FDA-APPROVED ESKETAMINE
Spravato (Esketamine) Therapy in Scottsdale
Spravato is the first FDA-approved esketamine treatment for treatment-resistant depression — and the first truly new antidepressant mechanism approved in over 35 years. Innerbloom Medical is a REMS-certified provider in Scottsdale offering it as a physician-supervised, in-office treatment.
What Is Spravato?
Spravato (esketamine) is a nasal spray manufactured by Janssen Pharmaceuticals, approved by the FDA in 2019 for treatment-resistant depression (TRD) and subsequently for major depressive disorder with acute suicidal ideation.
Unlike every other FDA-approved antidepressant — which work on serotonin, norepinephrine, or dopamine — Spravato targets the glutamate system via NMDA receptors, promoting neuroplasticity and producing antidepressant effects far faster than conventional medication. It is administered as a self-applied nasal spray under physician supervision in a certified REMS facility, and cannot be dispensed for home use.
Who Qualifies?
Spravato is FDA-approved for two indications:
- Treatment-resistant depression (TRD) — inadequate response to at least two antidepressants at adequate dose and duration
- MDD with acute suicidal ideation (MDSI) — adults requiring rapid stabilization
Spravato must be used alongside an oral antidepressant. Dr. Zabel will review your history during your free intake to confirm eligibility and screen for contraindications.
REMS Certification
Prescribing Spravato requires certification under the FDA's REMS program, which mandates specific on-site monitoring protocols and a minimum two-hour observation period after each dose. Innerbloom Medical is REMS-certified — one of a limited number of authorized providers in the Scottsdale area.
What a Session Looks Like
You arrive at the clinic, self-administer the nasal spray under physician observation, and remain for a minimum of two hours while dissociation, sedation, and vital signs are monitored. You may not drive yourself home.
The standard induction protocol is two sessions per week for four weeks, followed by weekly or biweekly maintenance sessions based on response. Spravato is particularly relevant for treatment-resistant depression and PTSD with a significant depressive component.
Insurance Coverage
Because Spravato is FDA-approved, it is eligible for insurance reimbursement — a significant advantage over IV ketamine, which is not. Most major commercial insurers cover it for patients who meet TRD criteria and obtain prior authorization. Many patients pay little to nothing out of pocket. Dr. Zabel will help clarify your coverage options before treatment begins.
Frequently Asked Questions
How does Spravato compare to IV ketamine?↓
Both target NMDA receptors and produce similar antidepressant effects. IV ketamine allows more precise dose titration and faster onset. Spravato is a self-administered nasal spray under physician supervision. The key practical difference: Spravato is FDA-approved and often covered by insurance; IV ketamine is typically out of pocket. Dr. Zabel will recommend which is appropriate during your intake.
What are the side effects?↓
The most common are dissociation, dizziness, nausea, sedation, and elevated blood pressure — all monitored during the required two-hour observation. Dissociative effects typically resolve within a few hours. You cannot drive after a session, so transportation is required.
Can veterans access Spravato through the VA?↓
VA coverage is evolving. Some VA facilities now offer it for eligible veterans with TRD. Innerbloom is applying to the VA Community Care Network, which would allow VA-referred veterans to access care here. Veterans who have failed multiple antidepressant trials are encouraged to reach out directly.
Do I need to stay on my antidepressant?↓
Yes. FDA approval requires concurrent use of an oral antidepressant — Spravato is not approved as a standalone therapy. If you're not currently on one, Dr. Zabel can discuss options or coordinate with your prescriber.
How do I get started?↓
Schedule a free physician intake with Dr. Zabel. He will review your history, confirm eligibility, and determine whether Spravato or IV ketamine is the better fit.
REMS-certified. FDA-approved. Physician-led. Begin with a free intake.
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