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Spravato® · Esketamine for TRD

A different path for
treatment-resistant depression.

FDA-approved Spravato® (esketamine) at our REMS-certified Pleasant Hill clinic — for adults whose depression hasn't responded to two or more traditional antidepressants. Insurance accepted.

Book an appointment Call (925) 825-1766

SMS appointment reminders are optional. You may opt in during booking — consent is not required to schedule or receive care. Msg & data rates may apply for opted-in numbers. Reply STOP to opt out anytime. See our SMS Consent & Terms.

A calm, private treatment room at the Universal Medical Group Pleasant Hill clinic
Universal Medical GroupPsychiatry · Est. 2008
2019
FDA-approved for TRD
2 hr
In-clinic monitoring per dose
50–60%
Of TRD patients respond
REMS
Certified Pleasant Hill clinic
5
Languages spoken
REMS-certified Spravato® clinic
Now accepting new patients
Aetna · BCBS · Cigna · United & most insurance
(925) 825-1766
Spravato® for treatment-resistant depression

A different mechanism. A different outcome.

Spravato® (esketamine) is the first FDA-approved medication for treatment-resistant depression that works through the glutamate system — not the serotonin and norepinephrine pathways targeted by traditional antidepressants.

For patients who have tried multiple SSRIs, SNRIs, or augmentation strategies without relief, Spravato offers a fundamentally different mechanism of action. Universal Medical Group is REMS-certified to administer Spravato at our Pleasant Hill clinic, where patients are monitored on-site for the required 2-hour observation window in a private, comfortable treatment room.

If you've cycled through two or more antidepressants without meaningful response, you may be a candidate.

Quick facts

  • FDA approval2019 (TRD), 2020 (MDSI)
  • AdministrationNasal spray
  • SettingIn-clinic only
  • Monitoring2 hours post-dose
  • Initial phaseTwice weekly × 4 weeks
  • MaintenanceWeekly or bi-weekly
  • InsuranceMost major plans
How it works

A mechanism in the synapse.

Most antidepressants act on serotonin and norepinephrine, and can take six to eight weeks to take hold. Esketamine works on a different system altogether — glutamate, the brain's most abundant signaling chemical.

At the synapse — the junction where one neuron passes its signal to the next — esketamine blocks the NMDA receptor. This is thought to set off a rapid cascade of synaptic repair, helping restore the connections that long-term depression wears down.

Who Spravato is for

Eligibility.

Spravato is approved for adults with treatment-resistant depression (TRD) and for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior (MDSI). Specific criteria include:

01

Treatment-resistant depression

Major depressive disorder with inadequate response to at least 2 different oral antidepressants, each given at adequate dose and duration.

Core indication
02

Adult patients

FDA-approved for adults 18 and older. Used in combination with an oral antidepressant.

Ages 18+
03

No active substance use issues

Active stimulant or opioid use disorders typically need to be addressed first; we can coordinate care.

Coordinated care
04

Stable cardiovascular status

Spravato can transiently elevate blood pressure. We screen and monitor before and during each session.

Screened & monitored
What to expect

Your first visit through maintenance.

From the comprehensive evaluation to ongoing maintenance, here is the path your Spravato care follows at our Pleasant Hill clinic.

01

Comprehensive evaluation (60–90 min)

Dr. Punia or another UMG provider reviews your full psychiatric history, prior medication trials, current symptoms, and medical history to confirm Spravato is right for you. We also handle insurance prior authorization at this stage.

Visit one
02

Insurance authorization

We submit the prior authorization. Most commercial insurance covers Spravato when criteria are met. Approval typically takes 1–2 weeks.

1–2 weeks
03

Induction phase (weeks 1–4)

Twice-weekly Spravato sessions in our Pleasant Hill clinic. You'll self-administer the nasal spray under medical supervision and remain in our private treatment room for 2 hours of monitoring afterward.

Twice weekly
04

Maintenance phase

If you respond, sessions taper to weekly, then bi-weekly. Most maintenance patients come in once every 1–2 weeks. Duration is individualized based on your response.

Weekly or bi-weekly
05

Each session logistics

Plan to be at our clinic for 2.5–3 hours per session. You cannot drive home afterward — arrange a ride or rideshare. Most patients read, watch shows, or rest during the monitoring window.

2.5–3 hours
Side effects & safety

What to know.

Spravato is administered under the FDA's Risk Evaluation and Mitigation Strategy (REMS) program because it can cause transient dissociation, sedation, and elevated blood pressure. This is why all sessions happen in a certified clinic, not at home.

Common side effects — usually wearing off within 2 hours — include dissociation (a feeling of being detached or "out of body"), dizziness, nausea, sedation, mild blood pressure increase, and headache.

What we monitor: blood pressure before, during, and after each dose; level of sedation; any dissociative reactions; and readiness to leave at the 2-hour mark.

What to discuss with your provider: any history of high blood pressure, cardiovascular disease, substance use, psychosis, or pregnancy and breastfeeding.

A UMG psychiatric consultation room
Inside the practice — calm, private, unhurried.
Spravato near you

Pleasant Hill clinic.

All Spravato sessions are administered at our Pleasant Hill location, with easy freeway access from across the East Bay.

Pleasant Hill

91 Gregory Lane, Suite 20
Pleasant Hill, CA 94523 · Contra Costa County

All Spravato® sessions · 2-hour monitoring Locations & directions

Serving the East Bay

Easy freeway access from Walnut Creek, Concord, Martinez, Lafayette, and Orinda. Patients also travel from Solano, Alameda, and Sacramento counties for Spravato treatment.

Bay Area & beyond Book a Spravato consult
Frequently asked

Spravato FAQ.

Spravato (esketamine) is the FDA-approved version. It's a single isomer of ketamine, given as a nasal spray, and is covered by most insurance for treatment-resistant depression. IV ketamine clinics typically use racemic ketamine off-label and are usually not covered by insurance.
Many patients notice improvement within the first 1–2 weeks of induction. The most reliable response signal comes around week 4 (end of induction). Spravato is not for everyone — about 50–60% of TRD patients respond meaningfully.
Yes — Spravato is FDA-approved to be used in combination with an oral antidepressant. We coordinate the full medication regimen.
Most commercial insurance covers Spravato when TRD criteria are met. We handle the prior authorization. Patient out-of-pocket cost varies by plan; we verify your benefits up front.
No. You cannot drive after Spravato until the next day. Plan a ride home, rideshare, or have someone pick you up. Many patients also avoid making major decisions or operating heavy machinery for the rest of the day.
Begin

When depression hasn't lifted, a different path may.

Universal Medical Group is accepting new patients for Spravato® at our REMS-certified Pleasant Hill clinic. We handle the insurance prior authorization for you.

Book a Spravato consult Call (925) 825-1766

SMS appointment reminders are optional. You may opt in during booking — consent is not required to schedule or receive care. Msg & data rates may apply for opted-in numbers. Reply STOP to opt out anytime. See our SMS Consent & Terms.