When the FDA approved SPRAVATO® in 2019, it marked the first nasal spray antidepressant with a genuinely novel mechanism of action — and the first new class of antidepressant in over thirty years. Despite its FDA-approved status and demonstrated efficacy in clinical trials, many patients with treatment-resistant depression in Minnesota have never had a conversation with a provider about whether SPRAVATO® might be right for them. At Aurora Mental Health & Wellness in Waite Park, we offer SPRAVATO® (esketamine) treatment as a certified provider, and we believe every patient with treatment-resistant depression in central Minnesota deserves access to a complete, informed conversation about their options.
How SPRAVATO® Differs from IV Ketamine
SPRAVATO® (esketamine) is not the same drug as IV ketamine, and the distinction matters clinically. SPRAVATO® is derived from the S-enantiomer of ketamine and has received specific FDA approval for two indications: treatment-resistant depression (TRD) in adults who have not adequately responded to at least two oral antidepressants, and major depressive disorder (MDD) with acute suicidal ideation or behavior in adults. IV ketamine, by contrast, is used off-label for psychiatric conditions — it has never received FDA approval for depression or any psychiatric indication. Both drugs act on the glutamatergic system, but they are distinct compounds, administered differently, approved for different purposes, and regulated under different frameworks. For a deeper look at how these two therapies compare, see our post on the difference between ketamine and esketamine.
Clinical Evaluation at Aurora Mental Health & Wellness
At Aurora Mental Health & Wellness, Emily Luitjens, FNP-BC, PMHNP-BC, evaluates each SPRAVATO® candidate with the same clinical rigor she brings to every evaluation. Her background in VA medicine — where she worked extensively with patients carrying complex psychiatric diagnoses including PTSD, MDD, and anxiety disorders with prominent somatic components — means she is experienced in evaluating the nuanced clinical presentations that often characterize patients who reach SPRAVATO® candidacy. Treatment-resistant depression is rarely straightforward, and the patients who benefit most from SPRAVATO® are often those whose histories require careful clinical attention rather than a quick assessment.
What to Expect During a SPRAVATO® Session
SPRAVATO® is administered as a nasal spray that patients self-apply under direct clinical supervision at our Waite Park facility. The FDA’s REMS (Risk Evaluation and Mitigation Strategy) program for SPRAVATO® mandates this supervised administration because the drug can cause dissociation, sedation, and temporary blood pressure changes during and after the dose. Following each SPRAVATO® session, patients are monitored at our clinic for a minimum of two hours before being cleared to leave — and we require all patients to arrange transportation, as driving after SPRAVATO® is prohibited. Our clinical team remains present throughout the monitoring period to ensure your comfort and safety.
The standard SPRAVATO® treatment schedule involves two sessions per week during the initial four-week induction phase, followed by a maintenance schedule that Emily Luitjens adjusts based on your clinical response. SPRAVATO® is used alongside an oral antidepressant — it is not intended as a standalone treatment — and coordinating it with your existing psychiatric regimen is part of the medication management services we provide. If you are currently working with another prescriber, we are experienced in collaborative care models and will communicate with your care team throughout.
Navigating Insurance Coverage
One barrier we encounter regularly is insurance navigation. SPRAVATO® is FDA-approved, which means it is covered by many insurance plans when prescribed within its approved indications and when medical necessity documentation is complete. However, the prior authorization process can be complex, and many patients arrive uncertain about whether their plan will cover it or how to navigate the process. At Aurora Mental Health & Wellness, we have experience with prior authorization for SPRAVATO® and can guide you through what is required. We encourage every patient to discuss with their provider the documentation and diagnosis criteria that support coverage before initiating treatment.
Addressing Patient Concerns About Monitoring
A second barrier that comes up is the uncertainty some patients feel about an FDA-approved treatment that still requires clinical monitoring. Some patients interpret the monitoring requirement as a sign of unusual danger rather than as a regulatory standard designed to protect all patients, including those who respond without any complications. We address this directly in every pre-treatment discussion. The monitoring period is a condition of the REMS program, not an indication that SPRAVATO® is inherently risky beyond what the FDA has evaluated and approved. Most patients experience it as a manageable transition period in a calm clinical environment. Results vary by individual, and we will assess your response at each phase of treatment and adjust accordingly. You can also learn more about how SPRAVATO® is changing depression treatment in our dedicated resource.
For patients in Waite Park, St. Cloud, Sartell, and the broader central Minnesota region who are living with treatment-resistant depression or severe MDD, access to a certified SPRAVATO® provider nearby removes a significant logistical barrier to care. We are here to provide not just the treatment, but the clinical relationship and communication that makes treatment meaningful.
Frequently Asked Questions
What is the difference between SPRAVATO® and IV ketamine?
SPRAVATO® (esketamine) is an FDA-approved nasal spray for treatment-resistant depression and MDD with acute suicidal ideation or behavior. IV ketamine is used off-label for psychiatric conditions and has not received FDA approval for depression. Both act on the glutamatergic system but are chemically distinct drugs administered differently under different regulatory frameworks.
Who qualifies for SPRAVATO®?
SPRAVATO® is FDA-approved for adults with TRD who have not adequately responded to at least two oral antidepressants, and for adults with MDD experiencing acute suicidal ideation with intent or behavior. Candidacy is determined through a clinical evaluation with Emily Luitjens.
Why must I stay at the clinic after taking SPRAVATO®?
SPRAVATO®’s REMS program requires a minimum two-hour monitoring period after each dose because the drug can cause dissociation, sedation, and blood pressure changes. This is a regulatory requirement designed to ensure patient safety, not a sign of unusual risk. Our team is present throughout the monitoring window.
Does insurance cover SPRAVATO® in Minnesota?
Many insurance plans, including Medicare and many commercial plans, cover SPRAVATO® within its FDA-approved indications. Prior authorization is typically required. Aurora Mental Health & Wellness has experience navigating this process and can guide you through what documentation is needed.
Can SPRAVATO® be combined with my current antidepressant?
Yes — SPRAVATO® is intended to be used alongside an oral antidepressant. Emily Luitjens will review your current medications and work with your care team to coordinate SPRAVATO® within your broader psychiatric regimen.
Key Takeaways
- SPRAVATO® (esketamine) is FDA-approved for treatment-resistant depression and MDD with acute suicidal ideation or behavior — it is a distinct drug from IV ketamine.
- Aurora Mental Health & Wellness in Waite Park is a certified SPRAVATO® provider, offering central Minnesota patients access to this FDA-approved treatment locally.
- The REMS-required two-hour monitoring period after each dose is a regulatory safety standard — our clinical team is present throughout every session.
- SPRAVATO® is often covered by insurance within its approved indications; our team assists with prior authorization navigation.
- Results vary by individual; Emily Luitjens evaluates response throughout the induction and maintenance phases and adjusts the plan accordingly.
Conclusion
SPRAVATO® changed the landscape of treatment-resistant depression when it received FDA approval, and patients in central Minnesota now have access to it without leaving the region. At Aurora Mental Health & Wellness, we offer SPRAVATO® within a clinical framework built on thorough evaluation, honest communication, and ongoing response monitoring. If you have not responded adequately to two or more antidepressants and want to understand whether SPRAVATO® is an appropriate next step, schedule a consultation with our team, discuss with your provider what your clinical history suggests about your candidacy, and take the step toward a treatment option that may genuinely be different from everything you have tried.
References
U.S. Food and Drug Administration — SPRAVATO® Approval. https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trials-snapshots-spravato
SPRAVATO® REMS Program Information. https://www.spravatorems.com/
Daly EJ, et al. — Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment. JAMA Psychiatry. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2717045
National Alliance on Mental Illness (NAMI) — Esketamine. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Esketamine-(Spravato)
About Emily Luitjens
Emily Luitjens, FNP-BC, PMHNP-BC, is the lead provider at Aurora Mental Health & Wellness in Waite Park, MN, bringing over 10 years of experience from VA medical centers where she specialized in conditions where physical and psychological symptoms intertwine in complex ways. Her dual training as both a family nurse practitioner and psychiatric mental health nurse practitioner gives her a comprehensive clinical lens for evaluating panic disorder, anxiety, depression, and PTSD — including presentations where somatic symptoms emerge before or instead of psychological fear. At Aurora Mental Health & Wellness, she offers comprehensive psychiatry services, medication management, and individualized care plans grounded in neurobiological precision and VA-level rigor.
Medical Disclaimer
The content on this page is intended for educational purposes only and does not constitute medical advice. Information provided by Aurora Mental Health & Wellness is not a substitute for professional medical evaluation, diagnosis, or treatment. Results vary by individual, and no outcomes are guaranteed. Always discuss with your provider before making any changes to your mental health treatment plan. If you are experiencing a mental health emergency, please call 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room.