Spravato is a prescription nasal spray containing esketamine, a medication approved by the FDA to treat treatment-resistant depression (TRD) — meaning depression that hasn’t improved after trying at least two antidepressants. It can also be used for certain adults with major depressive disorder with suicidal thoughts or behavior.

Spravato works differently from traditional antidepressants. Instead of targeting serotonin, it affects a brain system (glutamate/NMDA receptors) that can help relieve symptoms more quickly.

• It’s given as a nasal spray in a clinic or certified treatment center.

• You must be supervised by a medical professional during treatment.

• After receiving the dose, you’ll be observed for at least 2 hours before you can go home.

No. Spravato cannot be used at home — it must be administered in a healthcare setting due to safety monitoring requirements.

Typical treatment scheduling:

• Weeks 1–4: Twice per week

• Weeks 5–8: Once per week

• Ongoing: Once per week or every 1–2 weeks, depending on response
  Your doctor may adjust this plan based on how well you’re doing.

Some people notice improvement within hours or days after the first few treatments. Others may take several weeks before they see meaningful changes. Everyone’s response can vary.

Yes — the most common include:

• Feeling “spaced out” or detached

• Dizziness or drowsiness

• Nausea

• Temporary increase in blood pressure
  Because of these, you stay for observation after each session. Less common but more serious risks include breathing problems or rare bladder issues.

Yes. Because Spravato can affect alertness and coordination, you should not drive on the day of treatment and need someone to take you home.

Spravato has a potential for misuse, which is one reason it’s administered in a certified clinical setting under close supervision. When used as prescribed and monitored, the risk of addiction is considered low.

Many major insurance plans cover Spravato, but coverage varies. Some patients may also access support programs to help with medication and treatment costs.

Spravato may not be appropriate if you:

• Are allergic to esketamine or ingredients

• Have certain heart or blood vessel conditions

• Are pregnant or breastfeeding

• Have specific brain conditions — talk with your provider about your health history.

Stopping treatment prematurely may increase the chance of depression returning. Your provider will help decide how long you should continue based on your progress.

Spravato is not approved for other mental health disorders like PTSD, OCD, or anxiety, though research is ongoing. Its approval is currently focused on specific depression cases.