Treatment-resistant depression (TRD)—depression that hasn’t improved after trying at least two antidepressant medications at adequate doses—affects roughly 30% of people living with major depressive disorder, according to Johns Hopkins Medicine. If you’re searching for a Spravato provider in Manhattan, you’ve likely already walked a long road of medications that didn’t deliver lasting relief.
Here’s what matters most: the quality of your Spravato experience depends not just on the medicine, but on the environment, support, and therapeutic framework surrounding each session. Most REMS-certified clinics in Manhattan meet the FDA’s minimum requirements—medical supervision, a two-hour observation window—and stop there. A handful go further, treating the session itself as a therapeutic event rather than a medication appointment. That distinction can shape how treatment-resistant depression responds.
This guide walks through what to look for in a Spravato provider, why set and setting matter according to the latest research, and how Nushama’s model compares to the standard clinic experience.
What Spravato is and how it works
Spravato (esketamine) is a nasal spray approved by the FDA in 2019 for adults living with treatment-resistant depression. In January 2025, the FDA expanded that approval to include standalone use for major depressive disorder (MDD), meaning it no longer requires pairing with an oral antidepressant in all cases.
Esketamine works differently from traditional antidepressants. Rather than targeting serotonin or norepinephrine, it acts on the brain’s glutamate system—specifically NMDA receptors. This mechanism is thought to promote neuroplasticity (the brain’s ability to form new neural connections), which may help explain why some people experience relief within hours or days rather than the weeks that SSRIs and SNRIs typically require.
During a Spravato session, you self-administer the nasal spray under direct medical supervision. The medicine can cause temporary dissociation (a feeling of detachment from your surroundings), changes in blood pressure, sedation, and altered perception. These effects are the reason Spravato is only available through a restricted FDA program called REMS.
What REMS requires—and where it falls short
The Spravato REMS (Risk Evaluation and Mitigation Strategy) is a drug safety program the FDA put in place because of the medicine’s potential for sedation, dissociation, and misuse. According to the FDA’s prescribing label, key requirements include:
- Certified healthcare settings only. Spravato cannot be dispensed at a pharmacy or taken at home.
- Direct observation. You self-administer the spray under the supervision of a healthcare provider.
- Two-hour post-dose monitoring. A provider monitors your blood pressure, oxygen levels, and overall stability for at least two hours after each dose.
- Patient enrollment. Every person receiving Spravato is enrolled in the REMS program.
These are important safety measures. But REMS is a floor, not a ceiling. The program ensures you’re physically safe during the observation period. It does not address the emotional, psychological, or sensory dimensions of the experience—dimensions that emerging research suggests may influence treatment outcomes.
Why set and setting matter: the research
“Set and setting” is a concept from psychedelic research. Set refers to your internal mindset—expectations, emotional state, intentions. Setting refers to the external environment—the physical space, sensory inputs, and the people around you.
In 2025, an international team of researchers from the University of Exeter, McGill University, and Imperial College London published the ReSPCT guidelines in Nature Medicine—the first evidence-based consensus framework for reporting extra-pharmacological variables in psychedelic clinical trials. The 30-item guidelines, developed through a Delphi process with experts from 17 countries and 50 institutions, formally recognize that contextual factors like physical environment, therapeutic alliance, and participant experience are active treatment variables—not optional amenities.
This matters for Spravato because esketamine is pharmacologically related to ketamine, a dissociative anesthetic that produces psychedelic-like altered states at therapeutic doses. The same principles that influence outcomes in psychedelic-assisted therapy—how prepared you are, how safe your nervous system feels, whether someone skilled is present to support you—apply to Spravato sessions.
The practical implication: two people can receive the same dose of Spravato in two different Manhattan clinics and have meaningfully different experiences based on what surrounds the medicine.
The standard Manhattan Spravato clinic experience
At many REMS-certified clinics, a Spravato session looks like this:
- You arrive at a medical office or psychiatry clinic
- You self-administer the nasal spray in an exam room or observation area
- A nurse or technician monitors your vital signs for two hours
- You may be offered a chair in a shared waiting area, possibly with a TV or your phone
- After the observation window closes and you’re cleared, you leave
This model is compliant. It meets every REMS requirement. But it treats Spravato as a medication to be dispensed and monitored—not as an experience to be supported. The dissociative state that esketamine produces can surface difficult emotions, fragmented memories, or unfamiliar perceptual shifts. In a standard clinical setting, there may be no one trained to help you process what comes up.
How Nushama approaches Spravato differently
Nushama is a REMS-certified Spravato provider in Midtown Manhattan that treats each session as a guided therapeutic experience rather than a medication appointment. The differences begin before you arrive and continue after you leave.
Before the session: preparation
Preparation starts with a comprehensive medical intake and psychiatric assessment. Beyond screening for contraindications—a step every REMS clinic performs—Nushama’s team helps you set an intention for your session. This isn’t abstract or spiritual language for its own sake. Intention-setting is a practical framework: it gives your mind a focal point during the altered state, which may help direct the experience toward therapeutic territory.
You also receive guidance on how to prepare in the days leading up to treatment—what to eat, how to manage sleep, and how to create mental space for the session. This preparation mirrors what clinical trials increasingly recognize as a meaningful treatment variable.
During the session: a curated environment
Each session takes place in a private treatment room designed to support the medicine’s effects rather than fight them. The details matter:
- Zero-gravity chairs allow your body to fully relax, reducing physical tension that can interfere with the experience
- Ambient lighting and therapeutic dreamscapes replace the fluorescent overheads of a typical exam room
- Noise-canceling headphones with curated music provide an auditory anchor—research increasingly suggests that music selection during psychedelic-assisted therapy can influence emotional processing
- Eye masks encourage inward focus rather than distraction
Nushama books journey rooms for three hours per session—significantly longer than the two-hour REMS minimum—giving you time to settle in beforehand and ground gently afterward. When the medicine takes effect, you’re not alone with a vital signs monitor. A guide or therapist is present to offer emotional support, help regulate your nervous system if difficult material surfaces, and hold space for whatever emerges.
This is the core distinction: the presence of a compassionate professional who can help you process difficult emotions in real time turns a medication appointment into a therapeutic event.
After the session: integration
Integration—the process of making sense of your experience and applying insights to daily life—is where many clinics stop completely. At Nushama, preparation and integration coaching is built into the care model. After your session, an integration coach helps you:
- Identify key themes or insights from the experience
- Connect those insights to the patterns contributing to your depression
- Develop concrete next steps for daily life between sessions
This matters because a single Spravato session can surface powerful material—a new perspective on a relationship, a shift in how you relate to grief or trauma, a moment of feeling reconnected to yourself. Without integration support, those insights can fade within days. With it, they become building blocks for lasting change.
IV ketamine and Spravato: understanding both options
When researching ketamine-based treatments for depression, you’ll encounter two primary options at Nushama:
Spravato (esketamine) is the FDA-approved nasal spray administered under REMS protocols. Because it carries FDA approval for TRD and MDD, Spravato is widely covered by insurance—Nushama accepts Oxford, UnitedHealthcare, Cigna, Aetna, and Medicare, and the intake team handles prior authorization on your behalf.
IV ketamine is administered intravenously and offers distinct clinical advantages. Peer-reviewed research indicates that intravenous ketamine has approximately 100% bioavailability—meaning the full dose reaches your bloodstream—compared to approximately 50% bioavailability for intranasal esketamine. This gives clinicians more precise control over dosing, and the infusion can be stopped immediately if the experience becomes too intense. Nushama’s primary protocol involves six IV treatments over three to six weeks.
IV ketamine is not currently FDA-approved specifically for depression, which means it is typically not covered by insurance. However, for members whose treatment goals align with the precision and control that IV delivery offers, it may be the better clinical fit. Nushama’s medical team discusses both pathways during your initial consultation.
Insurance and access
Financial barriers shouldn’t prevent someone from receiving effective care. Nushama’s approach to access includes:
- Spravato insurance coverage. Nushama accepts major insurance plans for Spravato, and the intake team manages the prior authorization process so you know your costs before treatment begins.
- Transparent cost breakdown. Before your first session, you receive a clear separation of medication costs versus office visit fees.
- Community programming. Nushama offers group integration circles and community events that extend the therapeutic container beyond individual sessions.
How to choose the right Spravato provider in Manhattan
When evaluating providers, consider asking these questions:
- What happens during the two-hour observation period? If the answer is “we monitor your vitals,” that’s REMS compliance—not therapeutic support.
- Is there a trained guide or therapist present during the session? The presence of a compassionate professional during the altered state is one of the most meaningful differences between providers.
- Do you offer preparation and integration support? If the only touchpoint is the session itself, key therapeutic opportunities are being missed.
- What does the treatment environment look like? A quiet, private room with intentional sensory design signals a provider who understands how setting shapes outcomes.
- Do you offer both Spravato and IV ketamine? Having access to both modalities means your care plan can be tailored based on clinical need rather than limited by what the clinic happens to offer.
Frequently asked questions
Is Spravato the same as ketamine?
Not exactly. Spravato contains esketamine, which is the S-enantiomer (one molecular “mirror image”) of ketamine. Both act on the glutamate system, but they differ in formulation, delivery method, and regulatory status. Spravato is FDA-approved and delivered as a nasal spray; IV ketamine is administered intravenously and prescribed off-label for depression.
How quickly does Spravato work for treatment-resistant depression?
Some people notice shifts in mood within hours or days of their first session. However, Spravato is typically prescribed as a series of sessions—twice weekly during the first month (induction phase), then weekly or biweekly during maintenance. Individual responses vary, and not everyone experiences rapid relief.
Does insurance cover Spravato in Manhattan?
Yes. Because Spravato is FDA-approved, many commercial insurance plans and Medicare cover it. Nushama accepts Oxford, UnitedHealthcare, Cigna, Aetna, and Medicare. The intake team verifies your benefits and handles prior authorization before treatment begins.
What should I expect during a Spravato session at Nushama?
You’ll arrive at the Midtown Manhattan location, settle into a private treatment room with a zero-gravity chair, ambient lighting, and curated music. After self-administering the nasal spray under medical supervision, you’ll recline with an eye mask and noise-canceling headphones while a guide supports your experience. The full session—including settling in and grounding afterward—is booked for approximately three hours.
Can I receive both Spravato and IV ketamine at Nushama?
Yes. Nushama offers both modalities, and the medical team helps determine which pathway best fits your clinical needs, treatment history, and goals during your initial consultation.
If you’re exploring Spravato or IV ketamine for treatment-resistant depression and want to understand whether Nushama’s approach is the right fit, book a consultation to speak with the care team.
