FDA-approved Spravato® (esketamine) at our REMS-certified Pleasant Hill clinic. For adults whose depression hasn't responded to 2+ traditional antidepressants. Insurance accepted.
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Spravato® (esketamine) is the first FDA-approved medication for treatment-resistant depression that works through the glutamate system — not the serotonin/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. Patients are monitored on-site for the required 2-hour observation window in a private, comfortable treatment room.
If you've cycled through 2+ antidepressants without meaningful response, you may be a candidate.
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:
Major depressive disorder with inadequate response to at least 2 different oral antidepressants, each given at adequate dose and duration.
FDA-approved for adults 18 and older. Used in combination with an oral antidepressant.
Active stimulant or opioid use disorders typically need to be addressed first; we can coordinate care.
Spravato can transiently elevate blood pressure. We screen and monitor before and during each session.
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.
We submit the prior authorization. Most commercial insurance, Medicare, and Medi-Cal cover Spravato when criteria are met. Approval typically takes 1–2 weeks.
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.
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.
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.
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): dissociation (a feeling of being detached or "out of body"), dizziness, nausea, sedation, mild blood pressure increase, headache.
What we monitor: blood pressure before, during, and after each dose; level of sedation; any dissociative reactions; 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/breastfeeding.
All Spravato sessions are administered at our Pleasant Hill location:
91 Gregory Lane, Suite 20
Pleasant Hill, CA 94523
Contra Costa County
Easy freeway access from Walnut Creek, Concord, Martinez, Lafayette, Orinda, and the broader East Bay. Patients also travel from Solano, Alameda, and Sacramento counties for Spravato treatment.
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, Medicare, and California Medi-Cal cover 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.
