Chapter II · Supplement · Advanced Therapy
Spravato® (Esketamine) Treatment in Omaha, NE
Spravato (esketamine) is an FDA-approved nasal spray medication for treatment-resistant depression and for depressive symptoms in adults with suicidal thoughts or actions. It's administered only in a certified, monitored clinical setting, never taken home, under an FDA Risk Evaluation and Mitigation Strategy (REMS) program.
When the Pills Haven't Worked
If you've tried medication after medication and still don't feel like yourself, you already know the frustration of "just give it more time." Treatment-resistant depression isn't a lack of effort on your part. It's a sign your brain may need a different kind of intervention.
Spravato works differently than a daily pill, and for many people, it's the first thing that's actually moved the needle.
Treatment-resistant depression isn't a lack of effort on your part.
Why Felina
Spravato is a serious medication that requires serious oversight, which is exactly the environment we've built. As a psychiatric nurse practitioner with over 25 years of clinical experience, including both acute and psychiatric care, Felina doesn't just prescribe Spravato. She personally evaluates whether it's the right fit for you, walks you through what to expect, and stays involved in your care as your treatment progresses. You're not handed off to a rotating clinical staff for monitoring visits; your treatment plan reflects a provider who has seen how this medication performs across a wide range of real patients, including the more complex cases (comorbid PTSD, OCD, or anxiety alongside depression).
The Course of Care
What treatment looks like at Verve Collaborative Health in Omaha
Everything begins with an initial evaluation and full psychiatric assessment with Felina to determine if Spravato is appropriate, including a review of risk factors and contraindications. If Spravato is clinically indicated and appropriate, treatment follows a structured rhythm:
Education first
A full discussion of the treatment itself before anything starts: what it is, how it works, and what to expect.
In-office dosing sessions
Typically twice weekly to begin, in our dedicated Spravato treatment clinic.
Supervised monitoring
Each session requires two hours in-clinic, with supervised monitoring of blood pressure and vital signs.
Tapering over time
Session frequency is tapered down over time based on your clinical response.
Support between visits
Alongside Spravato sessions, we recommend guided journaling to track mood shifts, regular therapy sessions to build on the work Spravato supports, and consistent follow-up with Felina to keep your treatment progressing as expected.
Please plan ahead: patients must arrange a driver, as you cannot drive yourself home the day of treatment. Exact dosing schedules vary by patient and are determined individually.
Off-label use for comorbid conditions. Spravato is FDA-approved specifically for treatment-resistant depression and for depression with suicidal thoughts or actions. In select cases involving major depressive disorder with comorbid PTSD, OCD, or anxiety, Spravato may help recovery, based on clinical trial data and results observed in practice. This is not an FDA-approved indication, and outcomes vary by patient. Felina will discuss whether this may be appropriate for your specific diagnosis during your evaluation.
Safety Information
What to know about safety before you start
Spravato carries a boxed warning, the FDA's strongest warning, for sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors. This is a summary, not the complete picture: read the Medication Guide below before your first session, and ask Felina about anything that applies to you.
Sleepiness, dissociation, and breathing problems
Spravato can make you sleepy (sedation) or cause fainting. It can make you feel disconnected from yourself, your thoughts, your feelings, and space and time (dissociation). It can also cause difficulty breathing or stopped breathing (respiratory depression or respiratory arrest). This is why you are monitored for at least two hours at every session, and why your provider decides when you are ready to leave. Tell your provider right away if you feel you cannot stay awake or are going to pass out.
Abuse and misuse
Spravato contains esketamine, a Schedule III controlled substance. It can be abused and misused, which may lead to physical and psychological dependence. Your provider should check you for signs of abuse, misuse, and dependence before and during treatment, so tell Felina if you have ever abused or been dependent on alcohol, prescription medicines, or street drugs.
A restricted program (REMS)
Because of the risks of sedation, dissociation, respiratory depression, and abuse and misuse, Spravato is only available through a restricted program called the SPRAVATO REMS. It can only be given at healthcare settings certified in the program, and patients treated in a medical office or clinic must be enrolled in it.
Suicidal thoughts and actions
It is not known if Spravato is safe and effective for preventing suicide or reducing suicidal thoughts or actions, and it is not used in place of a hospital stay when your provider decides you need one, even if you feel better after the first dose. Antidepressant medicines may increase suicidal thoughts and actions in some people 24 years of age and younger, especially in the first few months of treatment or when the dose is changed. Spravato is not for use in children.
Warning signs: get help right away
Tell your provider or get emergency help right away if you or a family member notice any of these, especially if they are new, worse, or worry you: thoughts about suicide or dying; suicide attempts; acting on dangerous impulses; new or worse depression, anxiety, or irritability; panic attacks; feeling very agitated or restless; trouble sleeping; acting aggressive, angry, or violent; an extreme increase in activity and talking (mania); or other unusual changes in behavior or mood. Watch most closely when treatment starts or the dose changes.
Blood pressure
Spravato can cause a temporary rise in blood pressure that may last about four hours after a dose. Your blood pressure is checked before each dose and for at least two hours after. Tell your provider right away if you get chest pain, shortness of breath, a sudden severe headache, a change in vision, or seizures after a dose, including after you leave the clinic.
Thinking and bladder problems
Serious side effects also include problems with thinking clearly or remembering, and bladder problems such as trouble urinating, a frequent or urgent need to urinate, pain when urinating, or urinating frequently at night. Tell your provider if you notice any of these.
Who should not take Spravato
Do not take Spravato if you have blood vessel (aneurysmal vascular) disease, including in the brain, chest, abdominal aorta, arms, or legs. Do not take it if you have an abnormal connection between your veins and arteries (arteriovenous malformation), a history of bleeding in the brain, or an allergy to esketamine, ketamine, or any ingredient in Spravato. If you are not sure whether any of these apply to you, talk to Felina before starting.
Before you start
Tell Felina about all of your medical conditions, including heart or brain problems (such as high blood pressure; a slow or fast heartbeat that causes shortness of breath, chest pain, lightheadedness, or fainting; a past heart attack or stroke; heart valve disease or heart failure; a past brain injury; or any condition that raises pressure in the brain), liver problems, and any history of psychosis (seeing, feeling, or hearing things that are not there, or believing things that are not true). Also tell her about every medicine you take, including over-the-counter medicines, vitamins, and herbal supplements. Some need extra care: central nervous system depressants such as benzodiazepines, opioids, and alcohol may increase sleepiness, and stimulants or wakefulness medicines such as amphetamines, methylphenidate, modafinil, or armodafinil, as well as MAOI antidepressants (monoamine oxidase inhibitors), may raise blood pressure.
Pregnancy and breastfeeding
Spravato may harm an unborn baby and should not be taken during pregnancy. Tell your provider if you are pregnant or plan to become pregnant, and right away if you become pregnant during treatment. If you could become pregnant, talk with your provider about preventing pregnancy during treatment. Do not breastfeed during treatment with Spravato.
Common side effects
Feeling disconnected, dizziness, nausea, sleepiness, a spinning sensation, numbness, anxiety, lack of energy, increased blood pressure, vomiting, feeling drunk, headache, and feeling very happy or excited. They usually happen right after a dose and go away the same day. These are not all the possible side effects.
Driving and alertness
After each treatment, do not drive, operate machinery, or do anything that needs you to be fully alert and coordinated until the next day, after a restful sleep.
If you are in crisis or thinking about suicide, call or text 988 (the Suicide & Crisis Lifeline) or call 911. You can report side effects to the FDA at 1-800-FDA-1088.
Spravato Facts
Questions patients ask most
What is Spravato and how does it work?
Spravato (esketamine) is an FDA-approved nasal spray medication for treatment-resistant depression and for depressive symptoms in adults with suicidal thoughts or actions. It works differently than a daily pill, and it is administered only in a certified, monitored clinical setting, never taken home, under an FDA Risk Evaluation and Mitigation Strategy (REMS) program.
Who is Spravato for?
Spravato is FDA-approved for treatment-resistant depression (when you've tried multiple antidepressants without real relief) and for depressive symptoms in adults with suicidal thoughts or actions. Whether it's appropriate for you is determined at an initial evaluation and full psychiatric assessment with Felina, including a review of risk factors and contraindications.
What happens during a treatment session?
Dosing happens in our dedicated Spravato treatment clinic, typically twice weekly to start. Each session requires two hours in-clinic with supervised monitoring of blood pressure and vital signs. Session frequency is tapered down over time based on your clinical response.
Can I drive myself home after a session?
No. Patients must arrange a driver; you cannot drive yourself home the day of treatment.
How often will I need treatments?
Sessions are typically twice weekly at the start, with frequency tapered down over time based on clinical response. Exact dosing schedules vary by patient and are determined individually, so they aren't listed here.
Do you accept insurance for Spravato?
Spravato treatment requires insurance authorization prior to starting. We are currently unable to accept Medicare or Medicaid for Spravato specifically. Our team will verify your coverage and discuss any cost details with you before treatment begins.
Where in Omaha are Spravato treatment sessions held?
Sessions are held in our dedicated Spravato treatment clinic at Verve Collaborative Health, 11404 West Dodge Road, Suite 300, Omaha, NE 68154, where Elaion Mental Health, PLLC at Verve Collaborative Health operates. We serve patients from Omaha and the surrounding metro, including Bellevue, Papillion, La Vista, Elkhorn, and Council Bluffs. Consultations and scheduling go through Verve Collaborative Health.
Can Spravato help with PTSD, OCD, or anxiety alongside depression?
Spravato is FDA-approved specifically for treatment-resistant depression and for depression with suicidal thoughts or actions. In select cases involving major depressive disorder with PTSD, OCD, or anxiety, Spravato may help recovery, based on clinical trial data and results observed in practice. This is not an FDA-approved indication, and outcomes vary by patient. Felina will discuss whether this may be appropriate for your specific diagnosis during your evaluation.
Official Documentation
Patient documents to download and keep
These are the official Spravato® documents from Janssen Pharmaceuticals, provided here for your records. The Patient Brochure is the easiest overview to start with; the Medication Guide is the FDA-required safety summary to read before your first session.
- Download ↓
Spravato Patient Brochure
The friendliest place to start: Janssen's illustrated patient brochure covering what Spravato is, what treatment days look like, side effects, and cost support.
- Download ↓
Spravato Medication Guide
The FDA-required patient guide: the most important safety information, side effects to watch for, and what to avoid on treatment days.
- Download ↓
Full Prescribing Information
The complete FDA-approved labeling for patients who want every detail: indications, REMS program requirements, dosing, warnings, and clinical trial data.
Documents are reproduced from the manufacturer's current official labeling. The latest versions are always available at spravato.com and spravatorems.com.
Getting Started
Consultations are scheduled through Verve Collaborative Health, where Elaion Mental Health operates.
Schedule at Verve Collaborative →View on Psychology Today →
Prefer to talk first? Call Verve Collaborative Health at (402) 898-1113.
Serving Omaha and the surrounding metro, including Bellevue, Papillion, La Vista, Elkhorn, and Council Bluffs.
Return to Chapter II · Mind Align →
Mental Health · Felina Sno, Vol. I · Omaha, Nebraska