Advanced treatments
Spravato (esketamine)
If your depression hasn’t responded to other treatments, Spravato might be the answer. Many people start to feel different within days.
What Spravato does
Spravato (esketamine) was approved by the FDA in 2019 for depression that hasn’t responded to standard antidepressants — and in 2020 for depression with active suicidal thoughts. It’s the first new class of antidepressant approved in roughly 30 years.
Unlike most antidepressants, Spravato works on the glutamate system in the brain. That’s important because it works through a different pathway than the SSRIs and SNRIs that you may have already tried. Many people who didn’t respond to those medications respond to Spravato. Some people start to feel different within hours of the first dose.
What a Spravato visit will be like
Eligibility
Spravato is for people who’ve tried at least two antidepressants without enough relief. Your Northline clinician will look at your medication history and walk through whether you’re a good candidate.
The first month
Two visits per week for four weeks (eight visits total). At each visit, you’ll self-administer the nasal spray under our supervision and then rest in a comfortable private room for about two hours while we monitor you.
Maintenance
If you respond, treatment shifts to weekly, then every other week, then every four weeks. We continue as long as it’s helping.
Working with your other treatment
You’ll typically stay on a standard antidepressant during Spravato. Your existing therapy continues. Your Northline clinician keeps coordinating everything.
What it actually feels like
You’ll be in a comfortable private room with a recliner. After the spray, most people describe a floating or dissociative feeling that comes on within 30–45 minutes and resolves before you leave. Some people read or listen to music. Some doze. We check on you regularly and make sure you’re comfortable.
You won’t be able to drive after, so we’ll help arrange a ride home or a rideshare.
How well does it work?
In the major Spravato studies, about 50–70% of people with treatment-resistant depression respond to it, and 30–50% reach full remission. For depression with active suicidal thoughts, response can happen within 24 hours of the first dose — meaningfully faster than what’s possible with oral medications.
What to know about side effects
- Floating or dissociative feeling during the visit. This is the expected effect; it resolves before you leave.
- Higher blood pressure and heart rate for an hour or two after dosing. We monitor these throughout the visit.
- Mild nausea, dizziness, or headache are common.
- No driving for the rest of the day after a Spravato session.
Insurance and cost
Most major commercial plans cover Spravato when there’s documented treatment resistance. We handle the prior authorization paperwork. Your specific cost depends on your plan’s specialty drug coverage and where you are in your deductible — we’ll give you a clear estimate before you start.