In this episode Amy Della Rocca, PMHNP joins to discuss Spravato, the FDA-approved prescription esketamine nasal spray, and its place in the field of psychedelic medicine. Amy is a psychiatric nurse practitioner and the Clinical Director of Marpa, a Spravato treatment center in New York.
In this conversation, Amy offers a grounded and practical look at Spravato as one of the most accessible forms of psychedelic medicine currently available, especially for patients with treatment-resistant depression who may be priced out of intravenous or intramuscular ketamine treatments. She explains how insurance coverage, prior authorizations, and the 2025 shift allowing Spravato to be used as monotherapy have expanded access, while also walking through what treatment actually looks like in practice - from REMS monitoring and nasal spray administration to maintenance schedules and the importance of outside therapeutic support. Throughout, Amy emphasizes that Spravato can produce a wide spectrum of psychedelic effects, that it should not be dismissed as a "lesser" medicine because it is FDA-approved or pharmaceutical, and that the most effective treatment happens in a relational container that balances medical safety, emotional support, and realistic expectations about what the medicine can and cannot do.
In this episode, you'll hear:
- What Spravato is and how it differs from other forms of ketamine treatment
- How insurance coverage, Medicaid, and copay assistance can make psychedelic care more financially accessible
- Which two diagnoses Spravato is approved to treat
- Why the 2025 approval of Spravato as a monotherapy meaningfully changed patient eligibility
- What a typical Spravato session looks like, including dosing, REMS monitoring, and maintenance treatment
- Why therapy, integration support, and external community can strongly influence treatment outcomes
- How patients' experiences can range from subtle relaxation to deeply psychedelic states
- Why stigma within psychedelic spaces can invalidate ketamine experiences - and why Amy argues that needs to change
- What makes a patient a good candidate for Spravato treatment
- How clinicians can carefully work with complex cases, including suicidality, trauma histories, and bipolar depression
Quotes:
"Generally we have Medicaid covering [Spravato treatments]. We have no co-pays on that or maybe it's a five-dollar co-pay. With some insurances, if there's a big deductible, they will have to pay the deductible like other treatments." [6:38]
"In 2025, the FDA changed that requirement [to be on an antidepressant to receive Spravato treatments]. And now Spravato is… approved for monotherapy. So, as you know, so many of the people that are coming to us are not taking daily antidepressants because they've had terrible side effects. Or… they've felt worse, it increased their [suicidal ideation] or, you know, whatever it was. And so to have them still have to take one just felt like the wrong thing to do." [8:34]
"I would say 30% of the patients continue [regular Spravato treatments] on some level—40% maybe of maintenance. And that can be every two weeks; it can be every week. There are plenty of folks that find that the glutamate activity of this medicine helps them more than anything they've ever taken and so they end up tapering off of other meds and continue to get weekly sessions with us." [14:28]
"This treatment feels, in a way, like a half-treatment without outside therapy" [15:25]
Links:
Amy on LinkedIn
Marpa Minds website
Journey Clinical website
Psychedelic Medicine Association Course: Managing Medical Risk in Patients Seeking Psilocybin Therapy
Previous episode: Ending Pill Shaming: How Psychedelics and Pharmaceuticals Can Both Support Healing with Erica Zelfand, ND
Previous episode: Ketamine Therapy Explained: The Science Behind Mental Health Treatment with Dr. Jason Wallach
Psychedelic Medicine Association
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