SPV · FDA-approved
For depression that regular antidepressants hasn't helped.
If two or more antidepressants haven't worked, you're not the problem. One in three people don't respond to traditional depression medications. SPV is an FDA-approved treatment that acts on a different system in the brain. Many people feel a real shift within hours or days, not weeks.
What is SPV?
SPV is a prescription esketamine nasal spray for adults whose depression hasn't responded to other pills. The FDA approved it in 2019 for adults with depression that hasn't responded to other medications, and again in 2020 for adults with major depression who are having serious thoughts of suicide. You take it inside a certified clinic, where a team watches over you, in a course of sessions. It's the first depression medicine approved in decades that works on a different system in the brain than SSRIs and SNRIs.
- FDA-approved since 2019
- Covered by most major insurance
- Free eligibility & insurance check
- Real human follow-up
How SPV works
A different brain pathway ∼ and why that matters.
SSRIs and SNRIs target a chemical called serotonin. They work for many people, and are usually the first medication physicians recommend. But regular antidepressants don't work for everyone, and the way they work is part of the reason. SPV works with a different chemical messenger called glutamate. Glutamate is the most common chemical signal in the brain, and it plays a big role in how brain cells form and keep the connections between each other. If you have depression that several medications haven't fixed, research suggests your serotonin system may not be the main problem. Because SPV acts on the glutamate system instead, it may help quickly rebuild the connections between brain cells that depression has weakened. That's why some people feel a real shift after SPV within 24 hours, instead of the 4 to 6 weeks SSRIs usually need. The bigger story is that this is a different kind of treatment, which is why it can work when others haven't.
Could a different approach help you?See it in action
What the research shows
The numbers behind SPV.
These figures honestly express what SPV is. It is meaningfully more helpful than the next-line option for many people, with a different set of side effects. But SPV is not a miracle cure; just a tool that may target the actual problem more directly.
49%
of patients whose depression hadn't responded to regular antidepressants were in full remission at 32 weeks on SPV.
Reif et al., 2023, New England Journal of Medicine
∼70%
showed at least some improvement on SPV within 4 weeks.
Popova et al., 2019, American Journal of Psychiatry
24h
is when SPV's effect on depression first became measurable. SSRIs usually take 4 to 6 weeks.
Popova et al., 2019, American Journal of Psychiatry
<1%
of patients on SPV experienced libido loss, compared to up to 70% on SSRIs and SNRIs.
2025 systematic review, PubMed
The numbers are useful to build a picture, but a general one. The only way to know if SPV could work for you is to check the basics against your own history.
Take the 30-second quiz →Who SPV is for
Two FDA approvals. Two specific groups.
Depression that hasn't responded to pills
If you've tried at least two different antidepressants at the right dose for the right amount of time without enough relief, SPV may be right for you. The most common reason people are referred for SPV.
Major depression with thoughts of suicide
In 2020, the FDA also approved SPV for adults with major depression who are having serious thoughts of suicide. This use is also taken alongside an antidepressant pill, with closer medical follow-up.
If you or someone you love is in immediate crisis, please call or text 988 before doing anything else.
Your brain is healingYour brain is healingWho SPV is not for
- Adults who haven't yet tried at least two meds (SPV isn't currently approved as a first-line treatment for depression)
- People with certain blood vessel conditions in the brain, or a history of brain bleeds
- People who are pregnant or breastfeeding
- People with active psychosis or untreated bipolar disorder (a provider will decide case by case)
What to expect
Your treatment at a partner clinic near you.
SPV is always given inside the clinic, with in-person care. There's no at-home version, and anyone offering one is not offering SPV.
Before your first session
You'll meet with a licensed provider at the partner clinic in your city, or nearby, for an initial visit. They'll review your treatment history, current medications, and confirm if SPV is a fit. If it's a match, the clinic will request approval from your insurance to cover SPV.
During a session
SPV is administered in a private and comfortable room at the partner clinic. It starts working within minutes. For the next two hours, you'll rest while clinic staff check your blood pressure and how you're feeling. Many people describe a brief floating or psychedelic feeling during the first 40 minutes, which fades as the session goes on. You won't be able to drive home. Most people get a ride from a friend, family member, or rideshare.
Your treatment timeline
The starting phase is twice a week for 4 weeks (8 sessions total). After that, your provider will set a maintenance schedule based on how you're doing, often weekly or every other week, and visits can usually be spaced out over time. Some people find real relief after the first session. Others take longer
Insurance & cost
We'll handle the paperwork & process, together.
SPV is covered by most major insurance plans, including most commercial plans, Medicare, and some Medicaid plans as well. It usually has to be approved by your insurance first ~ that step is called prior authorization. Psycle Health and your partner clinic handle that approval for you. We check your benefits, help you with the paperwork, and tell you exactly what your out-of-pocket cost will look like before your first session.
Most plans
Commercial and Medicare cover SPV with prior auth
5~7 days
Typical prior authorization turnaround
Free
Benefits check and clinic matching at no cost
Without insurance, the out-of-pocket cost for SPV is high. It's best to consider all possible options for insurance coverage rather than paying in cash, which Psycle can help with. If you don't have coverage, our team can help you understand patient assistance programs offered by Janssen.
From SPV patients in their words
"The medication itself is wonderful, but the support around it is what really makes the difference. I've been able to continue with psychotherapy sessions after my SPV treatments, which helped me integrate everything I was learning. It's been an incredible experience, and I wouldn't go anywhere else."
Denise N.
"We both struggled with the after-effects of COVID. I dealt with fatigue that lasted about four months and gained a lot of weight because of it. I started working out, but kept hitting a wall; I just didn't have the energy. Now I have energy, motivation, and a lot more confidence that the work I'm putting in is actually paying off. Looking back, I can give myself credit. I was genuinely sick, and I needed something to help me through it."
Nick P.
"It was a joy I hadn't experienced in a very, very long time, maybe never. This treatment allowed my brain to let go of the worries that usually creep into even the most beautiful moments, so I could actually enjoy them. I couldn't do that before. Throughout the day I kept having these moments where I thought, this is profound. I've had a lot of good things happen to me, but I could never really feel them. Now I can."
Sonia C.
"During treatment, I found myself revisiting parts of my childhood, including people who had hurt me deeply. What surprised me was how much love and empathy I felt toward them in that moment. I actually felt sorry for them, wondering what happened to make them hurt me the way they did. It was the first time I ever felt real peace toward them."
Carol J.
"For years I lived in fear. My anxiety never let my mind shut off. TMS feels different than you'd expect, almost like it's gently balancing your brain out. From the moment I walked in, the team made me feel supported. Now I can go to therapy, run errands, do laundry, all in the same day. Something I haven't been able to do in over twenty years."
Simone D.
"I've been diagnosed with PTSD, and I was in a really bad place. My life had been deeply affected, and we'd exhausted so many treatment options without much relief. I heard about TMS through a radio ad, and my husband suggested we try something new. I'm so glad I took his advice. Learning that the brain can be stimulated in the areas connected to happiness gave me a completely different perspective. It really worked."
Patti, V.
"I was in the darkest period of my life, and SPV helped me out of it. It gave me a completely different way of thinking about my problems, a new perspective. Instead of dwelling, I learned to approach things proactively and pragmatically. Now when something difficult comes up, I don't spiral, I process it and move on."
Scott T.
"I lived with high-functioning anxiety for about 15 years. Once I started TMS, I felt the weight lift off my shoulders. I used to be go-go-go all day, every day, everything urgent, everything now. Now I can actually sit down and enjoy the parts of life that matter."
Grace L.
"I noticed a real difference in my behavior, my mood, my motivation. I was in a very deep depression, and medication just wasn't working. Then I found out about SPV, and it helped me move past that depression so much faster than I expected. The people caring for me were wonderful and genuinely concerned about my wellbeing. I wouldn't go anywhere else."
Judy P.
"I wasn't in a good place at all. Within 24 hours, I experienced a couple of deaths close to me and just couldn't function. I reached out for help, and was told to see a psychiatrist and get on medication. I didn't want to spend the rest of my life on a pill, so I looked for something different. From the moment I walked in, I knew I was in the right place. They made me feel comfortable, with no judgment at all, and that made all the difference. They actually care, they want to understand what's really going on, not just prescribe something. I feel like I'm finally getting somewhere, and I feel better than I have in a long time."
Brian N.
"I've completed 35 of my 36 TMS treatments, and I feel like a brand new person. I can concentrate. I can read something once instead of twelve times. I can stop working at 5pm and actually enjoy time with my family. By my second session, my mind used to race until 10pm every night. TMS gave me my focus, and my evenings back."
Elizabeth T.
"A friend recommended SPV when I was in a really dark place. Within two weeks, I noticed a real shift, in my mood, my energy, the way I showed up every day. I was happier, more motivated, getting things done at work again. I knew something had to change, and this is what changed it. SPV gave me my life back."
Nancy T.
"The desire to drink alcohol disappeared after just my first two treatments. By my third and fourth, I noticed a real shift, I could pause instead of reacting, and my self-awareness and ability to recognize my own emotions grew so much. I'd recommend this to anyone who feels out of touch with themselves or overwhelmed by anxiety. The possibility of living without that constant weight is immense."
Rachel M.
"My husband and I had both struggled with depression and anxiety for years. On the outside I looked fine, always smiling, but inside I didn't want to leave the house, didn't want to go to family functions. I finally told my husband, this is the year we do something about it. About two weeks in, I noticed a huge difference. I felt social again, like myself again. I've been in different types of therapy since I was 25, and this is the first thing that has truly worked."
Dana M.
"When medication doesn't give you the results you're hoping for, TMS offers another path, one that helps you feel better without changing who you are. Antidepressants made me feel like a different version of myself. With TMS, I found relief and reconnected with a part of me that had been asleep for a long time."
Dave S.
"It has changed my life in every way. I'm a much happier person, more outgoing, and I'm finally sleeping well. It's been like a miracle. If you're struggling, give this a try. I guarantee you won't regret it."
Marcus B.
"Within two weeks, I noticed a real difference, smiling more, getting out of the house, showing up for my life again. The team makes it easy too. They respond fast and make you feel like you actually matter. I'm grateful every day. I'm simply a different person now."
Julie S.
"I sat in that chair for an hour and came out with thirty years of junk cleared out of my head. That, to me, was a miracle. I haven't felt this good in probably three decades. It works. You can go from feeling like trash to feeling normal in the span of two hours. If you're on the fence, don't be. They'll treat you well, and you'll feel amazing when you leave."
Doug M.
"I'm investing in myself, and it's paying off. Before, I couldn't get out of bed. I didn't want to see anyone. I was afraid to go outside, overwhelmed by anxiety. TMS gave me space to reconnect with myself, not the person I used to be, but a new version of me. And there's something exciting about that."
Yvonne R.
"The first time I tried SPV Therapy, I noticed the change immediately. Before, I was living with anxiety and depression, on four different medications, trying to find relief without wanting all the side effects that came with them. I decided to give SPV Therapy a try, and it changed my life completely."
Kristen H.
"Where I come from, you don't talk about mental health. You just smile and say everything is fine, because the moment you admit something's wrong, people treat you differently. That fear keeps a lot of us quiet. This treatment doesn't bring back who you used to be, it introduces you to a new you, and there's something exciting about that, especially when you'd lost the will to even get out of bed. The best person you've been looking for your whole life is you."
Angela W.
Ready to get support?
- No commitment
- Real humans
- Free verification
- HIPAA-compliant
How to get started
We've made this as simple as we can.
01
Check
Take the 30-second quiz and share your insurance details so we can check coverage for free.
02
Consult
Meet with a Psycle Health Care Coordinator to confirm if a partner clinic is a fit.
03
Evaluate
Speak with a licensed medical professional to confirm you're a candidate.
04
Authorize
The clinic will submit a prior authorization to your insurance, which takes 5-7 days on average.
05
Improve
Begin twice-weekly starting sessions, with our team supporting you through every visit.
Frequently asked questions about SPV.
SPV (esketamine) is an FDA-approved nasal spray for treatment-resistant depression. It works on the brain's glutamate system — a different pathway than traditional antidepressants — helping restore connections between brain cells. It's taken in a certified clinic under medical supervision, usually alongside an oral antidepressant.
Yes. SPV was FDA-approved in 2019 for treatment-resistant depression, and in 2020 for depressive symptoms in adults with major depressive disorder with suicidal thoughts or actions. Because of this approval, it's covered by most major insurance plans.
SPV is the FDA-approved form of esketamine, delivered as a nasal spray, while IV Keta is used off-label for depression. That difference matters for cost: insurance typically covers SPV but rarely covers IV Keta, which usually runs $400-$800 per infusion out of pocket.
Most people feel a temporary sense of relaxation or mild dissociation — a dreamlike, floating feeling — within the first hour. You'll remain in the clinic for about two hours of monitoring while the effects wear off, and you'll need someone to drive you home afterward.
Some people notice improvement within hours or days of their first sessions — much faster than the weeks typical of oral antidepressants. Treatment starts with twice-weekly sessions for the first month, then tapers based on how you respond.
You haven't run out of options. You may just not have been offered the right ones yet.
Take the 30-second quiz. We'll tell you honestly whether SPV is a real option, verify your insurance for free, and ~ if you qualify ~ book a consultation at a partner clinic in your area.