If you’ve tried two or more antidepressants without lasting relief, you already know how exhausting the search for something that works can be. Spravato (esketamine)—an FDA-approved nasal spray for treatment-resistant depression (TRD)—may offer a different path forward. And because it carries FDA approval, it’s one of the few advanced depression treatments that insurance often covers.
This guide walks through what to look for in a certified Spravato treatment center near Miami, how the insurance process works, and what the evidence says about long-term outcomes.
What Spravato Is and How It Works
Spravato is the brand name for esketamine, a nasal spray derived from ketamine. It targets the brain’s glutamate system—a different pathway than the serotonin-based mechanism of traditional antidepressants like SSRIs and SNRIs. This distinction matters because people living with treatment-resistant depression have, by definition, not responded adequately to at least two conventional medications.
The FDA first approved Spravato in March 2019 as an add-on therapy alongside an oral antidepressant. Then, in January 2025, approval expanded to include monotherapy use—meaning Spravato can now be prescribed as a standalone treatment for adults with TRD, without requiring a concurrent oral antidepressant (Johnson & Johnson, 2025).
This monotherapy expansion is significant. Previously, even when an oral antidepressant wasn’t helping, members had to keep taking it to qualify for Spravato. That requirement has been removed for people who have tried at least two oral antidepressants without adequate relief.
Why REMS Certification Matters When Choosing a Center
Spravato is available only through a restricted program called the REMS (Risk Evaluation and Mitigation Strategy), an FDA-mandated safety framework. The REMS exists because esketamine can cause temporary sedation, dissociation (a feeling of being disconnected from your surroundings), and changes in blood pressure.
Here’s what REMS certification requires of any treatment center:
- Certified healthcare setting. The clinic must complete a formal application and maintain specific safety infrastructure, trained staff, and protocols for managing side effects.
- Observed dosing. You self-administer the nasal spray under the direct supervision of a healthcare provider—it’s never dispensed for home use.
- Two-hour post-dose monitoring. After every session, a clinician monitors your vital signs and overall well-being for at least two hours. This applies whether it’s your first dose or your fiftieth.
- Certified pharmacy supply chain. The medication is dispensed only through REMS-certified pharmacies directly to certified clinics.
When evaluating Spravato treatment centers in or near Miami, REMS certification is the non-negotiable baseline. Any center administering Spravato should be able to confirm their certification status.
What Separates a Good Center from a Certified One
Certification ensures safety compliance, but the quality of your experience depends on what a center builds beyond those minimums. Consider:
- Clinical team depth. Is a psychiatrist or psychiatric nurse practitioner involved in your intake and ongoing care, or is dosing managed by general staff?
- Integration support. Does the center offer preparation before sessions and integration support afterward? Spravato can open a window for emotional processing—structured support helps you make lasting use of that window.
- Environment. The setting where you spend those two post-dose hours matters. A calm, private space is different from a busy waiting room.
- Insurance navigation. A center with experience in Spravato-specific prior authorizations can significantly reduce administrative delays.
Spravato Treatment Near Miami: Nushama’s Aventura Location
Nushama operates a REMS-certified treatment center in Aventura at 2999 NE 191st Street, Suite 200, Aventura, FL 33180—serving the greater Miami area, including North Miami, Miami Beach, Sunny Isles Beach, and Hallandale Beach.
What distinguishes Nushama’s approach:
- Psychiatric-led intake. Every member begins with a medical intake and psychiatric assessment to confirm a TRD diagnosis and evaluate eligibility. This step establishes a personalized care plan rather than a one-size-fits-all protocol.
- Preparation and integration. Nushama treats Spravato as one part of a broader therapeutic process. Preparation and integration coaching helps members set intentions before sessions and process insights afterward—an approach grounded in the understanding that medicine can be a catalyst, but lasting change often requires continued inner work.
- Calming clinical environment. Sessions take place in a serene, private setting designed to support the neuroplastic benefits of treatment, rather than a sterile clinical space.
- Dedicated insurance coordination. Nushama’s care team manages the prior authorization and benefits verification process, communicating directly with your insurer to clarify your deductible, copay, and coverage limits before treatment begins.
How Insurance Coverage Works for Spravato
Because Spravato carries FDA approval, it’s covered by many major insurance plans—a meaningful difference from IV ketamine, which is typically an out-of-pocket expense due to its off-label status for depression.
Plans That Commonly Cover Spravato
At Nushama’s Aventura location, accepted insurance plans include:
- Florida Blue
- Aetna
- United Healthcare
- Medicare
Coverage typically includes both the medication cost and the in-office administration and monitoring fees, though specifics vary by plan.
The Prior Authorization Process
Most insurers require prior authorization before approving Spravato treatment. This generally involves:
- Diagnosis confirmation. Your provider documents a diagnosis of treatment-resistant depression—typically defined as inadequate response to at least two oral antidepressants taken at adequate doses for adequate duration.
- Treatment history documentation. Records of previous medication trials, including drug names, dosages, and duration.
- Clinical justification. A statement from the prescribing clinician explaining why Spravato is medically appropriate for your situation.
The process can take days to weeks depending on your insurer. Nushama’s intake coordinators handle this paperwork on your behalf, aiming to give you a clear financial picture before your first session.
Reducing Out-of-Pocket Costs
For commercially insured members, the Janssen CarePath savings program may significantly reduce medication copays, subject to eligibility and annual limits. Nushama’s team can help determine whether you qualify and guide you through enrollment so the savings card is active before treatment begins.
What the Evidence Says About Long-Term Outcomes
One of the most common questions about Spravato is whether it offers lasting benefit—or just temporary relief. The clinical evidence increasingly supports durable outcomes when treatment is maintained appropriately.
SUSTAIN-3: Long-Term Efficacy Data
The SUSTAIN-3 study, a phase 3, open-label extension trial, followed adults with TRD who continued esketamine treatment combined with an oral antidepressant for up to 4.5 years. Key findings:
- 46.1% of participants were in remission (MADRS total score ≤12) at the optimization/maintenance endpoint.
- Depression ratings generally persisted among those who remained in maintenance treatment.
- Only 4.4% dropped out due to lack of efficacy, and 0.6% discontinued due to worsening depression.
- No new safety signals emerged during the extended treatment period.
These numbers compare favorably to long-term outcomes with conventional antidepressants in treatment-resistant populations. In the well-known STAR*D trial, relapse rates for people who responded to a third or fourth treatment attempt reached 65–71% within one year.
Real-World Evidence
Beyond controlled trials, real-world studies have examined how Spravato performs in everyday clinical practice. The REAL-ESK study, a multicentric investigation published in the Journal of Affective Disorders, evaluated esketamine’s safety and effectiveness across multiple treatment sites. The findings supported the clinical trial results, suggesting that improvements seen in controlled settings translate to real-world practice.
It’s worth noting that individual responses vary. Some people experience meaningful improvement within the first few sessions, while others may need a full induction course before noticing change. Maintenance treatment—ongoing sessions at reduced frequency—appears to be an important factor in sustaining gains.
What a Treatment Course Looks Like
Spravato treatment follows a structured timeline:
Induction Phase (Weeks 1–4)
- Frequency: Twice weekly
- Dosing: Typically starts at 56 mg, with the option to increase to 84 mg based on tolerability and response
- Session length: Each visit lasts approximately 2.5–3 hours (self-administration plus the required two-hour monitoring period)
Maintenance Phase (Week 5 Onward)
- Frequency: Once weekly or once every two weeks, adjusted based on clinical response
- Ongoing monitoring: Blood pressure checks and observation continue at every session, regardless of how long you’ve been in treatment
Before each session, you’ll avoid food for two hours and liquids for 30 minutes. After the session, you’ll need a ride home—driving is not permitted for the rest of the treatment day.
Who May Be a Good Candidate
Spravato may be appropriate if you:
- Are an adult (18 or older) with a diagnosis of major depressive disorder
- Have tried at least two oral antidepressants at adequate doses without adequate relief
- Are in generally stable physical health
- Can commit to the in-office treatment schedule and post-dose monitoring
Spravato is not appropriate for people with:
- A history of aneurysmal vascular disease or arteriovenous malformation
- Hypersensitivity to esketamine or ketamine
- Certain cardiovascular conditions that make blood pressure changes risky
A thorough medical screening is part of every intake at a REMS-certified center. If Spravato isn’t the right fit, a comprehensive clinic like Nushama can discuss alternative options, including IV ketamine infusions or medication management.
Frequently Asked Questions
Is Spravato the same as ketamine?
Not exactly. Spravato contains esketamine, which is one molecular form (the S-enantiomer) of ketamine. While both act on the glutamate system, Spravato is FDA-approved and administered as a nasal spray in a certified clinic, whereas IV ketamine is delivered intravenously and is typically used off-label for depression. The key practical difference: Spravato is usually covered by insurance, while IV ketamine generally is not.
How quickly can Spravato start working?
Some people notice improvement within hours to days of their first session, though this varies widely. The monotherapy trial supporting the January 2025 approval showed statistically significant improvement in depressive symptoms as early as 24 hours after the first dose. A full induction course (about four weeks) gives the clearest picture of how you’ll respond.
Can I do Spravato without also taking an antidepressant?
Yes, since January 2025. The FDA’s expanded approval allows Spravato to be used as a monotherapy for adults with TRD who haven’t responded to at least two oral antidepressants. Your prescribing clinician will determine the best approach based on your treatment history.
What happens during the two-hour monitoring period?
After you self-administer the nasal spray, you rest in a comfortable, supervised environment. A healthcare provider checks your blood pressure and monitors for side effects like sedation or dissociation—both of which are typically mild and temporary. Many members describe this time as an opportunity for quiet reflection.
How long will I need Spravato treatment?
Treatment duration is individualized. After the initial four-week induction phase, maintenance sessions continue at a reduced frequency for as long as you and your clinician determine they’re helpful. The SUSTAIN-3 trial followed participants for up to 4.5 years, with sustained benefit and no new safety concerns emerging over that period.
Taking the Next Step
Finding the right Spravato treatment center in the Miami area means looking beyond REMS certification to the clinical team, therapeutic approach, and insurance support behind it. If you’re living with treatment-resistant depression and wondering whether Spravato might help, the most useful first step is a conversation with a qualified clinician who can review your history and walk you through what to expect.
Book a consultation with Nushama’s care team to verify your insurance coverage, discuss your treatment history, and learn whether Spravato—or another approach—may be a good fit for your path forward.