Spravato® (esketamine) is an FDA-approved nasal spray for adults with treatment-resistant depression. At our Union Square clinic, our psychiatrists evaluate you, handle the insurance paperwork and supervise every dose in a REMS-certified setting.
Spravato is a Schedule III (CIII) prescription medicine. It is never sent home with you: you take each dose in our office and stay with us for at least two hours afterwards.
Medically reviewed by Yuli Fradkin, MD, board-certified psychiatrist · Last reviewed October 2026
Or call (646) 817-2835 — speak with our team now
Rated 5.0
On Google reviews
FDA-Approved
Spravato® nasal spray
In-Network
Aetna, BCBS, Cigna, United
Board-Certified
Psychiatrists, 25+ years
verified Google Reviews
See all reviews →
Dr Fradkin helped me with treatment-resistant depression using TMS.
Valery Dinner Verified Google ReviewI had a great experience at the Village TMS Center for Autism and Depression. The staff is very kind, professional, and truly cares about their patients. They take the time to listen and explain the treatment process clearly.
kibriyo komilova Verified Google ReviewMy son just finished TMS therapy with Village Group Medical. I am pleased to mention pleasant and welcoming atmosphere of this office. It helped my son relax and agree to undergo the therapy.
Yelena Haskin Verified Google ReviewAs an R.N. for decades I’ve had myriad experiences with institutions and providers. It takes a lot to impress me and that’s what Dr Fradkin and his affable staff have done! My treatments have been attended to with integrity, friendliness and skill. They provided scheduling flexibility, cost transparency, and a comprehensive orientation to my TMS treatments with a smile. Thus I have no reservations advocating Village TMS and award Dr Fradkin and his staff an A+.
Dennis Moriarty Verified Google ReviewI've been using Village Medical Group services for quite some time and can recommend it to everyone. Very easy easy and transparent communications, warm and welcoming office with people who care. George is very knowledgeable, helpful and I really appreciate his help all the time. Dr. Fradkin is amazing specialist that carefully and precisely chose the treatment that helped. I feel safe and comfortable every time I visit the office.
Nikita Khvastunov Verified Google ReviewVery professional and caring team. I enjoyed learning more about this solution and was pleased with the provided service!
Raul Ifraimov Verified Google ReviewTMS session with George went great. Even though I just started and it’s a new experience for me, a cautious supervision and guidance of the specialist helps to get through. I had all my questions being answered before the procedure. Will come again!
Ekaterina Kokovikhina Verified Google ReviewJust had my first TMS session. Feeling great!
Sofia Dro Verified Google ReviewTHE BASICS
Spravato is the brand name for esketamine, a nasal spray. Esketamine is one of the two mirror-image forms of the ketamine molecule. The FDA approved Spravato in 2019 for treatment-resistant depression in adults, taken together with an oral antidepressant. In 2020 the approval was extended to adults with major depressive disorder who have acute suicidal thoughts or behavior, and in January 2025 the FDA also approved it as a stand-alone treatment for treatment-resistant depression.
Most antidepressants act on serotonin or norepinephrine and take four to six weeks to show their effect. Esketamine works on a different system: it blocks NMDA receptors in the brain's glutamate network, which is thought to help nerve cells form new connections. That different route is one reason it can help people whose depression has not responded to two or more standard antidepressants.
In the clinical trial that supported its approval, adults with treatment-resistant depression who used esketamine with a new oral antidepressant improved more over four weeks than those who took the antidepressant with a placebo spray (Popova et al., American Journal of Psychiatry, 2019). It is a supervised medical treatment, not a quick fix, and it works best as part of a wider plan with your psychiatrist.
Spravato is an FDA-approved drug, not an off-label use. Prescribing details are on the official Spravato site.
WHO QUALIFIES
Spravato is for adults 18 and over. Your psychiatrist confirms the diagnosis, reviews every medication you have tried and checks that Spravato is safe for you before anything is scheduled. To compare it with TMS and ketamine, see our treatment-resistant depression page.
APPROVED USE
Major depression that has not improved after at least two antidepressants, each taken at an adequate dose for long enough. Spravato can be added to an oral antidepressant or, since 2025, used on its own.
APPROVED USE
Adults with major depressive disorder who have acute suicidal thoughts or behavior, used with an oral antidepressant. Spravato does not replace emergency care. In a crisis, call or text 988 or go to the nearest emergency room.
SAFETY SCREEN
Spravato cannot be used by people with an aneurysm or related blood vessel disease, an arteriovenous malformation, or a past bleed in the brain. We also look carefully at blood pressure, heart health, pregnancy plans and any history of substance use.
SESSION DAY
You arrive, we check your blood pressure, and you give yourself the spray in our treatment room while a member of our clinical team watches. A dose uses two or three single-use devices, taken five minutes apart.
Then you stay with us for at least two hours. Federal REMS rules require this monitoring because Spravato can cause sleepiness, a detached or dreamlike feeling (dissociation) and a temporary rise in blood pressure. We recheck your blood pressure, and you leave once you are clinically stable. Details of the program are on the official SPRAVATO REMS site.
You may not drive or operate machinery until the next day, after a restful sleep, so arrange a ride home before each session. Because nausea is common, avoid food for two hours and drinks for 30 minutes before your dose. Many patients bring headphones or something to read.
SPRAVATO VS KETAMINE
Spravato and ketamine are related, but they are not the same treatment. Our guide to Spravato vs IV ketamine covers the differences in detail. Here is the short version.
| Treatment | How it's given | Time in clinic | FDA status | Insurance | Often suited to |
|---|---|---|---|---|---|
|
Spravato® nasal spray |
Self-administered nasal spray under supervision |
Dose plus at least 2 hours of monitoring |
FDA-approved for TRD and for MDD with suicidal thoughts |
Often covered, usually with prior authorization |
Adults with TRD who want an FDA-approved, insurance-covered option |
|
IV ketamine infusion |
Slow intravenous drip |
About 40 minutes, plus monitoring |
Off-label for depression (FDA-approved only as an anesthetic) |
Usually self-pay, typically $400-$800 per session |
People who prefer an infusion or are not candidates for Spravato |
|
IM ketamine injection |
Intramuscular injection |
About 40 minutes, plus monitoring |
Off-label for depression |
Usually self-pay |
A simpler alternative to IV for some patients |
Ketamine for depression is off-label and usually self-pay. Spravato is FDA-approved and given only in certified settings, which is why insurers are more likely to cover it. We verify your coverage for free. Read more on our ketamine therapy page.
COST AND INSURANCE
Many insurers cover Spravato for treatment-resistant depression when you meet their criteria. We are in network with Aetna, BCBS, Cigna, United, Empire BCBS, Oxford and Medicare.
Insurers usually ask for proof of the diagnosis and a list of the antidepressants you have tried. We gather the records and submit the prior authorization for you.
What you pay depends on your deductible, your copay and whether the medicine is billed under your medical or pharmacy benefit. Our Spravato cost guide explains the numbers.
People with commercial insurance may qualify for the manufacturer's savings program for Spravato. Ask us about it during your free insurance check.
GETTING STARTED
STEP 1
Tell us about your symptoms and the medications you have tried. We check your insurance at no cost.
STEP 2
A board-certified psychiatrist confirms the diagnosis, screens for blood pressure and other safety issues, and decides with you whether Spravato fits.
STEP 3
We submit the prior authorization and enroll you in the SPRAVATO REMS program, which every patient joins before the first dose.
STEP 4
You take your first dose in our office, followed by at least two hours of monitoring. Your psychiatrist reviews your progress throughout.
TREATMENT SCHEDULE
The induction phase: two sessions a week. Your dose is adjusted to how you respond and how well you tolerate it. At the end of week 4, your psychiatrist reviews whether Spravato is helping enough to continue, as the prescribing information recommends.
One session a week while your response settles. Most people keep taking their oral antidepressant during this time unless they are using Spravato on its own.
Maintenance: one session a week or every two weeks, set at the least frequent schedule that keeps your symptoms under control.
In a clinical trial, people who had responded and kept using esketamine had a lower risk of relapse than those switched to placebo (Daly et al., JAMA Psychiatry, 2019). How long you continue is a decision you make with your psychiatrist.
SAFETY
The most common side effects in clinical trials were dissociation (feeling detached or dreamlike), dizziness, nausea, sleepiness, a spinning sensation, numbness, anxiety, lethargy, feeling drunk, raised blood pressure and vomiting. Most begin soon after the dose and fade on the same day.
Spravato carries a boxed warning for sedation, dissociation, slowed breathing, misuse, and suicidal thoughts and behavior in young people taking antidepressants. These risks are the reason it is only given in certified settings, with our team checking on you throughout the monitoring period.
Before your first session you receive the Medication Guide, and we go through the risks with you and, if you like, your family. Tell us about every medicine and supplement you take. Some, such as benzodiazepines, opioids and stimulants, change how Spravato affects you.
Every dose is supervised by our clinical team under board-certified psychiatrists. For what patients say about the experience, read our roundup of Spravato reviews.
Board-certified psychiatrists with decades of experience treating depression, OCD,
and anxiety.
Board-Certified Psychiatrist · 25+
Years Experience
I founded Village TMS because so many of my patients had been failed by
standard treatment paths. My approach is unhurried, evidence-driven, and centred on what each person actually needs to feel like themselves again.
Board-Certified Psychiatrist · 15+ Years Experience
I came to TMS after watching patients
cycle through medications that didn't fit them. My focus is precision, matching the right protocol to the right person, and adjusting as we go.
Psychotherapist & Coach ·
Couples Therapy
I help adults and couples build self-awareness and deepen relationships. My work is grounded in Gestalt therapy and informed by EMDR, mindfulness, and transpersonal psychology. I combine deep emotional exploration with practical tools, working in a warm, collaborative space where clients feel genuinely seen and supported.
Everything you need to know before your free consultation.
It depends on your insurance. With coverage, what you pay comes down to your deductible, copay or coinsurance. Without insurance, the medicine itself is expensive, so we always check your benefits first. Our Spravato cost guide for 2026 breaks down typical costs, and our team gives you a personal estimate after a free insurance check.
It is straightforward if you meet the criteria. You need a diagnosis of major depression that has not improved after at least two antidepressants, or major depression with acute suicidal thoughts, plus a psychiatric evaluation that confirms Spravato is safe for you.
Insurers usually require prior authorization, which we prepare and submit. A regular pharmacy cannot fill Spravato for you to take home, because it is only dispensed to certified treatment centers.
For many people it does, though not for everyone. In clinical studies, adults with treatment-resistant depression who added esketamine to a new antidepressant improved more than those who added a placebo spray, and people who kept taking it after responding were less likely to relapse.
We review your progress at the end of the four-week induction phase and stop if it is not helping enough. Our roundup of Spravato reviews covers what patients report.
No. The SPRAVATO REMS program requires every dose to be taken in a certified healthcare setting, under direct supervision, followed by at least two hours of monitoring. Spravato cannot be mailed to you or used at home.
Twice a week for weeks 1 to 4, once a week for weeks 5 to 8, then once a week or every two weeks from week 9. Your psychiatrist sets the least frequent schedule that keeps you well.
No. You must not drive or operate machinery until the next day, after a restful night of sleep. Arrange a friend, family member or car service to take you home.
Often, yes. Many insurers cover Spravato for treatment-resistant depression when you meet their criteria, usually with prior authorization. We are in network with Aetna, BCBS, Cigna, United, Empire BCBS, Oxford and Medicare, and we verify your coverage for free before you start.
No. Spravato contains esketamine, one form of the ketamine molecule, in an FDA-approved nasal spray. IV and IM ketamine use the whole ketamine molecule and are off-label for depression; ketamine itself is FDA-approved only as an anesthetic.
Read Spravato vs IV ketamine for a full comparison, or our treatment-resistant depression page to compare Spravato with TMS.
INSIGHTS
· 5 min read
· 5 min read
· 5 min read
EXPLORE OUR SERVICES
VISIT US
Village TMS is at 80 Fifth Avenue, Suite 1405, at 14th Street, a short walk from the 14th Street-Union Square subway station. We see patients from across Manhattan, Brooklyn, Queens and northern New Jersey.
Greenwich Village ·
Chelsea · West Village ·
East Village · SoHo ·
Tribeca · Flatiron ·
Midtown
Williamsburg · Brooklyn
Heights · Park Slope ·
Long Island City · Astoria
· Forest Hills
Hoboken · Jersey City ·
Weehawken · Edgewater
· Fort Lee
