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Lifeline Psychiatry


Spravato (Esketamine) Ketamine Therapy

Spravato (Esketamine) is a new and breakthrough treatment approved by FDA in March 2019 for Treatment Resistant Depression (TRD) in adults. Spravato is administered only at approved and certified facilities under physician supervision. It is dispensed by certified pharmacies to treatment facility directly for administration under physician supervision.

Dr. Katragadda is certified by Spravato REMS (Risk Evaluation and Mitigation Strategies) program to do Spravato treatment in outpatient clinic. All new patients are required to come to clinic for initial evaluation to see Dr. Katragadda and complete the program enrollment forms. After enrollment in Spravato REMS program and approval by health plans, patients can start Spravato treatment.

Nasal Spray Device


Spravato is a brand name for Esketamine, a FDA approved medication for Treatment Resistant Depression (TRD). 

No, it is not the same. Ketamine is an anesthetic drug approved and used for decades in US. But it has been used off label for treatment resistant depression. Ketamine is not an approved medication for depression. It is only approved as an anesthetic agent. Esketamine (Spravato) was developed from Ketamine, and it was tested and proven to be effective for treatment resistant depression in multiple clinical trials. Esketamine was FDA approved on March 5th, 2019. This is a nasal spray as opposed to Ketamine which is available as injection for intravenous or intramuscular use.

All patients need to be evaluated by a psychiatrist who can advise if Esketamine is appropriate or not. 

Spravato belongs to a class of hallucinogens. It is safe if administered under supervision. You can expect feeling drowsy, dizzy or floating for an hour or so, then get back to yourself. You may have funny taste or nausea. Rarely, people can hallucinate or dissociate. 

Your vital signs such as blood pressure or heart rate or oxygenation can fluctuate during treatment, that is why you are monitored for two hours. 

There was no evidence for lasting side effects in short term or long-term studies. No memory deficits or cognitive impairment was noted in a yearlong clinical study that also established long term safety and tolerability.  

It can be if not used per treatment protocol. It belongs to a class of hallucinogens or psychedelics such as LSD or Special K. It is not advised for people who has history of addiction. It is recommended to discuss the pros and cons of taking Spravato with a psychiatrist.

It is administered only after careful evaluation for potential addiction or abuse versus potential lifesaving benefit for depression. It is not available in pharmacies for patients to self-administer. It is distributed through certified pharmacies and sent directly to administering medical centers. It is given in medical center under direct supervision to prevent diversion or abuse.

SPRAVATO treatment is very closely monitored by SPRAVATO REMS Program that certifies pharmacies, physicians and medical centers. Each dose of SPRAVATO is accounted for by SPRAVATO REMS program. Medical centers are required to report on the day of SPRAVATO administration each time.

Spravato works through a novel mechanism of blocking NMDA type of glutamate receptors. It is the only medication approved with this type of mechanism of action. It has shown to be working much faster than traditional antidepressants and help people with treatment resistant depression.

Spravato can be administered only at certified medical facilities by certified physicians. You can go to to look for nearest authorized center. 

GA Psychiatric Services / Dr. Katragadda is a certified Spravato facility. You can call (770) 458-0450 to schedule an appointment or get more information. 

You arrive to the center over night fasting (at least for 6 hours). You get urine drug sceen on arrival prior to Spravato administration each time. You can take your regular medications with a sip of water but recommended to hold any benzodiazepine medications (Xanax, Ativan, Klonopin, Valium etc..) on the day of treatment.

You need a friend or family member to take you home after the treatment since you are advised not to drive or operate heavy machinery on the day of treatment. 

You are given Spravato by nasal spray and then monitored for 2 hours. You get your vital signs checked periodically. Prepare to spend 2-3 hours in the medical center each time.

You need to agree and comply with treatment recommendations such as not driving on the day of treatment, getting someone to drive you home and not leaving medical center until released by physician. 

There are two phases to treatment. 

  1. Induction Phase: Spravato is administered twice a week for 1-4 weeks. Dosage is 56 or 84 mg each time.
  2. Maintenance Phase I: Spravato is administered once a week from week 5 to Week 9. Dosage is 56 or 84 mg each time
  3. Maintenance Phase II: Spravato is administered every other week after 9 weeks and up to one year. Dosage is 56 or 84 mg each time.

Treatment is individualized based on response to treatment. Some people may need more or different schedule. And, some people may need only 1-2 months of treatment and then maintain on oral medications.

Yes, Spravato is an adjunctive or add-on treatment which means you add Spravato to your antidepressant (s) for better results.

Spravato is relatively a new treatment option. Each health insurance uses its own criteria for Spravato treatment. It typically requires prior authorization and records review prior to approval. Health insurance will pay for the treatment once approved.

Your out-of-pocket costs depend on your insurance benefit plan. Your out-of-pocket cost generally includes price of medication, fee for administration at medical center and lab tests such as urine drug screen. 

Where do I get more information about Spravato?

You can visit following helpful links.

FDA News Release