If depression has stayed with you through much of 2026, you may be wondering whether to start esketamine treatment in Aventura now or wait until January. Esketamine and Spravato are the same medicine.
Your psychiatrist may have mentioned “esketamine,” or the word showed up in an insurance letter, and every search result said “Spravato.” Esketamine is the generic name, and Spravato is the brand name of the FDA-approved nasal spray that contains it.
Is esketamine the same as Spravato?
Yes. Esketamine is a form of ketamine, and Spravato is the nasal spray made from it for depression. For how it differs from IV ketamine, see our ketamine vs. esketamine guide.
What is esketamine approved to treat in 2026?
Esketamine is approved for two uses in adults, according to the current Spravato prescribing information: depression that hasn’t eased after other antidepressants, and depression that comes with thoughts of suicide.
| Approved use (adults) | Used on its own? | Used with an oral antidepressant? |
|---|---|---|
| Treatment-resistant depression | Yes, since January 2025 | Yes, as an option |
| Depression with thoughts of suicide | No | Yes |
Treatment-resistant depression generally means depression that hasn’t improved enough after at least two antidepressants, as clinical trials defined it.
In January 2025, the FDA approved Spravato on its own, without a daily antidepressant, for treatment-resistant depression. Johnson & Johnson notes that about one-third of adults with major depression don’t respond to oral antidepressants alone.
For adults with depression who are also having thoughts of suicide, esketamine (Spravato) may help ease depressive symptoms when taken alongside an oral antidepressant. It hasn’t been shown to prevent suicide or to reduce suicidal thoughts, and it doesn’t replace a hospital stay when one is needed. See how our team responds to acute distress in our Aventura crisis support protocol.
If you’re thinking about ending your life, please reach out now rather than waiting for an appointment. Call or text 988, the Suicide & Crisis Lifeline, or dial 211 to reach 211 Miami, which answers 24/7 in English, Spanish and Haitian Creole. You can also go to the nearest emergency room.
What does the research show?
In two large trials, more people reached remission on esketamine than on the comparison treatment. These are trial results, not a promise for you.
- In a 2023 study of 676 adults with treatment-resistant depression, everyone kept their usual antidepressant and added either esketamine or quetiapine XR, another medicine often added to antidepressants. After eight weeks, 27.1% of the esketamine group were in remission, compared with 17.6% on quetiapine XR, according to the AAFP’s 2024 summary of the study. Remission means symptoms faded to very low levels.
- In the study behind the 2025 approval, 22.5% of people on esketamine alone were in remission after four weeks, compared with 7.6% of people using a spray with no medicine in it.
Many people in both studies did not reach remission. That is one reason we pair the medicine with preparation and integration, the process of making sense of what comes up in treatment and carrying it into daily life.
Who might be a good fit for esketamine in South Florida?
Esketamine is usually a fit for adults with treatment-resistant depression who don’t have certain blood vessel conditions. The prescribing information says esketamine should not be used by people with:
- a weakened, bulging blood vessel (an aneurysm)
- an abnormal tangle of blood vessels (an arteriovenous malformation)
- a history of bleeding in the brain
Because esketamine raises blood pressure for a few hours after each dose, people with heart or blood pressure concerns are checked carefully first. Spravato also carries a boxed warning, the FDA’s most serious label alert. It warns about heavy sleepiness, feeling detached from your surroundings (dissociation), slowed breathing, misuse, and suicidal thoughts in younger people on antidepressants. That’s part of why every dose is given under watch in a specially approved clinic.
For eligibility and insurance basics, see our Spravato eligibility guide for Aventura.
What does starting esketamine before the end of 2026 look like?
If you reach out soon, you may be able to get through the first, busiest month before the holidays wind down. The Spravato label lays out the usual schedule:
- Weeks 1 to 4: two sessions a week
- Weeks 5 to 8: one session a week
- Week 9 on: once a week or every other week, based on how you’re doing
Our team guides you through the steps below, and starting early leaves room for them.
Check holiday travel and gatherings before you book, since each visit needs a ride home. If January works better, that’s fine too.
How do I start esketamine treatment in Aventura?
Starting takes four steps:
- Consultation. You meet with our psychiatric team to review your history, medications and goals.
- Benefits check. Our team handles the insurance approval process (prior authorization) and verifies your benefits for esketamine (Spravato) before your first session. Benefits vary by plan.
- Safety program enrollment. Spravato is only given through a federal safety program called REMS, which enrolls each person and approves the clinics that give it. Our Aventura REMS article explains what that means for you.
- First session. Your first treatment takes place at our Aventura center.
At Nushama Aventura, esketamine (Spravato) is given in our office at 2999 NE 191st St, Suite 200, with at least two hours of monitoring after each dose. Your blood pressure is checked before the dose and about 40 minutes after, as the Spravato label directs. You use the spray yourself while a clinician watches, then rest in a calm, softly lit room while the effects settle. Plan for a ride home, and avoid driving until the next day after restful sleep.
Your care is guided by our Aventura clinical team, including Steven Radowitz, MD, co-founder and chief medical officer, and Mark Braunstein, DO, senior psychiatrist.
If you’d prefer Spanish, just ask. 75.3% of Miami-Dade residents age 5 and older speak a language other than English at home. In Spanish, this medicine is esketamina (Spravato).
The Aventura center sits at the corner of Biscayne Blvd and NE 191st St, easily reached from the William Lehman Causeway. Aventura lies in northeast Miami-Dade on the Broward County line, about 12 miles from both Miami and Fort Lauderdale, near Sunny Isles Beach and Hallandale Beach.
FAQ
Is esketamine a controlled substance?
Yes. It’s a Schedule III controlled medicine, meaning federal rules limit how it’s stored and given because it can be misused. Separately, the federal REMS safety program requires every dose to be given in an approved clinic.
Do I have to keep taking my antidepressant?
It depends. For treatment-resistant depression, esketamine (Spravato) can be used alone or with an oral antidepressant. For depression with suicidal thoughts, it’s used alongside one. Don’t stop any medication without talking with your prescriber.
En español: La esketamina (Spravato) es un aerosol nasal aprobado por la FDA para adultos con depresión resistente al tratamiento, y desde enero de 2025 puede usarse sola o junto con un antidepresivo oral. En Nushama Aventura, pregunte por atención en español cuando nos contacte; conozca más sobre nuestra clínica bilingüe en Aventura.
How does Nushama care for members in Aventura?
At Nushama Aventura, a medical and psychiatric screening checks whether esketamine is a good fit before you begin. Assisted Spravato adds a therapist or integration coach during the session. With your permission, we work alongside the psychiatrist and therapist you already see. The center also offers IV ketamine.
A psychiatrist who knows your history can tell you whether esketamine fits. To close out 2026 with a plan for your healing, request a consultation in Aventura.
