Dealing with depression is challenging enough, but it’s even more frustrating when standard antidepressants just aren’t working. If you’ve tried multiple medications without feeling better, you might be experiencing treatment-resistant depression (TRD).
The good news is that there are newer treatments. Spravato — an esketamine nasal spray — works differently from traditional pills and is giving people a new path forward.
Wondering if this treatment could be the right option for you? This guide will help. I’ll explain Spravato, its effects, who it helps, and what to expect. No complicated medical jargon, just plain, straight information to help you understand your options.
What Is Spravato?
The basics: esketamine nasal spray
Spravato is a nasal spray that you put in your nose that has esketamine, a drug related to ketamine. The drug was first approved by the FDA in 2019 as an adjunctive treatment for adults with treatment-resistant depression (TRD) who are taking an oral antidepressant. Its authorized uses have since grown.
In early 2025, Spravato was approved to treat some adults with treatment-resistant depression on its own. It is also approved for the treatment of adults with major depressive disorder (MDD) with suicidal thoughts or behavior as an adjunctive treatment with an oral antidepressant.
Unlike an antidepressant pill that you take at home every day, Spravato is a controlled medication that must be administered in a certified medical setting under supervision.
How does Spravato work?
Most traditional antidepressants, like SSRIs and SNRIs, work on brain chemicals such as serotonin and norepinephrine. These medications can be beneficial, but it may take a few weeks for them to work fully.
Spravato works differently. It impacts the brain’s glutamate system, which is essential to the way brain cells communicate with one another. To be more specific, it blocks NMDA receptors, which aids in initiating changes in brain activity and promotes neuroplasticity, or the brain’s ability to make and strengthen connections.
Spravato, in simple terms, can help the brain repair and restore pathways related to mood faster than traditional antidepressants.
Some people feel better within hours or days, but it usually takes a few weeks for the full effect to develop during the first few weeks of treatment.
Quick comparison
- Spravato vs. SSRIs/SNRIs:
SSRIs and SNRIs target serotonin or norepinephrine, and Spravato targets glutamate. Spravato is administered as a nasal spray in a clinic, while SSRIs and SNRIs are usually taken daily at home in pill form. Traditional antidepressants often take weeks to work, but Spravato may work faster.
- Spravato vs. IV ketamine:
Both are working on the NMDA receptor system, but Spravato is FDA-approved and has a standardized treatment and safety program. IV ketamine is frequently used off-label, administered by infusion. Some studies show IV ketamine may work a little faster, but the results are overall pretty similar. Spravato may be more accessible through more established clinical and insurance routes.
Wondering if Spravato is Right for You?
Let’s break down exactly who this treatment is for and who might want to consider other options.
What is it approved for?
Spravato is primarily approved for treatment-resistant depression (TRD) in adults. That means you’ve already tried at least two different daily antidepressants and not found relief. You can take Spravato alone or with a daily pill. It’s also approved to treat adults with Major Depressive Disorder (MDD) who have acute suicidal thoughts or behaviors, offering much faster symptom relief when used in combination with an oral antidepressant.
Who makes a suitable candidate?
You might be a strong fit for this treatment if:
- Are 18 or older and haven’t had success with multiple traditional antidepressants.
- Struggle with severe or frustrating side effects from daily pills, like weight gain, fatigue, or sexual dysfunction.
- Need immediate relief because your symptoms are severely impacting your daily life.
- Have the time and support to attend in-clinic appointments and stay for observation after your treatment.
Of course, you’ll want a complete professional assessment of your diagnosis, treatment history, and overall health.
Who should avoid it?
Spravato isn’t for everyone. You should proceed with caution or avoid it entirely if you have the following:
- A history of psychosis, schizophrenia, or certain dissociative disorders.
- A history of substance abuse, as the medication has the potential for misuse.
- Uncontrolled high blood pressure, recent heart problems, or certain blood vessel issues.
- Aneurysms or conditions that increase pressure in your brain.
Keep in mind that Spravato is not a first-step treatment and is not approved for children or teenagers. You must get the medication in a clinic under medical supervision; you can’t take it at home. Always have an open, honest conversation with your healthcare provider about your full medical history to see if this is the safest step for your mental health journey.
What to Expect with Spravato Treatment
How You’ll Take It
Spravato is administered in a certified healthcare setting under the supervision of a healthcare provider to ensure safety. You’ll give yourself the nasal spray, but a health care professional will be with you to coach you through the process.
Here is what a typical schedule looks like:
- Starting (the first 4 weeks): You will have sessions twice a week.
- Moving forward: Sessions drop to once a week and eventually every one to two weeks, depending on how well you’re doing.
You’ll take your dose (usually 56 mg or 84 mg) and then hang out at the clinic for at least two hours. This means the staff can keep an eye on you, checking things like your blood pressure and making sure you aren’t too sleepy. We have clinics so that you find this time as comfortable and relaxing as possible.
How You Might Feel During and After
You might feel a little dizzy, sleepy, or detached from your thoughts and body a little while after taking the spray. Your blood pressure may also increase for a short time. Don’t worry, these feelings tend to peak early in the session and settle down within a few hours.
After Your Session
- Arrange a ride home: You will not be able to drive or operate heavy machinery for the remainder of the day. Please make arrangements for a friend or family member to pick you up.
- Take it easy: Hold off on making any major decisions until the next day.
- Rest up: Take time to relax and to process the experience. It’s incredibly helpful for many people to combine these sessions with regular talk therapy.
To help you get the best, longest-lasting results, Spravato is typically used alongside a daily oral antidepressant.
Benefits and Potential Results
The biggest advantage is that it’s quick. If you’ve been waiting for weeks or even months to feel better, a little improvement in just a few days can make your life completely different. Studies indicate that this treatment actually works, getting people back their mood, motivation, and ability to get through the day.
Many people also report a better overall quality of life, often with fewer sexual side effects than typical antidepressants cause. And for anyone with suicidal thoughts, it can provide immediate and much-needed stability.
Everyone is different, of course. For some people, the transition is a huge change right away; for others, it is more gradual. But for people who have not had luck with other treatments, this procedure gives a real hopeful option.
Risks, Side Effects, and Safety
Common Side Effects
Like most medications, Spravato has a few side effects, but they tend to occur immediately after your treatment and subside within a few hours. You might feel:
- Feeling disconnected from your body or reality (dissociation)
- Dizziness or feeling a bit “drunk.”
- Nausea or vomiting
- Sleepiness and fatigue
- A temporary spike in blood pressure
- A mild headache or feelings of anxiety
Serious Risks and Warnings
Because Spravato is a powerful medicine, it has important warnings about serious drowsiness, problems with breathing, higher blood pressure, and the possibility of misuse. There’s also the risk that mental health problems get worse, including suicidal thoughts, especially in younger adults. You need a special monitoring program to protect you. It can cause bladder problems with long-term use at high doses, but such an occurrence is rare, and your doctor will monitor you closely for this.
How Your Clinic Keeps You Safe
Your safety is our top priority. Clinics have very strict rules to ensure you are taken care of well. Your care team will check your vitals before your dose, continuously monitor you during your treatment, and make sure you are fully alert before you leave. The best care is when you’re honest about your medical history, follow your doctor’s instructions, and speak up if you feel uncomfortable. With the right medical team on your side, these risks are very manageable.
How Does Spravato Compare to Other Treatments?
If you’re researching mental health treatments, you may want to learn how Spravato stacks up to other treatments. Here’s a quick recap:
- Traditional Antidepressants: These are usually taken daily and may take some time to work. They also come with their own side effects. If these standard medications haven’t worked for you, then Spravato is often recommended.
- IV Ketamine: IV ketamine can sometimes be faster working or feel stronger, but it is considered an ‘off-label’ treatment and requires an intravenous (IV) drip. Spravato, however, is fully approved and comes as an easy-to-use nasal spray.
- TMS or ECT: These are brain stimulation therapies, not medications. You can, in fact, combine these treatments with Spravato or do them sequentially.
- Therapy and Lifestyle Changes: These are key parts of the puzzle. Spravato works best as part of a comprehensive care plan that includes regular counseling and healthy habits.
Everyone’s mental health journey is unique. Your healthcare provider can help you determine the best combination or sequence of treatments for your specific needs.
Cost, Insurance, and Access
Spravato Cost and Payment Options. Most major insurance plans, including Medicare, cover it for approved uses. Just know that your doctor will probably have to get prior authorization first.
If you have insurance, your out-of-pocket costs are usually manageable, often down to a few hundred dollars a month with financial assistance. If you don’t have insurance, the costs can be steep. The first month (which includes 8 doses) will usually cost around $4,000-$6,000+ but the price drops in subsequent months as you need fewer doses.
See manufacturer programs like SPRAVATO with Me to help reduce your bill. Eligible patients can pay as little as $10 a treatment and even earn rebates to help pay for the required observation time.
When you’re ready to take the next step, simply use the official online finder tool to locate a certified treatment center near you.
Frequently Asked Questions
Is Spravato the same as ketamine?
No. It’s the S-enantiomer (esketamine) of ketamine, formulated for nasal use with FDA approval and specific protocols.
How quickly does it work?
Many notice changes within hours to days; a full assessment is often made after several sessions.
Is it addictive?
It has abuse potential as a controlled substance, but in supervised medical use for depression, the risk of addiction is low. No typical physical withdrawal when tapered properly.
Can I use it at home?
No, only in certified clinics under supervision due to safety requirements.
What if it doesn’t work?
Not everyone responds. Providers reassess and may adjust, combine with other therapies, or explore alternatives like TMS, ECT, or different meds.