How Spravato Therapy Supports Mental Health and Peak Performance
- Brainz Magazine
- Sep 10
- 10 min read
Will Kimmins is an expert in trauma and the effects of chronic stress on mental health. Following a decades-long career in Special Operations for the US military, Will founded and owns Overwatch Counseling Services in multiple states in the USA.
High-performing professionals are great at pushing past obstacles until depression shows up and refuses to move. For some, no amount of grit, gym time, or green smoothies is enough to break through the fog. Traditional antidepressants? They can take weeks to kick in, if they work at all.
That’s where Spravato (Esketamine) changes the game. Delivered as an FDA-approved nasal spray, it works on a different brain pathway and often brings relief in hours, not months. Think of it less like a daily grind and more like hitting the reset button. Paired with therapy or coaching, Spravato doesn’t just lift symptoms, it helps restore clarity, performance, and that edge you thought you’d lost.
Why Esketamine?
If ketamine is the scrappy underdog that made its way into mental health through decades of off-label experimentation, then Esketamine better known by its brand name Spravato is the polished cousin who showed up in a suit, got FDA approval, and immediately got itself covered by insurance. It’s the same family, just with a more official résumé.
The story goes like this. For years, clinicians noticed that ketamine could pull people out of severe depression faster than most antidepressants even get through their opening credits. That was huge. But ketamine never quite made it through the FDA approval process for depression, leaving it in the “off-label but promising” category (not a huge issue, lots of drugs in the world of mental health get put in that box). Enter Esketamine, a molecule derived from ketamine, reformulated into a nasal spray, and formally blessed by the FDA in 2019 for treatment-resistant depression and major depressive disorder with acute suicidal ideation.
For patients, this means a few key things:
Legitimacy. Spravato isn’t just something your psychiatrist read about in a journal article, it’s an FDA-approved treatment. So, if that word off-label threw you off, Esketamine might be your ticket.
Insurance coverage. While most insurance plans still refuse to touch generic ketamine, Spravato often gets covered, which makes it financially accessible to more people.
Built-in structure. Because it’s a controlled program under REMS (Risk Evaluation and Mitigation Strategy), it comes with monitoring requirements, dosing protocols, and a very non-optional two-hour hangout at the clinic after each session.
Of course, FDA approval doesn’t mean Spravato is the miracle pill (or spray) some headlines made it out to be. It’s a tool. A powerful one, yes, but still just one piece of the treatment puzzle. As I often tell my clients, I’m willing to grab any tool in the toolbox if I’m qualified to use it and I think it will help you.
Think of it like this. If ketamine were an intrepid field medic figuring some stuff out using duct tape and a random assortment of items from someone’s broom closet, then Esketamine is a polished and purpose-built product presented by a smart marketing team in a comfortable boardroom. Both can get you to your destination.
So why Esketamine? Because it represents the bridge between innovation and legitimacy. It’s not ketamine therapy’s rebellious cousin anymore, it’s the one your insurance company will actually return your calls about.
Clinical rationale: How Spravato works (and why anyone should care)
Most antidepressants work on serotonin. They tinker with the system slowly, like nudging a stubborn thermostat and waiting days or weeks for the temperature to finally change. Spravato (Esketamine) plays a different game. Instead of targeting serotonin, it works on NMDA receptors, altering the glutamate system, the brain’s most abundant excitatory neurotransmitter. Translation, it helps the brain rewire itself more quickly, boosting neuroplasticity and opening up space for new patterns of thought and emotion.
This matters because for people stuck in treatment-resistant depression, the old pathways are like rutted dirt roads. Esketamine runs heavy equipment to level the road surface, allowing the client to choose slightly or very different paths in response to stimuli or their own internal thought patterns. It doesn’t make the healthy change for you, it makes it easier for you to choose to make that healthy change.
The FDA approved Spravato in 2019 for two very specific reasons:
Treatment-resistant depression (TRD). For people who’ve tried two or more antidepressants without results.
Major depressive disorder with acute suicidal ideation. Because when someone is in crisis, “wait six weeks to see if it works” is not an acceptable treatment plan.
Why intranasal delivery? The short answer, predictability. Spravato’s nasal spray format allows for consistent dosing under supervision. It’s less invasive than IV infusion and harder to misuse outside of a clinic.
This speaks to the hazard of finding treatment through experimentation with medications approved for other things. If it weren’t being done in a research or approved treatment setting, things like figuring out ketamine’s effect would fit the definition of misuse outside of a clinic. Spravato is a solution to the discomfort surrounding the fact that ketamine wasn’t developed specifically for depression, and therefore, we already know it can be used in a manner other than originally intended.
So, the clinical rationale is simple but powerful. Spravato isn’t just another antidepressant. It’s a mechanistic shift, fast-acting, supervised, and designed for people who can’t afford to keep waiting for change.
Desired effects and what clients can expect
If you’re used to traditional antidepressants, you know the drill. Start a new medication, wait four to six weeks, hope for the desired result, and cross your fingers you don’t gain ten pounds or start sleeping like a hibernating bear. Spravato doesn’t follow that script.
Because it acts on the glutamate system, patients can often feel an effect within hours to days, for someone living with severe depression or worse, active suicidal thoughts that speed matters. It’s not a cure, but for some people it can be the difference between hanging on and giving up.
What patients usually notice:
Mood lift. Not always fireworks, but often a noticeable reduction in the heaviness.
Clarity and energy. Many describe it as a mental “reset,” with less brain fog.
Rapid reduction in suicidal ideation. Clinical trials consistently showed significant improvements in this area within the first 24-48 hours.
What patients don’t always expect:
Dissociation. Some feel like they’re “watching themselves” or briefly disconnected from reality. It’s temporary and monitored, but can be unnerving if you don’t know it’s coming.
Physical effects. Dizziness, nausea, increased blood pressure, or feeling a little wobbly are common.
The two-hour hangout. After each dose, patients are required to remain in the clinic under supervision. Bring a podcast, a playlist, or that book you’ve been pretending to read for six months.
I sometimes think of this process as upgrading to business class from economy when traveling by air. You’re still going to get to the same destination over time, but this is going to make the trip slightly more comfortable. Not a first-class upgrade, mind you, this isn’t going to do the work for you or bring you complimentary drinks and premium snacks along the way. The focus here is to make symptoms manageable so the work in session becomes more approachable. Otherwise, you end up masking symptoms, and if you find yourself without access to the drug, then you may regress.
Key point: Spravato is not designed to make you “trip.” It’s designed to give your brain a jump-start for most patients, who look for relief from the crushing weight of depression, not a euphoric high. And when paired with therapy or coaching, those windows of relief can turn into lasting progress.
Course of treatment: What the Spravato journey looks like
Spravato isn’t a “one and done” therapy. It follows a structured, stepwise treatment plan that looks more like training cycles than casual office visits.
Phase 1: Induction (Weeks 1-4)
Dosed twice weekly.
Patients stay in the clinic for at least two hours after each session.
This is when most people notice whether it’s helping. Clinical trials measured significant symptom reduction within the first month (Daly et al., 2019).
Phase 2: Optimization (Weeks 5-8)
Dosing usually drops to once weekly.
Symptoms are reassessed regularly. Some patients stabilize, while others may need adjustments.
Phase 3: Maintenance (Week 9 and beyond)
Often, every other week, though frequency depends on individual response.
Long-term use is possible, but the goal is always to find the lowest effective dose.
Throughout all phases, patients are paired with an oral antidepressant (except now that monotherapy is approved, some may not need both) and supervised closely. Insurance typically requires documented adherence to these schedules for ongoing coverage.
This mimics how we work in the more traditional therapy space. When someone first comes in, we start at a high frequency, minimum one session a week, but often more than that. As time goes on and we make progress in therapy, the client needs less service because the treatment is working, so we reduce frequency. Eventually, the goal is to reach a point where the client doesn’t need me and goes on with their life.
The entire course is designed for safety and consistency. Unlike off-label ketamine therapy, which varies from clinic to clinic, Spravato’s REMS framework ensures every patient gets the same dosing rules, monitoring, and documentation.
Who can prescribe and administer Spravato
Spravato isn’t something you can pick up at Walgreens and DIY. Because of safety concerns, it’s only available through the FDA’s REMS program.
Prescribers: Typically psychiatrists, and in some cases, specially certified physicians, NPs, or PAs.
Clinics: Must be REMS-certified to dispense and administer Spravato.
Supervision: Every dose is given under direct medical observation, with required monitoring for at least two hours afterward.
Simple rule to follow here. No random back alley deals for “the good stuff” so you can free-dive into Spravato facilitated therapy. Only get the FDA-approved stuff from providers with a DEA number.
Integrating psychotherapy (and coaching) with Spravato
Here’s a difficult truth. Spravato by itself is not therapy. It’s a medical treatment that can create a window of relief, but what happens inside that window matters just as much as the medication. Without integration work, the brain may slip back into old ruts. With therapy or coaching, it can lay down new, healthier pathways.
This is the point where I come in. My work with clients often blends evidence-based trauma therapies like:
EMDR (Eye Movement Desensitization and Reprocessing): A structured approach to reprocessing painful experiences so they no longer hijack the present.
Cognitive Processing Therapy (CPT): A proven method for helping people identify “stuck points” and shift rigid, self-defeating beliefs that fuel depression and anxiety.
For clients who don’t want traditional psychotherapy, performance coaching might be a better alternative. Coaching is forward-focused, practical, and built around high performance, perfect for professionals who think in terms of goals, metrics, and growth. Performance coaching is also much more directive. Psychotherapy is about helping you find solutions and resolve problems for yourself, and we go to great lengths to not be instructive but to facilitate. Coaching is about agreeing upon a path to an objective and then having the coach push you along that path. In the coaching framework, Spravato isn’t just about symptom relief, it’s about creating clarity, sharpening decision-making, and getting back to operating at full capacity.
Whichever option feels right, the only wrong move is not pairing the Spravato treatment with some amplifying and integrating work. The Spravato creates an opportunity to achieve progress that might otherwise take weeks or months. The breakdown in barriers and the softening of those cognitive ruts allow many clients to move forward more quickly than they otherwise would.
In other words, Spravato opens the door. Therapy and coaching help you walk through it and keep moving forward.
Common uses and real-world applications
Spravato isn’t a catch-all. It’s FDA-approved for two very specific situations:
Treatment-resistant depression (TRD): When someone has tried two or more antidepressants without success.
Major depressive disorder (MDD) with acute suicidal ideation: For patients in immediate crisis who need faster relief than traditional options can offer.
Outside those approvals, there’s a lot of conversation (and research) about other uses, but they’re not official yet. That means things like PTSD, anxiety disorders, and chronic pain are still in the “promising but not FDA-approved” column.
So where does it show up in real life?
The executive who has “tried everything” and can’t afford months of downtime.
The high-performing professional who looks fine on paper but is privately stuck in a depressive fog.
The person in crisis who needs relief today, not six weeks from now.
And for many, Spravato is more accessible than generic ketamine because insurance is more likely to cover it. That can make the difference between “maybe someday” and “I can actually start treatment now.”
Spravato isn’t a magic potion that will make all of your struggles go away. It’s a specific tool that is meant to help you clear a bit of the fog so that you can approach the underlying causes of your symptoms without becoming overwhelmed or dysregulated.
Final thoughts
Spravato isn’t a silver bullet, but it is a breakthrough. For people who have been stuck in depression despite trying everything else, it offers something rare, speed, legitimacy, and accessibility.
But here’s the catch. Spravato doesn’t fix the patterns, beliefs, or pressures that fuel depression in the first place. That’s where therapy and coaching step in. Whether it’s EMDR to reprocess trauma, Cognitive Processing Therapy to untangle “stuck points,” or performance coaching to sharpen focus and resilience, the real work happens when relief from Spravato meets a plan for lasting change.
It's not going to make your crammed full inbox less irritating or your overbearing boss no longer a problem. What it’s going to do is allow you the space to find new ways of reacting to those things that don’t result in a depressive spiral. In the best-case scenario, you find new ways to perform at a higher level because things don’t seem so overwhelming. And maybe you have someone like me in your corner to take the work to the next level.
For high-performing professionals, the goal isn’t just surviving depression. It’s about regaining clarity, leadership, and balance so you can get back to doing what you do best, without depression calling the shots. Spravato can open the door. The rest is about what you choose to walk toward.
William Kimmins, Licensed Mental Health Therapist
Will Kimmins is a leader in treating chronic stress and trauma, especially in people who have been exposed to traumatic events repeatedly over long periods. After his career as a special operator in the US military, Will saw the shortfalls of the mental health field when engaging with people like him and decided to do something about it. Will founded his private mental health practice to engage with people who had survived chronic trauma exposure differently, increasing their competence and agency so that their healing comes from within. Will is also credentialed for animal-assisted therapy and continues to find ways to help people like him connect more effectively with the care they need.
