Spravato (esketamine) providers in St. Louis

By the STL Depression Clinics Editorial TeamIndependent, medically reviewed for accuracy

If two or more antidepressants have not helped your depression, Spravato is one of the newer, FDA-approved options a doctor may discuss with you. Here is what it is, who it is for, and how to find a certified provider near St. Louis.

What Spravato is

Spravato is the brand name for esketamine, a prescription nasal spray. The U.S. Food and Drug Administration approved it in 2019 for adults with treatment-resistant depression - meaning depression that has not improved after trying at least two different antidepressants - and later for depressive symptoms in adults with major depression who have suicidal thoughts or actions. It is related to ketamine but is a distinct, standardized medication delivered as a spray.

Because of how it works and its potential side effects, Spravato is only given in a certified healthcare setting. You cannot pick it up at a pharmacy and use it at home. You take the spray in a clinic, then stay and are monitored for at least two hours before someone else drives you home.

Who it may be for

Spravato is generally considered when several things are true: an adult has major depression, standard antidepressants have not worked well enough, and a qualified clinician believes the potential benefit outweighs the risks. It is most often used together with an oral antidepressant, though in 2025 the FDA also approved it to be used on its own for treatment-resistant depression, so a prescriber decides which approach fits your situation. It is not a first step, and it is not right for everyone. A prescriber will review your full history, other medications, blood pressure, and any history of certain conditions before recommending it.

Importantly, people usually do not search for "esketamine." They search for how they feel: nothing is working, the meds stopped helping, I have tried everything. If that describes you, Spravato is one of several things worth asking a clinician about. It is not a cure, and results vary from person to person.

What a visit is actually like

• You self-administer the nasal spray in the clinic under supervision.
• You stay for monitoring for about two hours, because the medication can raise blood pressure and cause short-lived dizziness, drowsiness, or a dissociated feeling.
• You do not drive afterward, so you arrange a ride home for treatment days.
• Early on, sessions are often twice a week, then taper based on response.

Because of the monitoring requirement, Spravato is delivered through a federal safety program called a REMS, and only registered clinics can offer it. That is why the list of certified local providers is shorter than for regular therapy or medication.

How to find a provider near you

Because Spravato requires certification, start by asking directly whether a clinic is an enrolled Spravato provider. In the St. Louis region, certified care is typically found through specialty depression and interventional psychiatry clinics rather than a general primary care office. Hospital systems such as Washington University Psychiatry and SSM Health treat treatment-resistant depression and can tell you whether they offer esketamine or can refer you to a site that does. Our provider directory lists several established regional options to start with.

When you call, useful questions include: Are you a certified Spravato provider? Do you also offer TMS? Do you take my insurance or MO HealthNet? How soon can I be evaluated? You can bring the same questions to your own doctor, whose recommendation is often the single biggest factor in feeling confident about a next step.

A word of caution

Be careful with clinics that promise guaranteed results or describe any depression treatment as a miracle cure. Responsible providers talk about probabilities, monitoring, and follow-up, not guarantees. Spravato helps many people who had run out of options, but it is one tool among several, and it works best as part of ongoing, supervised care.