Anxiety is a persistent, exhausting psychological weight that traditional antidepressants and therapy can’t always lift. Spravato (esketamine) is an FDA-approved treatment for depression that can help patients with anxiety, too.
Understanding Anxiety Disorders
Anxiety is a persistent state of fear and tension that doesn’t ease up even when there’s no clear threat. The mental disorder can also manifest through physical symptoms, such as restlessness, heart palpitations, tension, and shortness of breath.
Anxiety disorders include:
- Generalized anxiety disorder (GAD): Chronic worry across multiple areas of life, often paired with physical tension, fatigue, and difficulty concentrating.
- Social anxiety disorder: Intense fear of social situations and being judged by others, which can interfere with daily life and relationships.
- Panic disorder: Recurring, unexpected panic attacks and persistent fear of the next one.
- Post-traumatic stress disorder (PTSD): Anxiety rooted in past trauma, often involving hypervigilance, intrusive thoughts, and emotional withdrawal.
- Obsessive-compulsive disorder (OCD): Unwanted intrusive thoughts paired with compulsive behaviors used to manage distress.
Common treatments for anxiety include cognitive behavioral therapy (CBT) and traditional antidepressants such as SSRIs and SNRIs. For many patients, these approaches provide meaningful relief. For others, symptoms persist despite trying multiple treatments.
What Is Spravato?
Spravato (esketamine) is an FDA-approved nasal spray (often administered with an oral antidepressant) derived from ketamine, developed specifically for treatment-resistant depression. The treatment is administered in a certified clinical setting under medical supervision and REMS outlines.
The same dysregulation in glutamate signaling, neuroinflammation, and reduced neuroplasticity that underlie depression are frequently present in anxiety. That’s why Spravato and other treatments that help with depression have shown promise in treating anxiety.
But it is considered an off-label use, and insurance companies do not reimburse for Spravato for anxiety as the primary diagnosis.
How Can Spravato Help With Anxiety?
Spravato works differently from traditional antidepressants. Instead of targeting serotonin like SSRIs and SNRIs, it affects glutamate, a key neurotransmitter involved in learning, memory, and brain communication.
By blocking NMDA receptors, Spravato increases glutamate activity and stimulates the prefrontal cortex, a brain area responsible for mood regulation that’s often underactive in depression. This also supports neuroplasticity, helping the brain form new connections, repair stress-related damage, and break negative thought patterns.
Spravato (Esketamine) vs. Traditional Anxiety Treatments
When you’re weighing up options, it helps to see them side by side. Here’s how Spravato compares to more conventional approaches.
| Treatment | Spravato (Esketamine) | SSRIs / SNRIs | CBT / Talk Therapy |
| How It Works | Targets glutamate via NMDA receptors | Regulates serotonin or norepinephrine | Restructures thought patterns through guided sessions |
| Onset of Effects | Hours to days | Several weeks | Weeks to months |
| Administration | Nasal spray, in-clinic only | Daily oral medication | Weekly or bi-weekly sessions |
| Duration of Treatment | Twice weekly for 4 weeks, once weekly for 4 weeks, then maintenance sessions as needed | Several months to years | Typically 12–20 sessions; ongoing as needed |
| Insurance Coverage | Not covered for anxiety (only treatment-resistant depression) | Typically covered | Typically covered |
| Best Suited For | Treatment-resistant cases; co-occurring depression and anxiety | Mild to moderate anxiety; first-line treatment | All severity levels; for skill-building and processing |
| Potential Side Effects | Nausea, dizziness, dissociation, and increased blood pressure | Nausea, fatigue, weight gain, and sexual dysfunction | No physical side effects; may temporarily increase emotional distress during processing |
| Black Box Warning | None | Some antidepressants carry an increased risk of suicide (under 25) | None |
Who Is a Candidate for Spravato Treatment?
Spravato is FDA-approved for treatment-resistant depression and for major depressive disorder with suicidal ideation. Anxiety treatment with Spravato is typically considered in patients whose anxiety co-occurs with these diagnoses, or for whom other interventions have not provided adequate relief.
You may be a candidate if you:
- Have an anxiety disorder alongside major depressive disorder that hasn’t responded to at least two antidepressant treatments
- Have tried cognitive behavioral therapy and medication without significant improvement
- Are looking for a faster-acting treatment option
- Are medically cleared by a provider and willing to commit to an in-clinic treatment protocol
A thorough evaluation with your care team is always the first step. Spravato isn’t the right fit for everyone, but for the right patient, it can be life-changing.
What Spravato Sessions Look Like at Kadelyx
We are big believers in the “set and setting” concept, which is the idea that where and how a treatment happens shapes the outcome just as much as the treatment itself. This is especially true for patients dealing with anxiety, where feeling safe and unhurried is also clinically relevant.
During a Spravato session, you’ll self-administer the esketamine nasal spray under the guidance of our clinical team. Sessions are typically administered in a group setting of up to 6 people at a time. They’re conducted in a calm, carefully designed clinical space that’s nothing like a typical medical waiting room.
You’ll be monitored throughout, with staff present to support you. After your session, there’s space to reflect, ground yourself, and begin making sense of the experience. Healing doesn’t happen in a vacuum, and we don’t treat it like it does.
Break Free From Anxiety
If anxiety has made daily life harder than it needs to be, and traditional treatments haven’t given you the relief you were hoping for, Spravato may be worth exploring. Our team at Kadelyx is here to answer your questions honestly, evaluate whether Spravato is the right fit for you, and support you through every step of the process, so book your free consultation today.
