Rockville & Frederick, MD · Accepting new patients
Spravato treatment for treatment-resistant depression
If two antidepressants have already failed you, that is not a sign you are out of options. It is the clinical definition of treatment-resistant depression, and it is the exact point at which Spravato treatment becomes appropriate.
Spravato is an esketamine nasal spray you take in a doctor's office under supervision. It works on a different brain system than every antidepressant you have already tried, which is why it can help people whose depression has not responded to anything else. At Bright Horizons Psychiatry we have been providing Spravato treatment in Maryland since our founding, and we run it at both of our clinics.
A nasal spray that works differently
Spravato is the brand name for esketamine. It is one half of the ketamine molecule, purified and delivered as a metered nasal spray at a controlled dose. That is what let it go through full FDA trials and get approved for depression, where most ketamine is still prescribed off label. You take it in a certified clinic with a clinician present, never at home.
- 2019 FDA approves Spravato for treatment-resistant depression
- 2020 Approval extended to major depression with active suicidal thoughts
- 2025 Approved as a standalone treatment, no oral antidepressant required
How it is different, at a glance
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Nasal, not a pill
A metered spray you self-administer under supervision
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A new target
Works on glutamate, a system older antidepressants barely touch
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Faster
Some people feel a shift within a day, not weeks
Is Spravato right for you
It may be a fit if
- You have tried two or more antidepressants without relief in this episode
- You are an adult with major depression
- Your depression comes with active suicidal thoughts and speed matters
It is not the right fit if
- You have bipolar I, psychosis, a substance use disorder, or a personality disorder
- You have a history of certain blood vessel conditions in the brain
- You are under 18
Not sure where you land? A consultation sorts it out fast. We would rather tell you honestly that Spravato is the wrong fit than start you on something that will not help.
Why it can work when other treatments have not
Conventional antidepressants
Work on serotonin, norepinephrine, and dopamine. They take four to six weeks to do anything, and for many people they never do.
Esketamine
Works on glutamate, the brain's main excitatory messenger. It blocks NMDA receptors and sets off changes that appear to rebuild connections between neurons in the regions that regulate mood.
What to expect on the day
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Check in
We confirm your blood pressure is in range and review how you have been
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Self-administer
You spray the medication yourself while the clinician watches. About a minute
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Two hours of monitoring
A clinician stays on site, checks your blood pressure, and watches until you are clinically stable. This is a federal REMS requirement, not us being cautious
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Ride home
You cannot drive afterward. Plan on about two and a half hours door to door
The Spravato treatment schedule
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Getting Started
Weeks 1 to 4
Your treatment begins with two sessions each week. Depending on your care plan, you'll receive either 56 mg or 84 mg, given as two or three nasal sprays per nostril under medical supervision.
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Building Progress
Weeks 5 to 8
As treatment continues, most people move to one session each week. Your care team will monitor your response and make sure the schedule continues to meet your needs.
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Ongoing Care
Week 9 and Beyond
Once your symptoms have stabilized, treatment usually continues every week or every two weeks. Your prescriber will recommend the schedule that works best for you.
The first four weeks are the demanding part. Eight visits in a month, each taking most of a morning or afternoon. People who plan for it do far better than people caught off guard by it.
Spravato on its own
Since January 2025 it is approved as a standalone treatment. If oral antidepressants have given you bad side effects, that no longer rules you out.
Spravato with an antidepressant
Plenty of patients still do better on both. Which route we take depends on your history and how you have responded. We talk it through rather than defaulting to one.
How Spravato compares
| Feature | Spravato (Esketamine) | IV Ketamine Infusion | TMS Therapy |
|---|---|---|---|
| What It Is | Nasal spray — FDA-approved esketamine | IV drip of racemic ketamine | Magnetic pulses to the brain |
| FDA Status | FDA-approved for TRD & suicidal ideation | Not FDA-approved for depression (off-label use) | FDA-approved for depression & OCD |
| Administration | Clinician-administered nasal spray, in-office | IV infusion in a clinic, 40–60 min | Device placed on head, 20–30 min |
| Insurance | Covered by most major plans, Medicaid & Medicare | Rarely covered — typically out-of-pocket | Covered by most major plans |
| Speed of Effect | Hours to days | Hours to days | 2–3 weeks typically |
| Schedule | 2x/week → 1x/week → maintenance | 6 infusions over 2–3 weeks + boosters | 5 days/week for 4–6 weeks |
| Monitoring | 2-hour in-office observation required | Observation required during infusion | None — drive yourself home |
| Typical Cost | Copay only with insurance | $400–$800 per infusion (self-pay) | Copay only with insurance |
Because Spravato is FDA approved, most insurers cover it where they will not cover ketamine infusions. Which one fits is a consultation conversation, not a website decision.
Side effects to know about
- Dissociation
- Dizziness
- Nausea
- Sedation
- Short-term rise in blood pressure
- Numbness in the nose
Nearly all of these happen during or right after the session, which is exactly why we monitor you for two hours. Most patients find the effects get milder as Spravato treatment goes on. See our full guide to Spravato side effects .
Most plans cover it, and we handle the paperwork
Most major insurers cover Spravato treatment for treatment-resistant depression, including Medicare and Maryland Medicaid. Coverage almost always needs prior authorization first, which means documenting the antidepressants you have already tried.
- We submit the prior authorization
- We follow up with your insurer
- You know your out-of-pocket cost before you start
Johnson and Johnson also runs a savings program that can help with copays for commercially insured patients. See the plans we accept .
Two Maryland locations
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Rockville
Serves Montgomery County and the DC suburbs. The only one of our two clinics with BrainsWay Deep TMS on site.
Rockville Spravato clinic -
Both clinics are led by Dr. Amir Etesam, a Johns Hopkins-affiliated psychiatrist, and staffed by psychiatric nurse practitioners trained in Spravato administration. 4.8 stars across more than 216 reviews.
Common questions
Is Spravato the same as ketamine?
Esketamine is one half of the ketamine molecule, given as a nasal spray at a fixed dose, and it is FDA approved for treatment-resistant depression. IV and IM ketamine use the whole molecule and are prescribed off label.
How long before Spravato works?
Some people notice a shift within 24 hours. Most need two to four weeks for a clear change. If nothing has happened by week four, we reassess rather than continuing indefinitely.
Can I take Spravato at home?
No. Federal REMS rules require every dose in a certified clinic with two hours of supervised monitoring afterward.
Where can I find Spravato near me in Maryland?
We provide it at our Rockville and Frederick clinics. The FDA also keeps a directory of certified treatment centers if neither is convenient.
How long will I stay on Spravato?
There is no fixed endpoint. Some patients taper off after several months, others stay on a maintenance dose long term. We review it with you as you go.
Do I need to stop my current antidepressant?
No. Spravato is approved both on its own and alongside an oral antidepressant. We decide together which makes sense.