What Is Spravato and How Does It Work? A Detailed Guide for Patients

Spravato (esketamine) has become one of the most important advancements in modern psychiatric medication. For individuals in New York, White Plains, and Westchester County seeking new options for depression, understanding how Spravato works can help clarify whether it may be an appropriate treatment path.

Below is an in-depth explanation of Spravato’s mechanism, FDA approvals, safety requirements, insurance considerations, and clinical benefits — written in a clear and accessible way for patients and families.

What Is Spravato?

Spravato is the brand name for esketamine, a medication derived from one component of ketamine. It is administered as a nasal spray and is used in combination with an oral antidepressant.

In 2019, the U.S. Food and Drug Administration (FDA) approved esketamine for the treatment of:

• Treatment-resistant depression (TRD)

• Major depressive disorder with suicidal ideation (MDSI)

Since its approval, tens of thousands of adults in the United States have received Spravato in certified treatment centers. In areas like White Plains and Westchester, it has become a frequently discussed option for patients who have not responded well to traditional medications.

How Spravato Works in the Brain

Spravato affects the brain in ways that are fundamentally different from typical antidepressants. While SSRIs and SNRIs focus on serotonin or norepinephrine, Spravato works through the glutamate system, which is involved in mood regulation, learning, and neural connectivity.

Here are the primary ways Spravato influences the brain:

1. NMDA Receptor Modulation

Spravato interacts with NMDA receptors — proteins that help regulate the activity of glutamate, the brain’s main excitatory neurotransmitter. This modulation triggers a series of downstream neural changes associated with improved mood and cognitive flexibility.

2. Increased Prefrontal Cortex Activity

The prefrontal cortex plays a central role in emotional regulation, decision-making, and motivation. Many individuals with depression exhibit reduced activity in this region. Spravato helps increase activity, supporting more stable and adaptive emotional responses.

3. Enhanced Synaptic Plasticity

Depression is linked to weakened neural connections. Spravato promotes synaptogenesis — the formation and strengthening of neural connections. This effect may contribute to the rapid improvements many patients describe.

4. Improved Connectivity Between Brain Regions

By enhancing communication among key brain circuits, Spravato may help disrupt patterns of negative thought cycles, emotional rigidity, and cognitive slowing.

These biological changes can develop quickly, which is why some individuals begin noticing improvements within the first several treatments.

Who Is Eligible for Spravato?

A clinician evaluates each patient to determine eligibility. Most individuals who qualify meet criteria such as:

• Adult (18+)

• Diagnosis of major depressive disorder

• History of insufficient response to multiple antidepressants

• Symptoms that significantly impact functioning

• Stable medical history

• No contraindications such as certain vascular conditions or uncontrolled blood pressure

• Non-pregnant and not breastfeeding

Spravato is intended for adults who have followed appropriate medication trials and still struggle with depressive symptoms.

Safety Requirements and Monitoring

Spravato can only be administered in REMS-certified treatment centers due to safety protocols. Treatment requires monitoring for potential side effects such as:

• Dissociation

• Dizziness

• Nausea

• Fatigue

• Temporary changes in blood pressure

All patients must remain at the clinic for a two-hour monitoring period after the medication is administered. Because Spravato may cause temporary coordination or perception changes, patients must arrange transportation home — driving is not permitted on treatment days.

These safeguards ensure treatment is delivered safely and consistently.

Insurance Coverage for Spravato in New York and Westchester

Most insurance companies in New York provide coverage for Spravato, including:

• Medicare (Part B for outpatient-administered treatments)

• Commercial plans such as Aetna, Cigna, UnitedHealthcare, MVP, Blue Cross Blue Shield, and others

Coverage depends on:

• Clinical diagnosis

• Documentation of prior antidepressant trials

• Completion of prior authorization forms

• In-network provider status

Aurora Wellness In-Network Plans

Aurora Wellness in White Plains is in-network with many major insurers, which helps reduce costs for patients receiving Spravato. Being in-network means that the clinic has contracted rates with those insurers, lowering out-of-pocket expenses.

At Aurora Wellness, we are in-network with several major insurance providers, making Spravato treatment more affordable for our patients. Being in-network means we have pre-negotiated rates with these insurers, reducing your out-of-pocket costs.

We are in-network with:

• Aetna

• Cigna

• UnitedHealthcare (UHC/Optum)

• Blue Cross Blue Shield (BCBS)

• Humana

• Empire

• Anthem

• MVP Health Care

• Medicare

However, not all companies cover treatment, and it is essential to confirm with your provider whether Spravato is covered before undergoing treatment. Coverage also depends on whether you meet the clinical criteria and if you have the necessary prior authorization. To be eligible, you must:

• Be 18 or older

• Have no serious medical conditions that could make Spravato unsafe

• Have a qualifying diagnosis, such as TRD and MDSI

  
  

Why Patients Consider Spravato

Many individuals explore Spravato after experiencing:

• Limited progress on several antidepressants

• Persistent depressive episodes

• Emotional numbness or lack of motivation

• Trouble engaging in therapy due to overwhelming symptoms

• Recurring depressive relapses

• Feelings of hopelessness despite medication adherence

Because Spravato works differently than standard antidepressants, it offers a new avenue of treatment when other medications have not created meaningful change.

Commonly Reported Benefits

Patients often describe improvements such as:

• Increased energy or motivation

• Greater emotional responsiveness

• Improved ability to engage in daily tasks

• Reduced depressive heaviness

• Return of interest in activities

• Decrease in suicidal thinking

• Feeling “unstuck” after long periods of stagnation

These benefits vary from person to person, but many patients find Spravato to be a pivotal turning point.

Spravato at Aurora Wellness in White Plains

Aurora Wellness is a REMS-certified Spravato treatment provider serving:

• White Plains

• Westchester County

• Yonkers

• Scarsdale

• Rye

• Surrounding New York communities

The clinical team assists with evaluations, insurance verification, medical oversight, and long-term psychiatric medication management to ensure patients receive care that is safe, structured, and supportive.

Key Takeaways

• Spravato is an FDA-approved treatment for TRD and MDSI.

• It works through glutamate pathways and enhances neural connectivity.

• Treatment must occur in a REMS-certified setting with a two-hour monitoring period.

• Insurance coverage is widely available in New York, depending on plan details and medical criteria.

• Aurora Wellness in White Plains provides Spravato with experienced clinical oversight.