Spravato (Esketamine) Therapy in Scottsdale

Spravato (esketamine) is a nasal spray form of esketamine — the S-enantiomer of ketamine — manufactured by Janssen Pharmaceuticals and approved by the FDA in 2019 for treatment-resistant depression (TRD) in adults. It was subsequently approved for major depressive disorder with acute suicidal ideation or behavior as well.

Spravato represents a significant milestone in psychiatry. For decades, all FDA-approved antidepressants worked through monoamine mechanisms — primarily serotonin, norepinephrine, or dopamine. Spravato works through the glutamate system, targeting NMDA receptors, promoting neuroplasticity, and producing antidepressant effects far faster than any conventional medication. This is not an incremental improvement — it is a different category of treatment.

Unlike IV ketamine, Spravato is delivered as a self-administered nasal spray under physician supervision. Because of its dissociative effects and the risk of abuse, it is dispensed only through certified healthcare settings under a Risk Evaluation and Mitigation Strategy (REMS) program — not dispensed for home use.

To prescribe and administer Spravato, a practice must be certified under the Spravato REMS program. This involves specific protocols for monitoring, observation, and patient documentation after each session. Patients must be observed in the office for at least two hours following each dose.

Innerbloom Medical is REMS-certified, making us one of a limited number of providers in the Scottsdale area authorized to offer Spravato. To qualify, patients must have a diagnosis of treatment-resistant depression — generally defined as failure to respond adequately to two or more antidepressant treatments of adequate dose and duration. Spravato must be used alongside an oral antidepressant, not as a standalone treatment. Dr. Zabel will evaluate your history during the free intake consultation to determine if you meet criteria.

A Spravato session at Innerbloom follows the standard REMS protocol. You arrive at the clinic and self-administer the nasal spray under physician observation. The medication takes effect within minutes, and you remain in the clinic for a minimum of two hours while dissociation, sedation, and vital signs are monitored. You may not drive yourself home.

The typical induction protocol is two sessions per week for four weeks, followed by weekly or biweekly maintenance sessions depending on response. Maintenance frequency is individualized based on clinical response and adjusted over time.

Spravato is particularly relevant for patients with treatment-resistant depression and those whose PTSD co-occurs with a depressive component. See our pricing page for details.