Spravato
Nasal Spray for Treatment-Resistant Depression in Doylestown, PA (Coming Soon – Fall of 2026)
Buckingham Advanced Psychiatry in Doylestown, PA, will soon offer Spravato, the brand name for esketamine, delivered as a nasal spray for adults living with treatment-resistant depression (TRD) or major depressive disorder (MDD) with acute suicidal ideation or behavior (MDSI) if standard antidepressants have not worked. Spravato is used in combination with an oral antidepressant and administered in our Pennsylvania office under close monitoring. For those who have tried two or more antidepressants without enough relief, this FDA-approved option can help open a path forward. This treatment will be available exclusively at our Doylestown, PA office.
How Spravato Works
Esketamine targets the brain’s glutamate system by modulating NMDA receptors, which can rapidly enhance synaptic plasticity and mood circuits. Many patients notice meaningful symptom improvement within hours to days of initial sessions, with benefits building over the first several weeks. For MDD with acute suicidal ideation or behavior, Spravato may reduce symptoms quickly; however, it is not a substitute for emergency care. All treatments occur in our clinic through a Risk Evaluation and Mitigation Strategy (REMS) program, with a trained clinician guiding every step.
How Spravato is Administered Safely
Spravato is only available through the FDA-required REMS program and is not prescribed as a take-home medication. Each dose is self-administered in our office under the supervision of our clinical team, followed by a mandatory two-hour monitoring period before you are cleared to leave.
The observation period is required because Spravato can temporarily cause side effects such as dissociation, dizziness, or changes in blood pressure shortly after treatment. This monitoring ensures your safety while these short-lived effects resolve, typically before you leave the office. Due to these effects, you will need to arrange transportation home and should not drive or operate heavy machinery for the remainder of the day.
Who May Be a Candidate for Spravato?
Spravato may be appropriate for adults with TRD (inadequate response to at least two antidepressants from different classes) or for MDD with acute suicidal ideation or behavior. We conduct a thorough evaluation, review medical history, and coordinate with your current prescriber. Certain conditions require caution or may exclude use, such as uncontrolled hypertension, recent aneurysm or hemorrhagic stroke, certain vascular malformations, or pregnancy. We also discuss past substance use and potential medication interactions to support a safe plan.
What Spravato Treatment Visits Look Like
Spravato is self-administered in our Pennsylvania office under supervision. On the day of your Spravato treatment, you will begin by checking in and completing a brief health assessment, including a blood pressure check, to ensure it is safe to proceed. Once cleared, you will self-administer the nasal spray in a private, comfortable treatment room under the supervision of our clinical team. After dosing, you will remain in the office for approximately two hours while we monitor your response and well-being. During this observation period, many patients choose to relax, listen to music, or rest quietly. When the monitoring period is complete and you are feeling well, your designated driver can take you home to continue your day comfortably.
What to Expect from a Spravato Treatment Course
A typical Spravato treatment plan begins with an initial four-week phase in which patients receive treatment twice weekly to establish a therapeutic response. During the following four weeks, treatments are usually reduced to once per week as your provider evaluates your progress and adjusts your care plan as needed. After that, maintenance treatments are scheduled every one to two weeks based on your individual needs, with the goal of sustaining symptom relief using the lowest effective treatment frequency.
Meet Dr. Buinewicz
Trained in the combined use of psychotherapy and medication, he offers evidence based treatment for a variety of psychiatric disorders. He has specific expertise in mood and bipolar disorders, ADHD, anxiety disorders, OCD, and PTSD. He also offers care for common sources of stress including life transitions, decreased productivity at work, relationship issues, and grief.
Dr. Buinewicz believes all treatment should begin with a patient-centered comprehensive and holistic evaluation. Patients are involved in creating a treatment plan that may include medications, therapy, or a combination of both. He believes that therapy is often a critical component of care as evidence shows that it provides benefit over medication alone. His therapeutic approach is tailored to the individual patient and contains elements of psychodynamic psychotherapy, Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Acceptance and Commitment Therapy (ACT).
Spravato vs. BrainsWay Deep TMS: How Do They Compare?
Choosing the Right Path: BrainsWay Deep TMS is Also Available
Spravato (esketamine) is FDA-approved specifically for TRD and for MDD with acute suicidal ideation or behavior when used with an oral antidepressant.
Considering a non-medication alternative? BrainsWay Deep TMS is a non-invasive, medication-free option that stimulates mood-related brain networks. It uses gentle magnetic stimulation to activate targeted brain regions. This non-invasive treatment requires no medication, anesthesia, or recovery time and is FDA-cleared for depression, OCD, and more.
We offer both Spravato and BrainsWay Deep TMS, and we can help you compare benefits, side effects, visit schedules, and insurance coverage to decide what fits best.
Spravato FAQs
How is Spravato Different from Traditional Antidepressants? +
How Soon Might I Feel Better? +
What Side Effects Should I Expect from Spravato? +
Is Spravato Covered by Insurance? +
We recommend contacting our office with your insurance information so our team can verify your benefits and review any potential out-of-pocket costs before your appointment.
Do I Need to Stop My Current Antidepressant Before Taking Spravato? +
A Full Spectrum of Mental Health Care
Compassionate Care for Doylestown, PA
Our psychiatrists Dr. Jacob Buinewicz and Dr. Vihasa Govada, and psychologist Dr. Sophie Buinewicz, provide comprehensive, evidence-based mental health care. In addition to Spravato, we also offer BrainsWay Deep TMS, and the GeneSight Test, as well as other psychiatric services.
We take time to understand your history, goals, and what hasn’t worked yet. Whether you pursue Spravato, BrainsWay Deep TMS, or a combined approach with psychotherapy and medication management, we build a plan around you and check in often to keep you moving forward.