Spravato (Esketamine)

Spravato is the brand name for esketamine, an FDA-approved nasal spray for treatment-resistant depression and major depressive disorder with suicidal ideation. It's derived from ketamine and works on the brain's glutamate system — a different mechanism than traditional antidepressants like SSRIs.

Treatment is administered only at REMS-certified clinics under direct medical supervision. Patients self-administer the spray under a clinician's guidance, then remain at the clinic for at least two hours of monitoring after each dose. The induction phase typically involves twice-weekly sessions for four weeks, followed by weekly or biweekly maintenance dosing depending on response.

Many patients report meaningful symptom improvement within the first one to two weeks — substantially faster than the 4 to 8 weeks typical of oral antidepressants. Spravato is taken alongside an oral antidepressant, not as a replacement.

The most common side effects are dissociation, dizziness, sedation, and elevated blood pressure during and shortly after dosing. These typically resolve within the two-hour monitoring window. Patients cannot drive on the day of treatment.

Most commercial insurance and Medicare cover Spravato for treatment-resistant depression with prior authorization. Clinics offering Spravato in our directory hold active REMS certification and are staffed to provide the required in-clinic monitoring period.