Spravato (Esketamine) Explained

You may have heard that a nasal spray related to ketamine is helping people whose depression would not budge. Here is what Spravato actually is, how a visit works, and who it is meant for.

Spravato is the brand name for esketamine, a prescription nasal spray that the FDA approved for treatment-resistant depression, and also for depressive symptoms in adults with major depression who are having suicidal thoughts or actions. It is closely related to ketamine, a medication that has been used safely in medicine for decades. What makes Spravato notable is both how it works and how quickly some people respond compared with traditional pills.

How it is different from a standard antidepressant

Most antidepressants act on brain chemicals like serotonin and can take four to eight weeks to show their full effect. Esketamine works on a different system in the brain, one involving a messenger called glutamate that is tied to how brain cells form new connections. Because it works through a different pathway, it can help some people who never responded to the usual medications, and for a subset of people the lift can come faster.

Spravato works through a different brain pathway than standard antidepressants, which is why it can help when pills have not.

Why it is always given under supervision

Spravato is not something you pick up at the pharmacy and use at home. Because it can cause temporary side effects like drowsiness, a floaty or dissociated feeling, and a short rise in blood pressure, it is given in a certified clinic under a federal safety program. Here is what a typical visit looks like:

You take the nasal spray yourself, guided by staff, while seated comfortably in the clinic.
You stay and are monitored for about two hours afterward, while the temporary effects wear off.
You cannot drive the rest of that day, so you arrange a ride home.

Treatment usually starts with two visits a week for the first several weeks, then tapers to less frequent visits based on how you respond. It is often prescribed alongside a daily oral antidepressant, though it can also be used on its own for treatment-resistant depression. Your clinician decides which approach fits your situation.

Is it the same as the ketamine clinics you have seen advertised?

Not exactly. Spravato (esketamine) is FDA-approved specifically for depression and is covered by many insurance plans for that use. The intravenous ketamine offered at some clinics is a related but separate, off-label treatment. If insurance coverage matters to you, that distinction is worth asking a clinic about directly.

Who it is meant for

Spravato is generally considered for adults whose depression has not improved after trying at least two different antidepressants, the same situation described in our guide on when antidepressants are not working. It is not a first step, and it is not right for everyone. A clinician will review your history, other medications, and blood pressure before deciding whether it is a fit. If you are comparing supervised options, our explainer on TMS therapy covers the other main path for hard-to-treat depression.

Setting realistic expectations

Spravato has genuinely opened a door for people who had run out of options, but it is not a cure-all and results vary. Some people notice a meaningful shift; others do not respond and move on to something else. The honest framing is this: it is one more real, evidence-based tool, best discussed with a clinician who can weigh it against everything else in your history.