Conditions we treat
All treatmentsFDA-approved nasal spray
FDA-approved nasal spray for treatment-resistant depression, delivered in-clinic at all five Avesta locations. In-network with Aetna, Cigna, and the VA.
No obligation · No referral needed · We check your benefits up front
Overview
In short
Spravato (esketamine) is an FDA-approved nasal spray for treatment-resistant depression in adults. It is given in a certified clinic under medical supervision, never at home. With insurance, most Avesta patients pay $0 for the medication plus a $0 to $250 office visit.
Spravato (esketamine) is an FDA-approved nasal spray indicated for treatment-resistant depression in adults, as monotherapy or alongside an oral antidepressant, and for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior, in conjunction with an oral antidepressant. It is given in a REMS-certified clinic under medical supervision, never at home. At Avesta, Spravato is available at all five locations.
Spravato is esketamine, the S-enantiomer of ketamine, delivered as a nasal spray. Racemic ketamine contains both the S and R forms and is used off-label.
Spravato is FDA-approved and usually covered by insurance. IV ketamine is off-label, dosed by weight, and gives your prescriber more control over dose and duration. Many Avesta patients start with whichever their plan covers and switch if response is limited.
Conditions & Concerns
Spravato (esketamine) nasal spray is FDA-approved for adults with major depressive disorder who have not found relief with traditional antidepressant medications:
Spravato is contraindicated in people with
Your prescriber will review your full medical history at the consultation.
Twice weekly, then weekly
Weeks one through four: two sessions per week. Weeks five through eight: one session per week.
Every one to two weeks
From week nine onward: one session every one or two weeks, based on your response and in discussion with your provider.
Your Journey
You self-administer the nasal spray in our clinic under staff supervision, then stay for at least two hours while we monitor your blood pressure and how you are feeling. Most patients rest quietly. Bring headphones if music helps you settle.
You will need a ride home, and you should not drive again until the next day after a restful night of sleep.
A Patient’s Perspective
“Even after the first couple of infusions, they saw my light shining again. That felt amazing because it had dimmed quite a bit.”
Individual experiences vary. A patient story is not a guarantee of results.
Investment & Coverage
| Your situation | Medication | Office visit |
|---|---|---|
| With insurance | Most Avesta patients pay $0 | $0 – $250, depending on plan and deductible |
| Without insurance | $800 – $1,200 per session, depending on dose | $250 |
The medication is billed separately from the monitoring visit, which is why two patients on the same plan can pay different amounts. Three things set what you pay: whether your plan covers the medication, whether it covers the in-clinic monitoring visit, and where you are in your deductible year.
| Payer | Spravato | Where |
|---|---|---|
| Aetna | In-network | All 5 locations |
| Cigna, including NALC | In-network | All 5 locations |
| VA | In-network, authorization required | All 5 locations |
| Maryland Medicaid, including UnitedHealthcare plans | In-network | Bethesda, Columbia |
| Virginia Medicaid via Anthem HealthKeepers or Aetna Better Health | In-network | Tysons, Norfolk |
| Workers’ Compensation | In-network, authorization required | All 5 locations |
| Medicare | Out-of-network, all plans | Not applicable |
We handle prior authorization for you. See our full insurance breakdown or complete pricing guide for every treatment type.
Founder & Co-CEO · Georgetown University faculty
Dr. Eshkevari led a study with her Georgetown graduate students published in the Journal of Psychiatric Research, supporting ketamine therapy for people living with treatment-resistant depression. She sets the clinical protocols used at every Avesta clinic.
Patient Experiences
Amy GutierrezAugust 18, 2026BethesdaGoogle
Wendy LaffermanSeptember 25, 2026ColumbiaGoogle
Kate GowingAugust 2, 2026Norfolk/Virginia BeachGoogle
Spencer AgostiniAugust 2, 2026TysonsGoogle
Matthew ConnorsSeptember 10, 2026Washington DCGoogle
Paul ThompsonJuly 3, 2026BethesdaGoogle
Toby KatesAugust 2, 2026ColumbiaGoogle
Carole WilkinsFebruary 10, 2026TysonsGoogle
Elsa AlaswadJuly 18, 2026Washington DCGoogle
D SMay 3, 2026BethesdaGoogle
Carolyn ErwinAugust 1, 2026ColumbiaGoogle
B CJanuary 16, 2026TysonsGoogleSafety & Side Effects
The most commonly reported side effects of Spravato in treatment-resistant depression are dissociation, dizziness, nausea, sedation, vertigo, reduced sensation, anxiety, lethargy, increased blood pressure, vomiting, and headache.1 Most begin shortly after dosing and resolve the same day.
Dissociation is the most commonly reported effect, described as a temporary sense of detachment from your surroundings. It typically peaks around 40 minutes after dosing and fades within the monitoring window. Blood pressure rises for most patients and is checked before dosing, at roughly 40 minutes, and again before discharge.
Spravato is dispensed only under a restricted program called the Spravato REMS, which requires that the medication be administered in a certified healthcare setting with direct provider observation and at least two hours of monitoring afterward.2 Your Avesta prescriber reviews cardiovascular history, blood pressure control, and current medications before starting, and reassesses at every visit.
References. 1. Janssen Pharmaceuticals, Inc. SPRAVATO (esketamine) nasal spray, CIII. Highlights of Prescribing Information. Revised March 2026. 2. Spravato REMS Program. Requirements for certified healthcare settings and patient monitoring.
Locations
Every Avesta location is staffed by a licensed clinician for every session.
Frequently Asked Questions
Most Avesta patients with coverage pay $0 for the medication plus a $0 to $250 office visit. The exact amount depends on your plan, whether Avesta is in network with your payer, and where you are in your deductible year.
Most side effects begin within minutes of dosing and resolve within the two-hour monitoring window. Dissociation typically peaks around 40 minutes and fades before you are cleared to leave the clinic.
Not quite. Spravato is esketamine, the S-enantiomer of ketamine, delivered as a nasal spray and FDA-approved for treatment-resistant depression. Racemic ketamine contains both the S and R forms and is used off-label.
No. Arrange transportation home, and do not drive or operate machinery until the next day after a restful night of sleep.
Induction is twice weekly for four weeks, then weekly for four weeks, then every one to two weeks based on your response.
Yes at Avesta, in both states. Maryland Medicaid is covered at our Bethesda and Columbia clinics, and Virginia Medicaid through Anthem HealthKeepers or Aetna Better Health at our Tysons and Norfolk clinics.
For treatment-resistant depression, yes. The FDA label allows Spravato as monotherapy or alongside an oral antidepressant. For depressive symptoms with acute suicidal ideation or behavior, it is used together with an oral antidepressant.
Book a free 30-minute consult. No referral needed, and we check your benefits before you commit to anything.