Spravato With Your Current Prescriber: Questions to Ask

If your current prescriber does not offer Spravato (esketamine), the usual path is a separate evaluation at a practice that does, while your existing clinician continues managing the rest of your care. Whether that split works depends on both practices agreeing to coordinate — and the only way to find out is to ask each side specific questions before anything is scheduled. This article gives you those questions, and explains why each one matters.

Can I keep my current prescriber if I get Spravato somewhere else?

Sometimes, but it is never automatic. Two practices sharing responsibility for one person's psychiatric care is often called shared care or co-management, and it only works when both sides explicitly agree on who is responsible for what. Some practices are comfortable coordinating with an outside clinician. Others prefer to manage everything themselves. Some will provide Spravato only if they also take over your oral antidepressant. None of those positions is wrong — each reflects how a practice manages safety and accountability — but you need to know where each office stands before you invest time and money.

So the first question is not clinical at all. Ask the Spravato practice: "My medications are managed by another clinician. Do you evaluate patients in that situation, and if so, how do you coordinate with the other office?" And ask your current clinician: "If I'm evaluated for Spravato elsewhere, are you willing to keep prescribing my current medications and exchange records with that practice?"

If either answer is no, you will know early — before you have booked an evaluation that cannot lead anywhere.

Why does Spravato involve a second practice at all?

Spravato is not a prescription you fill and take at home. According to its FDA prescribing information, it is available only through a restricted program called a REMS, is administered under the supervision of a healthcare provider at a certified site, and requires monitoring for at least two hours after each dose. Patients are also told not to drive or operate machinery until the next day, after a restful sleep. This is why a practice with no certified treatment site can't just tack Spravato onto your existing appointments — and why a second practice so often ends up in the picture.

It also helps to know what Spravato is approved for. In adults with treatment-resistant depression, the label allows it to be used on its own or together with an oral antidepressant. For its other approved use — depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior — it is used together with an oral antidepressant. That distinction matters for the "who prescribes what" conversation below, because in many arrangements someone still needs to manage an oral medication.

The label also describes real risks, including sedation, dissociation (feeling disconnected from yourself or your surroundings), respiratory depression, the potential for abuse and misuse, and temporary increases in blood pressure. And it states plainly that Spravato has not been shown to prevent suicide or to reduce suicidal thoughts or actions. If you are having thoughts of suicide right now, call or text 988 (the Suicide & Crisis Lifeline) or call 911 — do not wait for an evaluation.

This article is about coordinating two practices, not about the treatment itself. For what a course of treatment involves, see our overview of how Spravato treatment works.

Who prescribes each medicine — and who handles refills?

Because Spravato for treatment-resistant depression may be given alone or alongside an oral antidepressant, the question of who manages the oral medication is not a technicality. Ask both offices:

• Who will prescribe the Spravato, and who will continue prescribing my oral antidepressant and any other psychiatric medications?
• If the Spravato clinician thinks my oral antidepressant should change, will they contact my current prescriber directly, or will I be expected to carry that message?
• Who do I call for a refill, and will each office be able to see — or at least be told — what the other has prescribed?
• If my current prescriber is also treating something else, such as anxiety or ADHD, does anything about those medications need to be reviewed before Spravato is considered?

One firm rule while all of this gets sorted out: do not change or stop any medication yourself to make the logistics simpler. Stopping psychiatric medication abruptly can be harmful, and any change should come from the clinician who prescribed it.

How will my records move between the two practices?

Medical records do not follow you automatically. Sharing them between two practices requires your written authorization — usually a release-of-information form at each office. Ask:

• What authorization forms do I need to sign, at each office, so the two of you can talk to each other?
• What does the evaluating practice need before my appointment — a diagnosis history, a list of medications I have tried and how I responded, my current medication list?
• After I start treatment, will notes or summaries go back to my current prescriber, and how often?
• How do you actually exchange records — secure fax, a patient portal, mailed copies — and how long does it take?

One caution worth stating plainly: do not send your medical history through a website contact form or a comment box. Those channels are typically for scheduling questions, not clinical information. If you are reaching out to a practice like ours, start with the booking process and save the clinical details for the intake paperwork and the appointment itself.

Who do I call about side effects or urgent concerns?

The most predictable effects — sedation, dissociation, blood-pressure changes — occur around the dose itself, which is one reason the label requires at least two hours of supervised monitoring at the clinic. But questions can come up that evening, or days later, and you should not be guessing at midnight which office to call. Ask:

• If I feel unwell hours after a session, which office do I call first, and what is the after-hours process?
• If a concern might be about my oral antidepressant rather than the Spravato, who is my first call?
• Are there symptoms where I should skip both offices and go straight to emergency care?

And the standing answer that applies regardless of what either office says: if you or someone with you is in immediate danger, call 911, and if you are in emotional crisis or having thoughts of self-harm, call or text 988.

What does a Spravato evaluation actually decide — and what doesn't it?

An evaluation is a clinical assessment of whether Spravato is appropriate for you. Expect the clinician to review your diagnosis, the treatments you have already tried, your medical history (including blood pressure), and your current medications. Spravato's approved uses are specific to depression in adults; if the diagnostic picture points elsewhere — for example toward bipolar disorder — the conversation may turn to different options instead.

It is just as important to know what an evaluation is not:

• It is not a guarantee you will be treated. The evaluating clinician may conclude Spravato is not appropriate for you right now, and may suggest other directions for your depression treatment.
• It is not insurance approval. Coverage is a separate process between the practice and your insurer, often involving prior authorization. Ask the practice how that works, review the insurance information any practice publishes, and confirm details with your insurance company directly.
• Nobody is taking over your care — not unless everyone involved, you included, agrees that's how it should work.

It is also fair to ask who will actually evaluate you. At MindVibe, evaluations are performed by our psychiatric clinicians; at any practice, you can ask about the evaluating clinician's role and licensure before you book.

How do I bring this up with my current clinician?

Plenty of patients hesitate here, worried that raising Spravato might offend the clinician who has been treating them all along. It should not. The National Institute of Mental Health encourages patients to write down questions before appointments and notes that discussing treatment options — including seeking another opinion — is a normal part of care. A clinician who has watched you work through multiple medications will usually understand exactly why you are asking.

Three questions to bring to that appointment:

• Based on what we have tried so far, do you think a Spravato evaluation is a reasonable next step?
• If I pursue it, are you willing to keep prescribing my other medications and share records with the evaluating practice?
• Is there anything in my history worth flagging to the other practice up front?

Frequently asked questions

Do I have to stop my current antidepressant to start Spravato?

Not necessarily. For treatment-resistant depression in adults, the FDA label allows Spravato on its own or together with an oral antidepressant. Decisions about your specific medications belong to the evaluating clinician and your current prescriber — never change anything on your own.

Will the Spravato practice take over all of my psychiatric care?

That hinges on two things: the practice's own policy, and what your current clinician agrees to. Some practices co-manage; others require a full transfer of care. Ask directly before booking — and don't assume any practice, ours included, will agree to a particular arrangement until you've confirmed it.

Can my current prescriber just refer me?

A referral or records summary from your current clinician often helps, and some practices will ask for one. But a referral by itself does not create a shared-care arrangement — the responsibilities still need to be agreed by both offices.

Does getting an evaluation mean I will be approved for Spravato?

No. An evaluation determines whether treatment is clinically appropriate for you, and even then, insurance coverage is a separate step. Treat the evaluation as a conversation, not a commitment in either direction.

Can I drive myself home after a Spravato session?

No. The prescribing information says patients should not drive or operate machinery until the next day, after a restful sleep. Plan for a ride to and from every session, and ask the practice how it confirms your transportation.

What if the two practices disagree about my treatment?

Ask each office, before you start, how disagreements would be handled — for example, whether the clinicians will speak directly rather than sending conflicting instructions through you. If you ever receive contradictory directions about a medication, call the prescriber of that specific medication and follow their guidance.

Is Spravato used for anxiety, ADHD, or conditions other than depression?

Its FDA approvals are for treatment-resistant depression in adults and for depressive symptoms in adults with major depressive disorder with acute suicidal thoughts or behavior. If your primary concern is a different condition, an evaluation may point you toward other treatments instead.

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If you are in crisis: call or text 988 to reach the Suicide & Crisis Lifeline, available 24/7, or call 911 or go to the nearest emergency room if you or someone else is in immediate danger.

Sources

• SPRAVATO (esketamine) Prescribing Information, Janssen Pharmaceuticals / Johnson & Johnson, revised March 2026: https://www.jnjlabels.com/package-insert/product-monograph/prescribing-information/SPRAVATO-pi.pdf
• National Institute of Mental Health, "Tips for Talking With Your Health Care Provider": https://www.nimh.nih.gov/health/publications/tips-for-talking-with-your-health-care-provider

This article is for educational purposes only and is not medical advice, a diagnosis, or a treatment recommendation. Talk with your own clinicians before making any change to your care.