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Spravato (Esketamine) in Beverly Hills, CA

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Two Antidepressants Down. Still Not Yourself. Here’s the FDA-Approved Option Built for Exactly That.

Standard antidepressants take weeks to work, if they work at all. If you’ve already tried more than one without real relief, you’re not out of options. You’re in the exact group Spravato was built for.

Spravato (esketamine) is an FDA-approved nasal spray for treatment-resistant depression, administered under medical supervision at Brain Spa in Beverly Hills. It’s not experimental. It’s not off-label. It’s a specific, approved treatment with its own dosing protocol, its own safety program, and a documented track record of working faster than oral antidepressants.

What Spravato (Esketamine) Is

Spravato is the brand name for esketamine, a nasal spray version of ketamine’s more active molecular mirror-image (its “enantiomer,” in chemistry terms). It’s approved by the FDA for two specific uses:

 

  • Treatment-resistant depression (TRD) in adults, used together with an oral antidepressant
  • Depressive symptoms in adults with major depressive disorder who have suicidal thoughts or actions

 

Esketamine received FDA breakthrough therapy designation, a status reserved for treatments that show real promise of major improvement over what’s already available for a serious condition.

 

This is different from the Ketamine-Assisted Psychotherapy and Ketamine-Assisted Hypnotherapy programs at Brain Spa. Those use ketamine itself, prescribed off-label for psychiatric care, paired with active psychotherapy or hypnotherapy during the dosing window. Spravato is an FDA-approved medication with its own separate protocol, and it’s self-administered as a nasal spray rather than delivered by infusion or injection.

How Esketamine Actually Works on the Brain

Standard antidepressants (SSRIs, SNRIs) target serotonin and norepinephrine, and typically take four to six weeks to show an effect.

 

Esketamine works through a different system entirely: glutamate, the brain’s main excitatory neurotransmitter.

 

The short version:

 

  • Esketamine blocks NMDA receptors, a type of glutamate receptor involved in regulating mood and cognition
  • That blockade triggers a glutamate surge that activates AMPA receptors elsewhere in the brain
  • AMPA activation sets off a signaling cascade that promotes synaptogenesis, the rapid formation of new synaptic connections, concentrated in areas of the brain tied to mood regulation
  • This mechanism is part of why esketamine can produce a measurable reduction in depressive symptoms within hours to days, rather than weeks

 

Esketamine is specifically the S-enantiomer of ketamine, the mirror-image molecule that binds more selectively to NMDA receptors. That’s part of the reason the FDA approval process treated it as a distinct, standalone drug rather than simply repackaged ketamine. You can read the official FDA-approved prescribing information directly if you want the full clinical detail behind the approval.

 

This is general background on the drug’s mechanism, not a promise of a specific outcome for any individual patient.

Who Is (and Isn’t) a Good Candidate

Spravato is specifically indicated for treatment-resistant depression, a clinical term with a real definition: adults who haven’t found adequate relief from at least two different antidepressant medications, taken at an adequate dose for an adequate length of time. It’s also indicated for adults with major depressive disorder experiencing suicidal thoughts or actions.

 

Typically a good fit if you:

 

  • Have depression that hasn’t responded to at least two prior antidepressant trials
  • Are currently on, or willing to start, an oral antidepressant alongside Spravato
  • Can commit to in-clinic dosing sessions with a required observation period afterward
  • Have reliable transportation arranged, since you cannot drive yourself home the day of treatment

 

Typically screened out or requiring extra caution:

 

  • Aneurysmal vascular disease or arteriovenous malformation (an FDA-listed contraindication)
  • A history of intracerebral hemorrhage
  • Uncontrolled high blood pressure or significant cardiovascular disease
  • A history of substance abuse or dependence, which requires closer monitoring under the drug’s safety program
  • Pregnancy, since Spravato is not recommended during pregnancy

 

A licensed provider makes the final candidacy determination during your intake evaluation, not this page.

 

Schedule Your Consultation Today

 

 

Your Session, Step by Step

What To Expect

Your Spravato Session, Start to Finish

The 2-hour observation window isn't optional. It's part of the FDA's required safety program.

1

Intake & Enrollment

Your provider confirms eligibility and enrolls you in the REMS safety program.

2

Self-Administration

You administer the nasal spray yourself, under direct staff supervision.

Required by FDA 3

2-Hour Observation

Mandatory monitoring for sedation, dissociation, and blood pressure changes.

4

Side Effect Check

Staff confirm dizziness, nausea, or blood pressure changes have settled.

5

Discharge

A pre-arranged ride takes you home. No driving yourself, same day.

2 hrs mandatory observation
FDA approved, not off-label
0 driving yourself home after
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  1. Intake and evaluation. A licensed provider reviews your treatment history, confirms you meet the criteria for treatment-resistant depression or MDD with suicidal ideation, and enrolls you in the required safety program.
  1. Self-administration under supervision. Spravato is a nasal spray you administer yourself, but only in a certified clinical setting, never at home. Staff supervise the administration directly.
  1. Post-dose observation. You remain under observation for at least two hours after dosing. This isn’t optional; it’s part of the FDA-required monitoring protocol for this specific medication.
  1. Monitoring for side effects. Common effects during this window include dizziness, nausea, dissociation, and a temporary rise in blood pressure. Staff track these throughout your observation period.
  1. Departure and aftercare. You cannot drive yourself home the day of treatment. Arrange a ride in advance. Most patients feel back to baseline by the next day.

Safety and Monitoring, in Plain Terms

Spravato carries FDA boxed warnings, the strongest label warning the FDA issues, and it’s worth being direct about what that means rather than glossing over it. What the boxed warning covers:
  • Risk of sedation, dissociation, and respiratory depression after dosing, which is why the 2-hour observation period is mandatory, not a suggestion
  • Potential for abuse and misuse, since esketamine is a Schedule III controlled substance
  • Increased risk of suicidal thoughts and behaviors in pediatric and young adult patients on antidepressants generally, requiring close monitoring for any worsening symptoms
Because of these risks, Spravato is only available through a restricted program called the SPRAVATO REMS (Risk Evaluation and Mitigation Strategy). This means it can only be administered at a certified healthcare setting, under direct observation, not prescribed for home use. Common side effects, typically resolving within the observation window:
  • Dizziness
  • Nausea
  • Dissociation
  • Temporary increase in blood pressure
Who’s present: A licensed healthcare provider supervises administration and remains responsible for your monitoring throughout the required observation period. Full sourcing behind these protocols, including the FDA prescribing information, is available on our references page.

Expected Timeline

  • First session: Many patients notice an improvement in depressive symptoms within hours of their first treatment
  • First few weeks: Dosing frequency is typically higher at the start (commonly a few times per week), tapering to a less frequent maintenance schedule as your provider assesses your response
  • Ongoing: Spravato is used alongside an oral antidepressant on a continuing basis for treatment-resistant depression, not as a short, fixed series
  • Individual results vary: Some patients see continued improvement over subsequent sessions; response and durability differ by patient
Your provider will build a specific dosing schedule based on your diagnosis and response, adjusting frequency over time.

Spravato vs. Other Approaches

How the approaches differ
Approach What Happens Who’s With You
Standard IV Infusion Ketamine delivered through an IV, off-label for psychiatric use. Monitoring is mostly vitals-based. Medical staff, minimal in-session therapy
Ketamine-Assisted Psychotherapy Off-label ketamine combined with active talk-therapy-based psychotherapy during dosing. A trained psychotherapist, present the entire time
Ketamine-Assisted Hypnotherapy Off-label ketamine combined with guided hypnotic suggestion. A trained hypnotherapist, present the entire time
Spravato (Esketamine) FDA-approved nasal spray, self-administered under supervision, paired with an oral antidepressant. Medical staff for mandatory 2-hour observation

Cost and Insurance

This is where Spravato differs the most from Brain Spa’s other ketamine programs.
  • Spravato is FDA-approved, which means it typically runs through standard medical and pharmacy insurance benefits rather than the out-of-network, private-pay path required for off-label ketamine.
  • Ask your insurance provider directly whether it covers Spravato treatment, and what prior authorization steps are required, since this varies by plan.
  • Ask about the REMS enrollment process at your consultation. Because Spravato requires certified-setting administration, your provider will walk you through what’s needed before your first dose.
If Spravato’s coverage pathway doesn’t fit your situation, ask about Ketamine-Assisted Psychotherapy or Ketamine-Assisted Hypnotherapy as alternative tracks.

Ready for an FDA-Approved Option Built for Treatment-Resistant Depression?

You’ve already tried the standard path. Spravato is the next step, backed by an FDA approval, a defined safety program, and a care team that monitors you through every session. Request Your Consultation or call (310) 628-1062 to learn more.

FAQ

Spravato is a nasal spray that contains esketamine, a form of ketamine. It works by targeting the NMDA receptors in the brain, helping to restore neural connections and reduce symptoms of depression, especially in those who haven’t responded to other treatments.

Spravato is administered in a clinical setting under the supervision of a healthcare professional. Patients self-administer the nasal spray, and then remain under observation for about two hours to monitor for any side effects.

Spravato is typically prescribed for adults with treatment-resistant depression, meaning those who have not found relief from at least two different antidepressants. A healthcare provider will determine if Spravato is the right treatment based on your medical history and current condition.

Common side effects include dizziness, nausea, and a temporary increase in blood pressure. These effects usually subside shortly after the treatment session. Your healthcare provider will monitor you during and after administration to ensure your safety.
Many patients experience improvement in their depressive symptoms within hours of their first treatment, with continued improvement over subsequent sessions. However, individual results may vary.

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