one of two mirror-image forms of ketamine. As Spravato it carries an FDA indication for treatment-resistant depression in adults, is given as a nasal spray only in a certified healthcare setting, and is dispensed through a restricted program called the Spravato REMS. Because it is approved for this use, insurers have a defined coverage pathway for it.
IV ketamine infusions
Off label for depression
Ketamine itself is an approved anesthetic. Using it intravenously for depression is off-label prescribing: legal and common, but not FDA approved for that use, not governed by the Spravato REMS, and usually paid out of pocket because there is no approved indication to bill against.
Both are used for the same problem. We offer Spravato because the approval, the monitoring requirement, and the insurance pathway all line up behind it.
Who qualifies for Spravato® treatment
Read both lists before you call. If the left column describes you, an evaluation is the next step. If anything in the right column applies, tell us at intake so we can look at it carefully or point you somewhere better suited.
Spravato may be a fit if
All of these generally need to be true.
You are 18 or older
You have a diagnosis of major depressive disorder
You have tried at least two antidepressants at an adequate dose and duration without adequate response
You can arrange a ride home after every session
You can commit to twice-weekly visits for the first four weeks
Eligibility is confirmed at a clinical evaluation, never from a web page.
Spravato is not a fit if
The first three are contraindications in the FDA label.
You have aneurysmal vascular disease or an arteriovenous malformation
You have a history of intracerebral hemorrhage
You have had an allergic reaction to esketamine or ketamine
You are pregnant or planning to become pregnant, which needs a separate conversation first
You are looking for a same-day walk-in treatment
If you are in crisis right now, call or text 988, or call 911.
What a session actually looks like
Roughly two and a half hours door to door. Nothing about the visit is a surprise, and you are never left on your own during it.
Before
Arrange your ride
No food for 2 hours and no liquids for 30 minutes before your dose, and a driver lined up for afterward. Take your other morning medications unless your prescriber says otherwise.
Arrival
Check-in and vitals
Blood pressure is taken before dosing. You are set up in a private, quiet room with a recliner, low light, and whatever helps you settle.
Dosing
You give the dose yourself
You spray the medication yourself while a member of the clinical team is present. Blood pressure is rechecked about 40 minutes after the dose.
Recovery
At least two hours of monitoring
You stay until the clinician confirms you are ready to go, which the REMS program requires at every session. Most people rest, listen to music, or doze.
The treatment schedule
The dosing intervals below come straight from the FDA label. Your prescriber sets the dose and confirms the interval based on how you respond.
Weeks 1–4Twice weekly
Induction. Eight sessions over four weeks, at 56 mg or 84 mg as your prescriber directs.
Weeks 5–8Once weekly
Sessions space out while your prescriber tracks response and side effects.
Week 9 onwardWeekly or every 2 weeks
Maintenance at the least frequent interval that holds your response.
Risks, stated plainly
Spravato carries a boxed warning. You should read this before your evaluation, not after, and bring every question to it.
Boxed warning
Sedation. Dissociation. Respiratory depression. Abuse and misuse. Suicidal thoughts and behaviors. These are the reasons Spravato is only given in a certified setting with monitoring, and the reason antidepressant treatment in general is watched closely at the start.
Common side effects
Dissociation, a sense of detachment during the session
Dizziness and vertigo
Nausea or vomiting
Sedation and lethargy
Increased blood pressure
Numbness, anxiety, feeling drunk, headache
Contraindications
Aneurysmal vascular disease of the brain, chest, or abdomen
Arteriovenous malformation
History of intracerebral hemorrhage
Hypersensitivity to esketamine, ketamine, or any excipient
Rules that are not optional
At least two hours of monitoring at every session
No driving or operating machinery until the next day after a restful sleep
Dosing only in a REMS-certified healthcare setting
Blood pressure checked before dosing and about 40 minutes after
Source: SPRAVATO® (esketamine) nasal spray FDA prescribing information, 2025. Read the full label. This page is a summary for patients and does not replace the prescribing information or a conversation with your clinician.
Does insurance cover Spravato®?
Cost is the question people are most afraid to ask, so we answer it before you are in the room.
Insurance
Spravato is covered under many commercial and Medicare plans. Coverage is decided by your specific plan, not by us, and it nearly always requires prior authorization.
Prior authorization
The authorization has to document which antidepressants you tried, at what dose, and for how long. Our office assembles that record and files it. You do not chase your insurer.
What you will owe
Your share depends on your deductible, copay, and coinsurance for in-office drug administration. We verify benefits and give you the number in writing before your first session.
Manufacturer support
Janssen runs a patient support program for Spravato that some patients qualify for. We will tell you whether it applies to you rather than leaving you to find it.
Two visits, two charges
The evaluation that decides whether Spravato is appropriate is billed as a psychiatric visit. Dosing sessions are billed separately, per session.
Questions people ask us first
If yours is not here, call the office. Nobody will pressure you into scheduling.
Is Spravato the same thing as ketamine?
They are related but not identical. Ketamine is a mixture of two mirror-image molecules; esketamine, the drug in Spravato, is one of them. Spravato is the form the FDA has approved for treatment-resistant depression, it is given as a nasal spray in a certified office, and because it is FDA approved it is the form insurance plans are set up to cover. IV ketamine for depression is used off label, which is a different regulatory and billing situation.
How do I know if I qualify?
The label indication is treatment-resistant depression in adults, which generally means depression that has not responded to at least two antidepressants taken at an adequate dose for an adequate length of time. That determination is made at a clinical evaluation here, where we review your diagnosis, every medication you have tried, your medical history, and your blood pressure history. Nobody is approved or ruled out from a web form.
How long does an appointment take?
Plan on about two and a half hours for a dosing visit. You self-administer the nasal spray under supervision, then stay for at least two hours of monitoring, which the REMS program requires at every session before you can be discharged.
Can I drive myself home?
No. You will need someone to drive you, or a ride service, and the label instructs patients not to drive or operate machinery until the next day after a restful sleep. We ask you to arrange the ride before your first appointment.
Will my insurance cover it?
Spravato is covered under many commercial and Medicare plans, and coverage almost always requires prior authorization documenting the antidepressants you have already tried. Our office verifies your benefits and files that authorization before you are scheduled, so you know your cost before the first session, not after.
How many sessions will I need?
The label schedule is twice weekly for weeks 1 through 4, once weekly for weeks 5 through 8, then once weekly or once every two weeks from week 9 on. Your prescriber sets the actual schedule based on your response, and treatment continues only as long as it is helping.
Do I stop my other medication?
Not on your own. Spravato is approved both as monotherapy and alongside an oral antidepressant, so the plan depends on what you are taking and how you have responded. Any change is made with your prescriber.
Do I need a referral from another provider?
No. You can request an evaluation directly. If you are already working with a therapist or prescriber, we will coordinate with them, with your written authorization.
Referring a patient?
We accept referrals from psychiatrists, APRNs, primary care, and therapists across Connecticut. Send the diagnosis, the antidepressant trial history, and current medications, and our office handles the authorization and reports back to you.
