SPRAVATO® at Bluebird TMS
Quick Answer
SPRAVATO® (esketamine) is an FDA-approved nasal spray for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or actions. At Bluebird TMS it is self-administered in a private room under supervision, followed by a monitoring period of about two hours, and many insurance plans cover it when their criteria are met.
Plan the visit, not just the dose
Unlike a TMS session, a SPRAVATO® visit is a block of time: the spray, then roughly two hours of monitoring in the clinic, then a ride home — you cannot drive until the next day. Sessions are usually twice weekly during the first month and less frequent after. For a working patient that means a half-day, twice a week, for about a month, then a lighter schedule. We say that plainly up front so you can plan for it.
How it works
Esketamine acts on the brain's glutamate system rather than the serotonin pathways most antidepressants use. In January 2025 the FDA approved SPRAVATO® as a standalone treatment for adults with treatment-resistant depression, so your psychiatrist can use it with or without an oral antidepressant depending on your plan.
Safety
SPRAVATO® can cause sedation, dissociation, and increases in blood pressure, and carries a boxed warning. It is available only through a restricted program (REMS) at certified treatment centers. Read the full Important Safety Information →
SPRAVATO® or TMS?
Both are options here for depression that has not responded to medication. SPRAVATO® visits are longer but fewer; TMS visits are shorter but daily. Your psychiatrist will weigh your history, your coverage, and your schedule with you — it is often the schedule that decides.
If you are in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or go to the nearest emergency room.