Esketamine (Spravato) in Hilo, Honolulu & Kailua Kona

What Is Spravato (Esketamine)?

Spravato is the brand name for esketamine, a prescription nasal spray medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of treatment-resistant depression (TRD) in adults. It was approved by the FDA in March 2019 — the first genuinely new antidepressant mechanism approved in decades — and represented a landmark moment in psychiatric medicine.

Esketamine is the S-enantiomer of ketamine, meaning it is a specific molecular form of the ketamine compound that has been isolated for its potent antidepressant properties. Like its parent compound, esketamine works by targeting NMDA (N-methyl-D-aspartate) glutamate receptors in the brain — a mechanism of action fundamentally different from all traditional antidepressants, which primarily work on serotonin, norepinephrine, or dopamine systems. This unique mechanism is why Spravato can produce meaningful antidepressant effects in patients who have not responded to multiple conventional antidepressant medications, and why its effects can be felt much more rapidly than SSRIs or SNRIs.

Spravato is used in conjunction with an oral antidepressant and must be administered in a certified clinical setting under direct medical supervision. It cannot be taken home by patients. At Hawaii Wellness Clinic, we are a certified Spravato REMS (Risk Evaluation and Mitigation Strategy) program site, meeting all federal safety requirements for the administration of this medication.

Who Is Spravato For?

Spravato may be appropriate for adults who meet all of the following criteria: a diagnosis of major depressive disorder (MDD) with treatment-resistant characteristics, meaning inadequate response to at least two different oral antidepressant treatments of adequate dose and duration, currently under the care of a medical or mental health provider, able to remain in the clinic for the required monitoring period following each treatment session, and cleared through our comprehensive medical evaluation as suitable candidates for esketamine therapy. A thorough consultation with our medical team at Hawaii Wellness Clinic is required to determine whether Spravato is medically appropriate for your individual situation. Conditions that may disqualify a patient from Spravato include certain cardiovascular diagnoses, a history of psychosis, active substance use disorder, pregnancy, and others — all of which are assessed during the screening process.

How Spravato Treatment Works at Hawaii Wellness Clinic

At Hawaii Wellness Clinic in , every Spravato treatment visit is conducted within our certified clinical environment under the direct supervision of our medical and psychiatric team. Here is what you can expect from each treatment visit.

Medical Evaluation & Screening

Before your first treatment and at the start of each subsequent visit, you will be assessed by our clinical team to review your current health status, medications, blood pressure, and any changes since your last session. This evaluation ensures your safety and confirms that it is appropriate to proceed with treatment that day.

Spravato Administration

Spravato is self-administered as a nasal spray under the guidance of our clinical team. Each device delivers a precise dose of esketamine. The administration process is brief — typically taking just a few minutes — and is conducted in our designated treatment room where you are comfortable and supported throughout.

Clinical Monitoring Period

Following administration, you are monitored in our clinic for approximately two hours. This monitoring period is required under the Spravato REMS program to ensure your safety, as Spravato can temporarily cause dizziness, dissociation, increased blood pressure, nausea, or sedation. Our clinical team remains attentive throughout this period, checking in regularly to assess your comfort and wellbeing. You will not be cleared to leave until our team has confirmed that these effects have resolved and you are safe to go home — with a designated driver, as driving is not permitted on the day of treatment.

Psychiatric Oversight & Progress Monitoring

A licensed psychiatrist oversees all Spravato treatment at Hawaii Wellness Clinic, evaluating your clinical progress, monitoring for treatment response, and coordinating with your broader care team to ensure that Spravato is working optimally as part of your overall mental health treatment plan. Regular follow-up appointments allow us to assess your response, adjust frequency as needed, and make decisions about continuing or modifying treatment.

Spravato Treatment Schedule

The Spravato treatment schedule is divided into two phases, both of which are individualized based on your clinical response and your provider’s guidance. During the induction phase — typically the first four weeks of treatment — Spravato sessions are administered twice weekly. This intensive initial phase is designed to establish therapeutic response and begin building the neuroplastic changes associated with antidepressant benefit. During the maintenance phase, session frequency is gradually reduced — typically to once weekly for weeks five through eight, then to once weekly or once every two weeks thereafter — based on your individual response and your provider’s clinical assessment. Treatment duration is evaluated on an ongoing basis, with continuation recommended for patients who are responding well.

Possible Side Effects of Spravato

Spravato is generally well-tolerated, and most side effects are temporary and resolve during or shortly after the monitoring period. Common side effects that patients may experience during or after a Spravato session include dissociation or a dreamlike feeling, dizziness or a sense of unsteadiness, nausea, sleepiness or sedation, increased blood pressure (which is monitored throughout your visit), and headache. These effects are the reason that in-clinic monitoring is required. Our clinical team is experienced in managing these responses, and the vast majority of patients complete their monitoring period without significant discomfort.

Spravato vs. Ketamine IV Therapy — Which Is Right for You?

Both Spravato (esketamine) and ketamine IV therapy are available at Hawaii Wellness Clinic and both target NMDA receptors to produce rapid antidepressant effects. The choice between them depends on a range of clinical factors. Spravato is FDA-approved specifically for treatment-resistant depression and is often covered by insurance, making it more accessible for some patients. Ketamine IV therapy delivers racemic ketamine intravenously, providing a higher degree of dose control and is supported by a larger body of clinical evidence across a broader range of conditions including chronic pain, PTSD, anxiety, and OCD. During your consultation, our team will review your specific history, diagnosis, insurance coverage, and treatment goals to recommend the option best suited to your needs — or a combination of both therapies where appropriate.

Why Choose Hawaii Wellness Clinic for Spravato Treatment?

At Hawaii Wellness Clinic in , we are proud to be one of the few certified Spravato REMS provider sites in Hawaii, offering patients access to this FDA-approved treatment within a clinically rigorous, compassionate, and fully supported environment. Our licensed psychiatrists, board-certified physicians, and skilled nursing team work together to deliver Spravato treatment that is safe, effective, and embedded within a broader, integrative mental health care plan. We complement Spravato with additional therapies — including neurofeedback, IV vitamin therapy, and NAD⁺ therapy — to maximize and sustain your treatment response. If you would like to find out whether Spravato is right for you, call us at (808) 201-2343 - Honolulu Office , (808) 201-2343 - Kailua Kona Office or (808) 201-2343 - Hilo Office or request a consultation online today.

Frequently Asked Questions About Esketamine (Spravato) in Hawaii