Clinic Hours
- Weekdays 8am - 5pm
- Saturday By Appointment
- Sunday Closed
Centia Health
Call/Text : +1 (610) 400-4885, +1 (267) 702-5246
Mail : contact@centiahealth.com
Address : Suite 130, 150 S. Warner Rd., King of Prussia, PA 19406.
Address : 8016 State Line Road, Suite 205, Prairie Village KS, 66208.
A Different Route Out of Depression
Not everyone with major depressive disorder improves on oral antidepressants. If you have given two or more medications a fair trial and still wake up flat, exhausted and unable to feel much of anything, the problem is not your effort. It may simply be that your depression needs a treatment that works on a different part of the brain.
Spravato (esketamine) is an FDA-approved nasal spray for treatment-resistant depression. Standard antidepressants act mainly on serotonin, norepinephrine and dopamine. Spravato is an NMDA receptor antagonist, which means it works on the brain’s glutamate system instead. That difference is why it is considered for people who have not responded to other medications.
At Centia Health, Spravato is delivered by a triple board-certified psychiatrist as part of a full treatment plan, not as a standalone procedure. You are assessed, dosed, monitored and followed by the same team, in the same practice, with your other care coordinated alongside it.
An important safety note. Spravato is a Schedule III controlled substance available only through the FDA's Risk Evaluation and Mitigation Strategy (REMS) program. It is never dispensed for home use. Every dose is self-administered in a certified healthcare setting, under direct observation, followed by at least two hours of monitoring before you leave.
What Spravato Is Approved to Treat
The FDA has approved Spravato for two distinct groups of adults:
- Treatment-resistant depression (TRD). Adults with major depressive disorder who have not responded adequately to at least two oral antidepressants in the current episode. Since January 2025, Spravato is approved for this group either on its own or alongside an oral antidepressant, making it the first standalone treatment of its kind for TRD.
- Depressive symptoms in adults with MDD who have acute suicidal thoughts or behavior. In this situation Spravato is used together with an oral antidepressant. It is important to understand that Spravato has not been shown to prevent suicide or reduce suicidal thoughts, and it does not replace hospitalization when that level of care is needed.
Spravato is approved for adults aged 18 and over. It is not approved for children or adolescents.
If you are in crisis right now, call or text 988 to reach the Suicide & Crisis Lifeline, or go to your nearest emergency department. Please do not wait for an appointment.
How Spravato Works in the Brain
Esketamine is the S-enantiomer of ketamine, delivered as a nasal spray at controlled doses. It is a non-competitive antagonist of the NMDA receptor, part of the glutamate system rather than the serotonin pathway most antidepressants target. Being straight with you about one point: the prescribing information states plainly that the mechanism by which esketamine produces its antidepressant effect is unknown. What the trials did measure is timing. In the studies submitted to the FDA, a difference between Spravato and placebo on the standard depression rating scale was seen at around 24 hours after the first dose, and held through day 28. Traditional oral antidepressants are usually assessed over weeks. Spravato is not a stimulant, not an opioid, and not a benzodiazepine. It is also not the same as the at-home ketamine lozenges and telehealth programs advertised online, which are compounded, not FDA-approved for depression, and not monitored.
Is Spravato Right for You?
Spravato tends to be considered when the following describe your situation:
- You have been diagnosed with major depressive disorder as an adult
- You have taken at least two different antidepressants, each at an adequate dose for an adequate length of time, without sufficient improvement
- Your depression is affecting your work, your relationships or your ability to function day to day
- You are able to arrange transportation home after each session and can commit to roughly two visits a week during the first month
When Spravato is not appropriate
Spravato should not be used if you have aneurysmal vascular disease, an arteriovenous malformation, or a history of bleeding in the brain, because a rise in blood pressure would carry serious risk. It is also not used in people with a known allergy to esketamine or ketamine. Pregnancy, breastfeeding, uncontrolled high blood pressure, certain heart and liver conditions, active substance misuse and a history of psychosis all require careful discussion before treatment is considered. Your evaluation exists to work through exactly these questions.
Not sure whether you qualify?
A psychiatric evaluation is the only reliable way to answer that. We review your full medication history, current symptoms and medical background, then tell you honestly whether Spravato is the right next step or whether something else would serve you better.
What a Spravato Session Actually Looks Like
Most people are anxious about the first visit because they do not know what to expect. Here is the sequence. Build your day around at least two hours of monitoring after your dose, plus check-in and administration time before that.
1: Before you arrive
Avoid food for at least two hours beforehand and liquids for at least 30 minutes, which reduces the chance of nausea and vomiting. If you use a nasal corticosteroid or decongestant, take it at least an hour before your dose. Arrange your ride home in advance. Bring something comfortable: many patients bring headphones or an eye mask.
2: Check-in and blood pressure
We take your blood pressure before dosing. If it is elevated, we may delay the session. You will be settled into a quiet, low-stimulation room with a recliner.
3: You administer the spray yourself
Each device delivers 28 mg in two sprays, one per nostril. A 56 mg dose uses two devices, an 84 mg dose uses three, with a five-minute rest between each. A clinician stays with you and talks you through it.
4: The two-hour monitoring period
Blood pressure is rechecked at around 40 minutes, which is when the increase peaks, and again as clinically needed. Your breathing is monitored throughout, including with pulse oximetry. Many people describe a floating or detached sensation during this window. You rest; we watch.
5: Discharge
You leave once a clinician confirms you are clinically stable, and no sooner than two hours after dosing. Your ride takes you home. You must not drive or operate machinery until the following day, after a full night's sleep.
What a Spravato Session Actually Looks Like
Spravato follows a structured course. Visits are frequent at first, then taper as you stabilize. Your psychiatrist adjusts both dose and frequency based on how you respond.
| Phase | Frequency | Typical dose |
|---|---|---|
| Induction Weeks 1 to 4 | Twice per week | 56 mg or 84 mg |
| Maintenance Weeks 5 to 8 | Once per week | 56 mg or 84 mg |
| Continuation Week 9 onward | Weekly or every two weeks | 56 mg or 84 mg |
At the end of the induction phase we assess whether you have gained meaningful benefit and decide together whether to continue. The goal from there is the least frequent schedule that holds your response steady. For adults with MDD and acute suicidal thoughts or behavior, the schedule is different: 84 mg twice weekly for four weeks, alongside an oral antidepressant.
Side Effects and Risks
Spravato carries an FDA boxed warning covering sedation, dissociation, respiratory depression, the potential for abuse and misuse, and suicidal thoughts and behaviors. The two-hour monitoring requirement exists because of the first three.
What most people experience
The most commonly reported reactions in the treatment-resistant depression trials were dissociation, dizziness, nausea, sedation, vertigo, reduced sensation, anxiety, lethargy, increased blood pressure, vomiting, feeling drunk and headache. When these occur they usually happen right after dosing and resolve the same day.
Dissociation, explained plainly
Dissociation is the effect patients ask about most. In the trials it was transient and occurred on the day of dosing. People describe it as watching themselves from slightly outside, time stretching, or colors and sound feeling unusually vivid. It is expected, it is monitored, and it is not a sign that something has gone wrong.
Blood pressure
Spravato raises blood pressure at all recommended doses. The increase peaks at roughly 40 minutes and lasts about four hours. That is why your blood pressure is checked before dosing and monitored for at least two hours afterward, and why people with certain cardiovascular and cerebrovascular conditions need careful assessment first.
Other things to know
Cases of ulcerative or interstitial cystitis have been reported with long-term off-label ketamine misuse, and bladder and urinary symptoms are monitored during treatment. Tell us if you develop pain or urgency when urinating. Spravato is not recommended during pregnancy and breastfeeding is not recommended during treatment, so tell us if you are pregnant, planning to be, or nursing.
Bring your full medication list
Central nervous system depressants such as benzodiazepines, opioids and alcohol can increase sedation. Psychostimulants and MAOIs can raise blood pressure further. Tell us everything you take, including over-the-counter products, supplements and anything occasional.
Spravato Compared With At-Home Ketamine Programs
Patients often arrive having already looked at online ketamine services. The two are not equivalent, and the difference is worth understanding before you decide.
| Spravato (esketamine) | Compounded at-home ketamine | |
|---|---|---|
| FDA status |
FDA-approved for treatment-resistant depression |
Not FDA-approved for depression; prescribed off-label |
|
Where it is taken |
In a REMS-certified clinic, under observation | At home, typically unsupervised |
| Monitoring | At least two hours, with vital signs checked | Usually none, or a video check-in |
| Insurance |
Often covered, usually with prior authorization | Commonly self-pay |
|
Evidence base |
Randomized, double-blind, placebo- controlled trials submitted to the FDA |
Limited controlled data for at- home use |
Insurance and Cost
Coverage for Spravato varies by plan. Prior authorization is commonly required, and insurers typically want documentation that you have tried at least two antidepressants without adequate response. Our team works through that paperwork with you rather than handing you a form.
Billing has two parts: the medication itself and the in-clinic observation period. The manufacturer also runs patient support and savings programs, though eligibility is restricted and the terms change, so we check what currently applies to you. Before your first dose we verify your specific benefits and give you an estimate. You should not be surprised by a bill.
See all insurance plans accepted at Centia Health
Why Patients Choose Centia Health for Spravato
Psychiatrist-led, not technician-led
Your treatment is directed by Dr. Sosunmolu Shoyinka, a triple board-certified, Yale-trained psychiatrist with more than 25 years of clinical experience. Spravato sits inside your psychiatric care rather than beside it.
The whole picture, not just the prescription
Centia Health specializes in the places where mind and body meet: hormones, chronic illness, career pressure, life transitions. If something else is driving or worsening your depression, we look for it rather than treating around it.
Your other care continues
Medication management, psychotherapy, pharmacogenomic testing and neurocognitive evaluation are all available in the same practice, so nothing has to be coordinated across three different offices.
A calm room and a team that stays
Sessions are unhurried and private. Someone is with you throughout, not checking in from a hallway.
FAQs
How quickly will I feel a difference?
In the FDA trials, a measurable difference from placebo appeared at around 24 hours after the first dose. Individual experience varies, and some people need several sessions. Response is assessed formally at the end of the four-week induction phase, which is the point where we decide together whether to continue.
Can I drive myself home?
No. You must arrange transportation for every session, and you should not drive or operate machinery until the next day, after a full night’s sleep. Rideshare, a family member or a friend all work. This applies to every session, not just the first.
Do I have to stop my current antidepressant?
Not necessarily. Since the 2025 monotherapy approval, Spravato can be used alone or alongside an oral antidepressant for treatment-resistant depression. Your psychiatrist will recommend one approach or the other based on your history and how you have tolerated your current medication.
Is Spravato addictive?
Esketamine is a Schedule III controlled substance and carries a boxed warning for abuse and misuse. That risk is a central reason it is administered only in a certified setting, never dispensed for home use, and monitored at every session. Your history of substance use is part of the initial evaluation, and it is a conversation, not a disqualification.
How long will I stay on it?
There is no fixed endpoint. Many patients continue for several months and then move to the least frequent schedule that maintains their response. Duration is reviewed at every visit and is always a shared decision.
Can I have Spravato by telehealth?
No. Federal REMS rules require in-person administration and on-site monitoring in a certified healthcare setting. Your evaluations and follow-up appointments can be virtual, but dosing sessions cannot.
What if Spravato does not work for me?
It does not work for everyone, and we will tell you that plainly rather than extending treatment indefinitely. If you do not gain meaningful benefit by the end of induction, we reassess and discuss other options, which may include medication adjustment, pharmacogenomic testing to guide prescribing, psychotherapy, or referral for other interventional treatments.
Will I be conscious during the session?
Spravato is not approved as an anesthetic and is not used as one here. Sedation is common, so you may feel drowsy, detached or unusually relaxed, and staff monitor you for the full session. Tell your clinician right away if you feel you cannot stay awake.
What happens if I miss a session?
If your depressive symptoms have not worsened, you generally continue on your current schedule. If you miss sessions during maintenance and your symptoms worsen, your psychiatrist may move you back to the previous, more frequent schedule. Tell us as soon as you know you need to reschedule.
Take the Next Step
Treatment-resistant depression is exhausting in a particular way, because the exhaustion includes having already tried. If you have done the trials, taken the medications and are still not well, that is worth a conversation with a psychiatrist who treats this specific problem. Appointments at Centia Health are typically available within one to two weeks. This page is for general information and is not medical advice. Spravato is available only by prescription, through the FDA REMS program, in a certified healthcare setting. Whether it is appropriate for you can only be determined by a licensed clinician after an individual evaluation. Clinical information on this page, including indications, dosing, monitoring requirements, contraindications and adverse reactions, is drawn from the FDA-approved prescribing information for Spravato (esketamine) nasal spray, CIII, revised April 2025, and from the Spravato REMS program requirements at SPRAVATOrems.com. Insurance coverage and manufacturer support program terms change and should be confirmed directly.