Spravato can be a genuine turning point for people whose depression hasn’t responded to other treatments, but it isn’t available to everyone. This guide covers who qualifies, the safety requirements, and how to find out where you stand if you live in Aventura or anywhere in South Florida.
What Spravato is (in one paragraph)
Spravato is the brand name for esketamine, a nasal spray derived from ketamine. Unlike IV ketamine, which is used off-label for depression, Spravato has been FDA-approved since 2019 and can often be billed to insurance. It’s taken in a certified clinic under medical supervision, never at home. As of January 2025, the FDA also approved Spravato as a standalone treatment for treatment-resistant depression, so it can now be used with or without an oral antidepressant. For many people, its biggest advantage is rare in this space: a fast-acting mechanism and a path to insurance coverage.
The two conditions Spravato is approved for
The FDA has approved Spravato for two specific situations. You may be a candidate if one of these describes you:
- Treatment-resistant depression (TRD). This generally means you have major depressive disorder and have tried at least two different antidepressant medications, at an adequate dose and duration, without enough relief. As of January 2025, Spravato can be used alone or with an oral antidepressant for TRD.
- Major depressive disorder with acute suicidal thoughts or behavior. Spravato is also approved as part of care for people experiencing a depressive episode with active suicidal ideation, used alongside an oral antidepressant.
If you’ve tried multiple medications without enough relief, you may fit the first category. That’s exactly who Spravato was designed for.
A quick self-check: are you likely a candidate?
You may be a good fit to explore Spravato if several of these are true:
- You’ve been diagnosed with major depressive disorder.
- You’ve tried two or more antidepressants without sufficient improvement.
- You’re open to discussing whether Spravato alone or Spravato with an oral antidepressant is the better fit.
- You can commit to in-clinic sessions and stay for post-dose monitoring.
- You have someone who can drive you home afterward.
This is a starting point, not a diagnosis. A clinician makes the final call after reviewing your full history.
Who may not qualify, and why
Spravato affects blood pressure and perception, so certain conditions can make it unsafe. A provider will look closely if you have:
- Aneurysmal vascular disease, arteriovenous malformation, or a history of intracerebral hemorrhage. These are formal contraindications in Spravato’s prescribing information.
- Elevated or unstable blood pressure. Spravato can temporarily raise BP, so your provider will assess blood pressure before each session and may delay treatment if levels are too high.
- Pregnancy or breastfeeding. The prescribing information warns of potential embryo-fetal toxicity and recommends against breastfeeding during treatment.
None of these automatically rules you out of all treatment. Sometimes it simply means another option, such as monitored IV ketamine, is the better path. An evaluation helps find the safest, most effective approach for you.
The REMS program, explained simply
REMS stands for Risk Evaluation and Mitigation Strategy, an FDA safety framework that governs how esketamine can be given. The name sounds bureaucratic, but the purpose is simple: Spravato can only be administered where you can be properly cared for. In practice, that means:
- Certified sites only. Spravato can’t be dispensed to take at home. It must be given in a REMS-certified healthcare setting, like Nushama’s Aventura clinic.
- Supervised dosing. You self-administer the nasal spray under the direct observation of trained staff.
- Post-dose monitoring. You stay and are monitored for at least two hours after each dose, because blood pressure can rise temporarily and some people feel sedated or dissociated for a while.
- No driving that day. Per the prescribing information, you’ll arrange a ride home and skip driving until the next day after a restful sleep.
These rules are why Spravato feels different from a pharmacy prescription. They’re also what makes it safe.
Will insurance cover it?
Many commercial insurance plans and Medicare cover Spravato, often after a prior authorization confirming you meet criteria (usually two failed antidepressants). Nushama’s Aventura location accepts Medicare, and our team can walk you through eligibility and prior authorization at no cost. Coverage and copays vary by plan, so the honest answer is “often, but it depends.” If cost is a concern, ask about the manufacturer’s patient savings programs or Nushama’s own scholarships and access programs for communities across South Florida.
How Nushama Aventura approaches Spravato
Nushama is a REMS-certified provider with a bilingual (English and Spanish) team in Aventura, serving members from Sunny Isles Beach, Hallandale Beach, North Miami Beach, and the broader Miami-Dade area. Our care goes beyond safety requirements: private, calming rooms and attentive staff, because set and setting (your mindset and your surroundings) shape how treatment feels. The clinic was designed as a sanctuary, not a sterile waiting room, and we treat the monitoring period as part of the healing rather than a formality. Because depression rarely travels alone, we coordinate Spravato with therapy and ongoing support rather than offering it in isolation.
What the treatment schedule looks like
Once you qualify, the next question is usually “what am I signing up for?” Knowing the schedule helps you plan your life around treatment, not the other way around.
The induction phase
Treatment starts with twice-weekly sessions for the first four weeks. Each visit follows the same pattern: you arrive, self-administer the nasal spray under supervision, then rest in a monitored space for at least two hours while your team tracks your blood pressure and how you’re feeling.
The maintenance phase
If you respond well, visits space out to once weekly during weeks five through eight, then once weekly or every two weeks after that. How long maintenance continues is an individual decision guided by your progress, not a rigid calendar.
How to prepare for your evaluation
Bring a rough list of the antidepressants you’ve tried (names, roughly when, and why each was stopped) so your clinician can confirm whether you meet the treatment-resistant standard your insurer uses. Your current medication list and any relevant medical history (especially anything involving blood pressure or the heart) also matters. Write your questions down beforehand; they’re easy to forget in the moment.
Good questions to ask your provider
- Based on my history, do I meet the criteria for Spravato, or would another option fit better?
- What will my insurance likely cover, and what might I pay out of pocket?
- What does the schedule look like for me specifically, and how long is the initial phase?
- How will Spravato work alongside my current antidepressant and therapy?
- What should I plan for on treatment days: transportation, time off, aftercare?
What treatment days feel like
Most people find a Spravato visit calmer than they expected. After you take the spray, you settle into a quiet space. Some people feel floating, mild dissociation, or drowsiness during the first hour. These effects typically peak around 40 minutes and ease well before you leave. At Nushama, the monitoring period is designed as a restful part of the experience, not something to endure. You’ll have a ride arranged for afterward and skip driving until the next day.
Why people choose Nushama
- Experience. We work with some of the most proficient practitioners in psychedelic medicine.
- Science. We focus on scientifically tested modalities backed by clinical trials and real-world results.
- Safety. Strong screening, thoughtful preparation, and medically monitored treatment at every step.
- Access. Scholarships and programs help extend care to communities where mental-health access has historically been limited.
- Spiritually informed. A holistic experience designed to support healing of mind, body, and spirit.
Beyond treatment-resistant depression, Nushama works with anxiety and panic, PTSD, alcohol use disorder, and other trauma-related conditions including OCD, eating disorders, suicidal ideation, and postpartum depression. See everything we treat.
Visit Nushama Aventura
Nushama’s Aventura center is located at 2999 NE 191st St, STE 200, Aventura, FL 33180, at the corner of Biscayne Blvd and NE 191st St in Midtown Aventura. The clinic is easily reached from the William Lehman Causeway and is a short drive from Sunny Isles Beach, Hallandale Beach, North Miami Beach, and most of Miami-Dade County. Our team includes medical specialists in mood, eating, and alcohol use disorders, alongside leading researchers and practitioners in ketamine and other psychedelic therapies (meet the team).
Treatments offered in Aventura: Spravato (esketamine) · IV Ketamine Infusions · NAD+ Therapy · NIAGEN (NR) Therapy · integration support.
Not sure if you qualify?
Nushama’s Aventura team can review your history, check your insurance, and tell you honestly whether Spravato or another option is the better fit. Book a Spravato eligibility consultation at Nushama Aventura today.
Frequently asked questions
How many antidepressants do I need to have tried?
For treatment-resistant depression, the general standard is at least two different antidepressants tried at an adequate dose and for enough time without sufficient relief. A clinician will confirm whether your history meets the criteria your insurer uses.
Can I take Spravato at home?
No. Under the REMS program, Spravato must be self-administered in a certified clinic under supervision, followed by at least two hours of monitoring. This is a safety requirement, not a clinic preference.
Do I have to stop my current antidepressant?
Not necessarily. For treatment-resistant depression, Spravato can now be used alone or alongside an oral antidepressant. For MDD with suicidal ideation, it is still used together with an oral antidepressant. Your provider will coordinate your medications as part of your plan.
What if I don’t qualify for Spravato?
You still have paths worth exploring. Monitored IV ketamine, medication management, and other approaches may fit where Spravato doesn’t. A consultation helps you understand the full menu rather than a single door.
Is the consultation available in Spanish?
Yes. Nushama’s Aventura team is fully bilingual and works with members in both English and Spanish across every step of care, from the initial consultation through ongoing treatment.
Do you accept Medicare in Florida?
Yes. Nushama’s Aventura location accepts Medicare. If you’re a Medicare beneficiary in South Florida dealing with treatment-resistant depression or another qualifying condition, our team can walk you through eligibility and prior authorization.
This article is for educational purposes and is not medical advice. Spravato (esketamine) is a prescription medication administered only in REMS-certified settings; eligibility, benefits, and coverage are determined individually by qualified clinicians and your insurer. If you or someone you love is in crisis, call or text 988 (Suicide & Crisis Lifeline) in the U.S.
