Esketamine (Spravato®) therapy for major depression that hasn't responded to standard antidepressants. administered in a private, supervised clinical setting.
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Esketamine acts on a different receptor system than every antidepressant you've likely tried. That's the reason it can work when they haven't.
TRD is a clinical designation, not a self-assessment. The evaluation reviews your full psychiatric and treatment history — which medications, at what doses, for how long — alongside current medications, cardiovascular health, and relevant medical history. If you meet criteria and want to understand exactly what this treatment involves before committing, that's what the first conversation is for.
Sessions are administered in-office. Spravato® is delivered as a nasal spray under Dr. Wasserman's direct supervision—not a prescription you take at home. Following administration, you remain in the clinic for monitored observation. Vital signs are checked; any temporary side effects are managed. Sessions are private, always. You'll need to arrange transportation home—you cannot drive yourself after a session.
The initial phase is two sessions per week. Frequency is reduced based on your individual response. The protocol doesn't have a fixed endpoint—it's an ongoing clinical assessment of how you're responding and what the next phase looks like. Dr. Wasserman adjusts accordingly.
Dr. Wasserman is involved throughout the protocol, not only at intake. If you have an existing therapist or psychiatrist, coordination with your broader care team is encouraged. Esketamine therapy is most effective as part of a comprehensive mental health plan. It addresses a biological component of treatment-resistant depression; the remainder of care addresses everything that surrounds it.
Complete medical history, physical examination, and comprehensive hormone testing including total/free testosterone, estradiol, DHT, thyroid function, growth hormone, and complete metabolic panel to establish your baseline and identify optimization opportunities.
Development of your individualized hormone optimization protocol incorporating testosterone replacement therapy options (injections, creams, pellets), peptide therapy selections, growth hormone protocols, and estrogen management strategies based on your specific needs and goals.
Begin your supervised hormone optimization with prescribed treatments, professional injection services available, and ongoing support. Evening clinic hours available for working professionals, EMS, police, and firefighters with flexible scheduling options.
Regular follow-up appointments with Dr. Wasserman, quarterly lab monitoring, treatment adjustments based on results and symptoms, and 24/7 text access for questions about dosing, side effects, and optimization strategies.
Medicine moves quickly, and so do the rules that govern it. Dr. Wasserman tracks both closely. Everything listed here is a treatment he can currently, legally prescribe and administer—nothing is offered on the strength of hype or promise alone.
Spravato® is an FDA-approved nasal spray formulation of esketamine, approved specifically for treatment-resistant depression and for major depressive disorder. The mechanism is distinct from every standard antidepressant, which is why it remains a clinical option when serotonergic treatments haven't produced adequate results.
Because esketamine can cause temporary dissociative effects, perceptual changes, and sedation during and shortly after administration, it is only available through a certified treatment program with in-office supervision. The two-hour monitoring period is a safety requirement, not a formality.
Dr. Wasserman holds dual board certification in Emergency Medicine and Obesity Medicine. His background in emergency medicine—twenty-five years practicing in some of medicine's highest-acuity settings—shapes how he approaches every patient in this program: with full attention, no assumptions, and no shortcuts.
Spravato® is an FDA-approved nasal spray containing esketamine (a derivative of ketamine) intended for adults with treatment-resistant depression (TRD) or major depressive disorder with acute suicidal ideation. Unlike traditional oral antidepressants (such as SSRIs or SNRIs) that target neurotransmitters like serotonin or norepinephrine over several weeks, Spravato targets the brain's glutamate pathway via NMDA receptors. This mechanism works more rapidly, with many patients experiencing symptom relief within hours or days rather than weeks.
While both involve ketamine-based treatments, they have key differences:
Spravato (esketamine): Uses the S-enantiomer component of ketamine, is delivered via nasal spray, and is FDA-approved specifically for psychiatric treatment. Because of its FDA approval status, it is eligible for insurance coverage.
Ketamine Infusions: Typically use racemic ketamine delivered intravenously (IV). IV ketamine for depression is considered an off-label use and is generally not covered by insurance, requiring out-of-pocket payment.
No, Spravato cannot be taken at home or purchased at a pharmacy. Under FDA regulations (the REMS program), it must be administered at a certified medical clinic under healthcare provider supervision. During a typical session, you self-administer the nasal spray under direct medical supervision, and you rest in a comfortable, quiet treatment room for at least two hours while staff monitor your blood pressure and side effects. You must have a designated driver to take you home after your session, as you cannot drive or operate machinery until the following day.
Spravato treatment follows a phased schedule that gradually decreases in frequency over time:
Induction Phase (Weeks 1–4): Twice per week for the first month to build up therapeutic benefits.
Optimization Phase (Weeks 5–8): Once per week during the second month to maintain progress.
Maintenance Phase (Week 9 onwards): Once every 1 to 2 weeks, depending on your individual response and how well your symptoms remain controlled.
No. Spravato is designed to be used in combination with an oral antidepressant, not as a complete replacement. Your provider will work with you to keep you on a daily oral medication while adding Spravato sessions to your overall treatment plan to achieve the best results.
Yes, because Spravato® is FDA-approved for treatment-resistant depression and major depressive disorder with acute suicidal ideation, most major private insurance plans, Medicare, and Medicaid cover it. Coverage usually requires prior authorization to confirm eligibility (such as documented proof of trying at least two traditional antidepressants without success during the current episode). Patient assistance programs and copay savings cards may also be available to help reduce out-of-pocket costs for eligible patients.
Complete medical history, physical examination, and comprehensive hormone testing including total/free testosterone, estradiol, DHT, thyroid function, growth hormone, and complete metabolic panel to establish your baseline and identify optimization opportunities.
Development of your individualized hormone optimization protocol incorporating testosterone replacement therapy options (injections, creams, pellets), peptide therapy selections, growth hormone protocols, and estrogen management strategies based on your specific needs and goals.
Begin your supervised hormone optimization with prescribed treatments, professional injection services available, and ongoing support. Evening clinic hours available for working professionals, EMS, police, and firefighters with flexible scheduling options.
Regular follow-up appointments with Dr. Wasserman, quarterly lab monitoring, treatment adjustments based on results and symptoms, and 24/7 text access for questions about dosing, side effects, and optimization strategies.
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If you've been through standard treatments without adequate relief,you deserve a clinical evaluation that takes your history seriously.
