SPRAVATO TREATMENT
FDA-approved esketamine therapy for adults whose depression has not responded to other treatments.
Reviewed by Dr. Samuel
WHAT SPRAVATO IS
Spravato is the brand name for esketamine, a nasal spray approved by the FDA for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder who have suicidal thoughts. It works differently than standard antidepressants. Rather than acting on serotonin over a period of weeks, esketamine acts on the brain’s glutamate system, and many patients notice a change sooner.
Spravato can be prescribed alongside an oral antidepressant, or on its own. The FDA approved it as a standalone treatment for treatment-resistant depression in January 2025, and your provider will decide which approach fits your situation. If you are not sure whether you have reached that point, start with our depression treatment page.
WHO IT IS FOR
Spravato is generally considered when an adult has tried at least two antidepressants at an adequate dose and duration without sufficient relief. Our providers review your full treatment history before recommending it, and we will be direct with you about whether it is a reasonable next step.
WHAT A TREATMENT VISIT LOOKS LIKE
Because of how esketamine works, Spravato can only be given in a certified healthcare setting under the FDA’s REMS program. You self-administer the nasal spray in our office, then stay for at least two hours while our staff monitors your blood pressure and how you are feeling. You cannot drive yourself home afterward, so plan for a ride. Our guide to what ketamine therapy feels like walks through the session in more detail.
Treatment typically starts twice weekly, then steps down over time based on how you respond.
SIDE EFFECTS AND MONITORING
The most common effect is dissociation, a temporary sense of being disconnected from your body or surroundings. With Spravato this is expected, and it usually resolves within a couple of hours. That is exactly why the two-hour monitoring window exists. Other common effects include increased blood pressure, dizziness, nausea, and sedation. We cover all of these in detail in Spravato side effects: what to expect and why the monitoring matters.
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