Treatment-Resistant Depression

Spravato (Esketamine) in Las Vegas and Henderson

You've tried two antidepressants, then a third. You showed up, took them as prescribed, and waited. The fog didn't lift. Spravato is an FDA-approved nasal spray for depression when other medications haven't helped. This guide covers how Spravato works, who qualifies, what a visit looks like, what Nevada insurance covers, and how to find a certified center in the Las Vegas valley.

Last verified October 2026. Reviewed by a licensed Nevada clinician. Based on the FDA prescribing information for Spravato.

Illustration of a woman resting in a recliner under a blanket while a clinician in scrubs sits nearby and checks on her

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Tell us your insurance, neighborhood, and schedule. Within 24 hours, we'll reach out with certified Spravato providers in Las Vegas, Henderson, and across the valley who have openings. Free.

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Not for emergencies. In crisis, call or text 988.

What Is Spravato?

Spravato is the brand name for esketamine, a nasal spray made by Johnson & Johnson. Esketamine is a close chemical relative of ketamine. Instead of working on serotonin like most antidepressants, Spravato acts on glutamate, a different brain messenger involved in mood.

The FDA approved Spravato in 2019 for treatment-resistant depression in adults. In 2020, approval expanded to adults with major depression and suicidal thoughts or actions, alongside an oral antidepressant. In January 2025, the FDA approved Spravato on its own, without a daily antidepressant, for treatment-resistant depression.

Illustration of an orange nasal spray device used for Spravato treatment

Three things set Spravato apart from other depression medications:

You never take Spravato home. Every dose happens at a certified office, under a clinician's watch.
You stay for at least 2 hours after each dose so staff check your blood pressure and how you feel.
Spravato is a Schedule III controlled substance, so every certified center follows a federal safety program called the Spravato REMS.

Who Spravato Is For

Spravato is approved for adults 18 and older in two situations.

Treatment-Resistant Depression

Treatment-resistant depression means major depression still hangs on after at least two antidepressants, each taken at a full dose for long enough to work, usually 6 to 8 weeks. For this group, Spravato works alone or alongside a daily antidepressant.

Depression With Suicidal Thoughts

For adults with major depression and thoughts of suicide or recent suicidal actions, Spravato is approved alongside an oral antidepressant. Spravato does not replace crisis care or a hospital stay. If you're thinking about ending your life right now, call or text 988, or call 911.

Signs Spravato Is Worth Asking About

You've finished two or more antidepressant trials and still feel stuck.
Side effects made you stop more than one medication.
Therapy helps, but the heaviness keeps coming back.
You're tired of waiting 6 weeks to learn whether the next pill works.

Only a psychiatrist, psychiatric nurse practitioner, or another prescriber decides whether Spravato fits you. Bring a list of every antidepressant you've taken, the dose, and how long you took each one. The list speeds up insurance approval.

Who Should Not Take Spravato

The FDA lists four situations where Spravato is never used:

An aneurysm, or a history of aneurysm, in the brain, chest, belly, arms, or legs
An arteriovenous malformation (a tangle of blood vessels)
A past bleed in the brain
An allergy to esketamine or ketamine

Talk through these with your prescriber before you start:

High blood pressure, heart disease, or a past stroke or heart attack
Pregnancy, breastfeeding, or plans to get pregnant. Spravato carries risk to a developing baby.
A history of substance use, including alcohol
A history of psychosis
Age 65 or older. Studies in this age group didn't show a clear benefit for treatment-resistant depression.
Other medications, especially benzodiazepines, opioids, stimulants, and MAOIs

What a Spravato Visit Looks Like

Plan on about 2 and a half to 3 hours from check-in to checkout.

1.Before you arrive. Skip food for 2 hours and liquids for 30 minutes before your dose, since nausea is common. In a Las Vegas summer, drink plenty of water earlier in the day so you don't show up dehydrated.
2.Check-in. Staff take your blood pressure. If your numbers run high, they wait and recheck, or reschedule.
3.Your dose. You give yourself the spray, one device at a time, 5 minutes apart. Each device holds 28 mg. A 56 mg dose uses 2 devices. An 84 mg dose uses 3.
4.Rest and watch. You settle into a recliner. Many people feel floaty, dreamy, sleepy, or disconnected for a while. Staff check on you and recheck your blood pressure about 40 minutes after the dose.
5.Checkout. After at least 2 hours, a clinician confirms you're steady enough to leave.
6.Getting home. Don't drive yourself. Someone else drives you home, or you take a rideshare. No driving or running machinery until the next day after a full night's sleep.

Bring headphones, a playlist or podcast, an eye mask, and a light sweater. Medical offices in Las Vegas keep the air conditioning cold.

How Often You Go: The Spravato Schedule

For treatment-resistant depression, the FDA schedule runs in three phases:

Phase	How often	Typical visits
Weeks 1 to 4	Twice a week	8 visits
Weeks 5 to 8	Once a week	4 visits
Week 9 and after	Every week or every 2 weeks	Set by your prescriber

Doses are 56 mg or 84 mg, based on how you respond. Around the 4-week mark, your prescriber checks whether Spravato is helping enough to keep going.

For depression with suicidal thoughts, the schedule is twice a week for 4 weeks, alongside an oral antidepressant.

Planning Spravato Around Las Vegas Life

Twice a week, plus a ride home, takes planning in a 24-hour town.

Shift Work

On treatment days, no driving and no running machinery until the next morning. For swing and graveyard workers, this usually means scheduling Spravato on days off. Ask each center about early morning or late afternoon slots.

Rides Home

Line up a ride before your first visit. A spouse, friend, or family member works, and so does Uber or Lyft. If you drive for a rideshare or delivery app, treatment days are off days.

Time Off Work

Eight visits in the first month adds up. Ask HR about intermittent FMLA leave if you qualify, so your job is protected while you're in the twice-weekly phase.

Distance

Certified centers sit across the valley, from Henderson and Green Valley to Summerlin, the southwest, and North Las Vegas. In the first month, a center 10 minutes away beats a slightly better fit 40 minutes away.

How Well Does Spravato Work?

Spravato doesn't work for everyone, but for many people with treatment-resistant depression, results show up faster than with a new pill.

In the study behind the 2025 approval, 22.5% of people taking Spravato alone reached remission by week 4, compared with 7.6% on placebo.
Some people in the same study felt better within 24 hours of the first dose.
Earlier studies paired Spravato with a new oral antidepressant and showed bigger gains than the antidepressant alone.

Remission means symptoms dropped low enough to count as minimal. Many more people improve without reaching full remission. Your prescriber tracks your progress with a short questionnaire at visits.

Spravato works best as part of a plan. Keep up therapy, sleep, and the basics while you're in treatment.

Spravato Side Effects and Safety

Most side effects show up during the visit and fade within a few hours. This is why you stay at least 2 hours.

Most common side effects in studies of Spravato with an oral antidepressant:

Side effect	How often
Feeling disconnected or dreamy (dissociation)	41%
Dizziness	29%
Nausea	28%
Sleepiness	23%
Spinning feeling (vertigo)	23%
Numbness, often around the mouth	18%
Anxiety	13%
Higher blood pressure	10%
Vomiting	9%

Important Safety Information

Spravato carries an FDA boxed warning, the strongest kind, for these risks:

Sedation, dissociation, and slowed breathing. You're watched for at least 2 hours after each dose.
Misuse and abuse. Spravato is a controlled substance and stays at the certified office.
Suicidal thoughts in young people. Antidepressants raise this risk in people under 25. Tell your prescriber right away about new or worse thoughts of suicide.

Spravato also raises blood pressure for a few hours after a dose, and some people notice trouble thinking clearly for a short time. Ask your prescriber for the full Medication Guide.

Meet Your Neighbors

These are composite stories. Names and details are invented.

Denise, Henderson

Denise deals blackjack on the Strip and lives off Sunset Road in Henderson. Two antidepressants in two years, and she still couldn't get out of bed on her days off. Jasmine, a psychiatric nurse practitioner, suggested Spravato. Her casino's health plan approved treatment in 9 days. Denise moved her twice-weekly visits to her days off, and her sister drives her home. By week 5, she was cooking dinner again.

Luis, North Las Vegas

Luis works at a warehouse near Nellis and has Molina Medicaid. After three antidepressants, Dr. Aisha, a psychiatrist, sent a prior authorization with his full medication history. Medicaid approved Spravato with no copay. His brother drives him home from his Tuesday and Friday visits. Spravato didn't fix everything, but Luis says the weight lifted enough to start therapy again.

Tom, Summerlin

Tom, 52, wanted Spravato after reading about Spravato online. During his evaluation, Dr. Aisha learned Tom had a brain aneurysm repaired years ago. Spravato wasn't safe for him. She referred him for TMS, a magnetic treatment with no sedation. Tom drives himself to his daily sessions near Summerlin.

Spravato vs. Ketamine Infusions vs. TMS

Las Vegas has all three. Here's how they compare.

	Spravato	IV ketamine	TMS
Type	Esketamine nasal spray	Ketamine through an IV	Magnetic pulses, no medication
FDA status for depression	Approved	Not approved for depression, used off-label	Cleared for depression
Where	Certified office	Ketamine clinic	TMS office
Visit length	About 2 to 3 hours	About 1 to 2 hours	About 20 to 40 minutes
How often at first	Twice a week	Often 6 infusions over 2 to 3 weeks	5 days a week for about 6 weeks
Drive yourself home	No	No	Yes
Insurance	Usually covered with prior authorization	Usually self-pay	Often covered with prior authorization

Many ketamine clinics in Las Vegas advertise for depression. IV ketamine isn't FDA-approved for depression, and most insurance won't pay. Spravato and TMS both have FDA approval or clearance for depression, and most Nevada insurance plans cover them once you meet the criteria.

Spravato Cost and Insurance in Nevada

Every Spravato bill has two parts: the medicine and the 2-hour monitored visit. Ask about both before your first dose.

Employer and Marketplace Insurance

Most employer and marketplace plans cover Spravato with prior authorization. Call the member services number on your card and ask. The Spravato withMe savings program lowers the medicine cost to as little as $10 per treatment for people with commercial insurance. The program doesn't cover the monitored visit, so ask the center what you'll owe for the visit.

Nevada Medicaid

Nevada Medicaid covers Spravato with prior authorization. Since January 1, 2026, every Nevada Medicaid plan uses the same drug list: Anthem, CareSource, Health Plan of Nevada, Molina, SilverSummit, and fee-for-service. Your prescriber submits your diagnosis and the antidepressants you've tried. Copays are low or zero.

Medicare

Medicare Part B covers Spravato given at a certified office. After the 2026 Part B deductible of $283, you pay 20% of the approved amount for each visit, unless a supplemental plan covers your share. Medicare Advantage plans usually require prior authorization. The Spravato withMe savings program doesn't apply to Medicare.

Veterans and TRICARE

The VA offers Spravato to eligible veterans. Ask your VA mental health team. For TRICARE, ask your plan about prior authorization. The Spravato withMe savings program doesn't apply to VA or TRICARE coverage.

Paying Out of Pocket

Without insurance, Spravato costs several hundred dollars or more per visit, and the twice-weekly first month adds up fast. Ask each center for the full price per visit, including the medicine and monitoring. You have the right to a Good Faith Estimate before you start.

How Prior Authorization Works

Your prescriber's office sends your insurance a request with your diagnosis, a depression score, and every antidepressant you've tried, with doses and dates. Approval usually takes a few days to a few weeks. Approvals often last a set number of months and get renewed if Spravato is helping.

See how each Nevada plan handles mental health care in our Insurance and Cost guide.

Where to Get Spravato in Las Vegas and Henderson

Spravato is offered at certified psychiatry offices across the valley, in Henderson, Green Valley, Summerlin, the southwest, central Las Vegas, and North Las Vegas. Every center must be certified in the Spravato REMS program.

Two ways to find one:

1.Ask us. Tell us your insurance, neighborhood, and schedule. Within 24 hours, we'll reach out with certified Spravato providers who have openings. Free. Some providers in our network have a professional relationship with our team.
2.Search on your own. The treatment center finder on spravato.com lists certified centers by ZIP code.

Already seeing a psychiatrist or psychiatric nurse practitioner? Ask whether their office gives Spravato, or whether they refer out. Learn who does what on our Provider Types page.

Questions to Ask a Spravato Center Before You Start

Are you certified in the Spravato REMS program?
Do you take my insurance, and does your office handle the prior authorization?
What will I pay per visit, including the medicine and the 2-hour monitoring?
Who prescribes and adjusts my dose, a psychiatrist or a psychiatric nurse practitioner?
Who watches me during the 2 hours, and what happens if I feel unwell?
Do you offer early morning or late afternoon appointments?
How do you measure whether Spravato is working?
Will you coordinate with my therapist?

Spravato FAQ

What is Spravato?

Spravato is an FDA-approved nasal spray of esketamine for adults with treatment-resistant depression, and for adults with depression and suicidal thoughts alongside an oral antidepressant. Every dose happens at a certified office, with at least 2 hours of monitoring.

Is Spravato the same as ketamine?

No. Esketamine is a close chemical relative of ketamine. Spravato is FDA-approved for depression and given as a nasal spray at certified offices. IV ketamine is used off-label for depression and is usually self-pay.

Where can I get Spravato in Las Vegas?

Certified psychiatry offices across the valley offer Spravato, including in Henderson, Summerlin, and North Las Vegas. Tell us your insurance and neighborhood, and we'll connect you with certified providers who have openings within 24 hours.

How much does Spravato cost in Las Vegas?

With commercial insurance and the Spravato withMe savings program, the medicine costs as little as $10 per treatment, plus whatever your plan charges for the monitored visit. Nevada Medicaid copays are low or zero. Medicare Part B pays 80% after the deductible. Without insurance, expect several hundred dollars or more per visit.

Does insurance cover Spravato?

Most Nevada insurance plans cover Spravato with prior authorization when you've tried at least two antidepressants without enough relief.

Does Nevada Medicaid cover Spravato?

Yes, with prior authorization. Every Nevada Medicaid plan, including Anthem, CareSource, Health Plan of Nevada, Molina, and SilverSummit, follows the same drug list.

Does Medicare cover Spravato?

Yes. Medicare Part B covers Spravato given at a certified office. You pay 20% after the Part B deductible. Medicare Advantage plans usually require prior authorization.

How long does a Spravato treatment take?

Plan on 2 and a half to 3 hours. The dose takes about 10 to 15 minutes, followed by at least 2 hours of monitoring.

Can I drive after Spravato?

No. Someone else drives you home, or you take a rideshare. No driving or running machinery until the next day after a full night's sleep.

How fast does Spravato work?

Some people feel better within a day of the first dose. Most people know whether Spravato is helping within the first 4 weeks.

What does Spravato feel like?

Many people feel floaty, dreamy, or detached from their body or surroundings for a while after the dose. Some notice changes in sound, color, or time. Staff stay close the whole visit, and most of these feelings fade before you leave.

Is Spravato addictive?

Esketamine carries a risk of misuse, which is why Spravato never leaves the certified office and every dose is supervised. Tell your prescriber about any history of alcohol or drug use before you start.

What are the side effects of Spravato?

The most common are feeling disconnected or dreamy, dizziness, nausea, sleepiness, a spinning feeling, and higher blood pressure. Most fade within a few hours, during or shortly after the monitored visit.

Can I take Spravato without an antidepressant?

Yes, for treatment-resistant depression. Since January 2025, the FDA has approved Spravato on its own. For depression with suicidal thoughts, Spravato is still given alongside an oral antidepressant.

Do I need a referral for Spravato?

Not always. A psychiatrist or psychiatric nurse practitioner evaluates you and prescribes Spravato. Some insurance plans want a referral from your primary care provider, so check your plan.

Who should not take Spravato?

People with an aneurysm, an arteriovenous malformation, a past brain bleed, or an allergy to ketamine or esketamine. Spravato isn't recommended during pregnancy and isn't approved for anyone under 18.

Ready to Ask About Spravato?

Tell us what you need. Within 24 hours, we'll reach out with certified Spravato providers who have openings. Free.

Get Connected

This guide is for education, not medical advice. Information is based on the FDA prescribing information for Spravato and public coverage rules as of October 2026. Talk with a prescriber about your own care. Spravato and Spravato withMe are trademarks of Johnson & Johnson. Therapy Las Vegas is a free referral service, not a clinic, and is not affiliated with Johnson & Johnson.