Spravato (esketamine)
A nasal spray with specific adult depression indications. It must be administered in a certified health-care setting under direct observation, followed by at least two hours of monitoring.¹
San Francisco · ketamine decision tool
Before you pay the package price.
A calm room, a medical title, and the word transformative tell you almost nothing. Name the drug. Find the licence. Inspect the monitoring. Price the whole course.
Evidence and regulatory facts checked August 29, 2026. Licensed-prescriber review is pending; no clinical-review badge is claimed.
First distinctionFDA-approved use Off-label use Not FDA-approved
Which thing is the clinic actually selling?
FDA-approved ketamine injection
Approved for IV or IM use as an anesthetic, not for a psychiatric condition. Psychiatric IV or IM use of the approved injection is off-label. Evidence, dose, monitoring, and maintenance standards must be explained rather than borrowed from the Spravato label.² ⁴
Compounded ketamine
FDA has not reviewed a compounded oral or nasal product for safety, effectiveness, or quality. FDA has specifically warned about psychiatric use without onsite monitoring.³
What the evidence permits
Not a first-treatment shortcut.
The 2022 VA/DoD depression guideline suggests against ketamine or esketamine as an initial medication choice. After a partial or absent response to an adequate medication trial, it lists switching to ketamine or esketamine among several options, not ranked above psychotherapy or other medication strategies.⁴
Compare ketamine and esketamine →Private on this page
Five checks before a deposit.
Nothing you mark or write is sent or saved. Print a blank copy, or use the boxes while the page is open.
0 of 15 answers in hand
01 · Name the treatment
One word is hiding three different products.
Write down the generic drug and route. Do not let “ketamine therapy” stand in for the answer.
02 · Test the reason
Ask why this treatment, now.
A sale is not a treatment rationale. The answer should start with your diagnosis, prior care, medical history, and the alternatives still available.
03 · Find the accountable person
A certificate is not a California licence.
Record the prescriber—not only the brand name of the clinic. Verify the person independently before paying a package deposit.
04 · Inspect the room
Monitoring is part of the treatment.
Spravato has a required supervised program. Psychiatric use of FDA-approved ketamine injection is off-label and does not inherit that protocol merely because the drugs are related.
05 · Price the whole course
A session price is not a course price.
Ask for screening, drug sessions, monitoring, preparation, follow-up, maintenance, cancellation, and insurance assumptions in one written answer.
Pause the purchase
Six answers that should stop the deposit.
- “Ketamine is FDA-approved for depression.”
- “Spravato can be taken home.”
- “Our certification is all the licence information you need.”
- “We use the same monitoring for everyone.”
- “Buy the package first; the prescriber will decide later.”
- “Integration is required, but we cannot separate its price.”
A pause is not a verdict that a clinic is unsafe. It is a reason to get a specific answer before money makes the decision harder to revisit.
San Francisco alternatives
The marketed treatment is not the only next move.
Two records the advertisement cannot edit.
The documents behind the checklist.
- U.S. Food and Drug Administration, Spravato prescribing information, revised 2025: indications, boxed warnings, REMS, observation, blood-pressure assessment, and driving restriction.
- U.S. Food and Drug Administration, Ketalar prescribing information, revised October 2025: ketamine hydrochloride injection for intravenous or intramuscular use as a general anesthetic.
- U.S. Food and Drug Administration, compounding risk alerts: compounded ketamine products for psychiatric disorders and risks without onsite monitoring.
- Department of Veterans Affairs and Department of Defense, 2022 Clinical Practice Guideline for Major Depressive Disorder: initial treatment and options after partial or no response.
- Medical Board of California, physician licence verification.
- California State Board of Pharmacy, pharmacy and compounding licence verification.
- San Francisco Behavioral Health Services, mental health and substance use disorder member handbook (2026 edition, effective 1 February 2026, updated 30 April 2026): the county’s 24/7 Behavioral Health Access Line on 1-888-246-3333 and county access responsibilities. The April 2026 file this page previously linked has been withdrawn from the city’s document store; this link is the page the city keeps pointed at the current handbook.
- Centers for Medicare & Medicaid Services, good faith estimates for uninsured or self-pay care.
Every external link on this page was re-checked on 23 September 2026 and served from the organisation that publishes it. One had died and is replaced: the San Francisco member handbook the city published in April 2026 has been withdrawn from its document store, and the citation now points at the page the city keeps pointed at the current handbook.
Educational information, not individual medical advice or a determination that a clinic is safe. Evidence and regulatory facts checked August 29, 2026. Licensed-prescriber review is pending.