If you’ve been diagnosed with treatment-resistant depression and antidepressants have not given you adequate relief, you may have heard about SPRAVATO®. Navigating a new treatment option can feel overwhelming, especially when the language around it is dense and the stakes feel high. At Mindful Infusions, our Salt Lake City clinic is a certified SPRAVATO® treatment center serving the Wasatch Front. We want to give you a clear, honest picture of what this treatment is, who it may help, and what you can expect here in Utah.
SPRAVATO® is a nasal-spray form of esketamine. It is FDA-approved for treatment-resistant depression in adults, either alone or with an oral antidepressant, and for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior when used with an oral antidepressant (U.S. Food and Drug Administration [FDA], 2025). Unlike IV ketamine, which is used off-label for psychiatric conditions, SPRAVATO® has FDA approval for these specific indications. That distinction can matter for patients, providers, and insurance coverage.
Understanding the FDA Approvals
SPRAVATO® is FDA-approved for two distinct uses:
Treatment-resistant depression in adults, as monotherapy or alongside an oral antidepressant.
Depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior, when used with an oral antidepressant.
For patients with treatment-resistant depression, the clinical picture often includes a history of multiple antidepressant trials that have not provided adequate relief. Our evaluation looks carefully at that history, along with your current symptoms, medications, and broader care needs.
For patients experiencing acute suicidal ideation or behavior, SPRAVATO® is approved for depressive symptoms in the context of comprehensive clinical care. The FDA label states that SPRAVATO® has not been shown to prevent suicide or reduce suicidal ideation or behavior, and it does not replace hospitalization when hospitalization is clinically warranted (FDA, 2025).
Who Qualifies for SPRAVATO® at Mindful Infusions?
To be considered for SPRAVATO® at our Salt Lake City clinic, you need a diagnosis and treatment history consistent with one of its FDA-approved indications. Our team conducts a thorough evaluation before starting treatment, reviewing your psychiatric history, current medications, cardiovascular health, and other factors that may affect safety or appropriateness.
SPRAVATO® carries boxed warnings related to sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors. Each session takes place under direct clinical supervision with at least two hours of post-treatment monitoring. You will also need to arrange transportation home and should not drive or operate machinery until the next day after a restful sleep (FDA, 2025).
At Mindful Infusions, we coordinate scheduling and intake to make these requirements as practical as possible for patients coming from across Salt Lake City and the broader Wasatch Front.
How SPRAVATO® Works
Esketamine is the S-enantiomer of ketamine and is classified as a noncompetitive NMDA receptor antagonist. It affects glutamate signaling, a system involved in learning, memory, and synaptic communication. The exact mechanism by which esketamine produces antidepressant effects is not fully known, though research continues to examine glutamate-related pathways, synaptic plasticity, and related downstream signaling (Abdallah et al., 2015; FDA, 2025).
Clinical trials have shown reductions in depression symptom severity as early as 24 hours for some patients. At the same time, results vary, and a recent systematic review found that the overall effect in treatment-resistant depression is modest across trials. This is why we focus on realistic expectations and individualized follow-up rather than promises about a specific outcome (Fountoulakis et al., 2025).
For a closer look at the broader neuroscience, read our guide to how ketamine therapy works in the brain for depression relief.
SPRAVATO® is self-administered intranasally under clinical supervision. For treatment-resistant depression, the labeled induction schedule is twice weekly for four weeks, followed by weekly treatment for four weeks. After that, treatment may continue weekly or every two weeks, based on response and tolerability (FDA, 2025).
SPRAVATO® vs. IV Ketamine: How We Help Patients Understand the Difference
Patients often ask us to compare SPRAVATO® and ketamine therapy for mood disorders and chronic pain. Both affect glutamatergic pathways, but they differ in important ways.
SPRAVATO® is FDA-approved for specific depressive-disorder indications, while IV ketamine for psychiatric conditions is off-label. SPRAVATO® is administered as a nasal spray in a certified treatment setting, while IV ketamine is delivered intravenously. Their administration, monitoring, dosing schedules, and insurance considerations can differ.
Some patients come to us after trying IV ketamine elsewhere and want to understand whether SPRAVATO® may be appropriate. Others are deciding between the two as an initial option. Our providers walk through both pathways honestly, explain the practical differences, and make recommendations based on your specific history and goals.
What Utah Patients Often Ask About Insurance
Insurance coverage is one of the most common practical questions we receive. Because SPRAVATO® is FDA-approved, some commercial insurers and Medicaid plans may cover it for qualifying patients. Prior authorization is common, criteria vary by plan, and coverage cannot be guaranteed.
Our team assists with the prior authorization process where possible and provides documentation your insurer may require. We are transparent about financial considerations from the first consultation because navigating treatment should not feel like navigating a bureaucracy alone.
Results vary by individual. What we can offer is an honest evaluation of whether you meet criteria, a clear walkthrough of the treatment process, and consistent support throughout your care. To learn more about what our evaluation involves, visit our page on ketamine treatment FAQs.
Key Takeaways
SPRAVATO® is FDA-approved for treatment-resistant depression in adults and for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior.
For treatment-resistant depression, SPRAVATO® may be used alone or with an oral antidepressant. For the acute-suicidal-ideation indication, it is used with an oral antidepressant.
SPRAVATO® affects NMDA glutamate receptors, though its full antidepressant mechanism is not yet known.
Every SPRAVATO® session takes place under clinical supervision with at least two hours of monitoring. You need transportation home and should not drive until the next day after a restful sleep.
Insurance coverage may be available for qualifying patients, but prior authorization and coverage requirements vary by plan.
Results vary by individual, and our role is to help you understand whether SPRAVATO® is a reasonable option for your situation.
If you think you may qualify for SPRAVATO®, or if you’re unsure whether SPRAVATO® or IV ketamine is the right path, our team at Mindful Infusions is here to help you think through it clearly. We serve patients throughout Salt Lake City and the Wasatch Front. Call us at (385) 299-0473 or schedule a consultation to get started.
References
Abdallah, C. G., Sanacora, G., Duman, R. S., & Krystal, J. H. (2015). Ketamine and rapid-acting antidepressants: A window into a new neurobiology for mood disorder therapeutics. Annual Review of Medicine, 66, 509–523. doi: https://pubmed.ncbi.nlm.nih.gov/25341010/
Fountoulakis, K. N., Saitis, A., & Schatzberg, A. F. (2025). Esketamine treatment for depression in adults: A PRISMA systematic review and meta-analysis. American Journal of Psychiatry, 182(3), 259–275. doi: 10.1176/appi.ajp.20240515
U.S. Food and Drug Administration. (2025). SPRAVATO® (esketamine) nasal spray: Prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211243s019lbl.pdf
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Ketamine infusion therapy and SPRAVATO® should only be pursued under the supervision of a licensed provider familiar with your full medical and psychiatric history. Individual results vary. SPRAVATO® is FDA-approved for specific indications; IV ketamine for psychiatric conditions is used off-label. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.