What is Spravato?
Last updated September 3, 2026.
Spravato is esketamine nasal spray, approved for adults with treatment resistant depression and given only in certified clinics with at least 2 hours of monitoring per session. It targets glutamate signaling rather than serotonin, which is why it can work where standard antidepressants have not, and it is typically combined with an oral antidepressant. The experience is structured by its boxed warning: sedation, dissociation, respiratory depression, abuse potential, and suicidal thoughts. Those risks are why it sits inside a restricted REMS program: certified sites only, no take-home doses, blood pressure checks before and after (it can raise pressure temporarily), a mandatory observation period, and no driving until the day after. Sessions usually start twice weekly for the first 4 weeks, then space out. Common session effects are dissociation, dizziness, nausea, and a floating or detached feeling that peaks and passes within the monitored window. It is a real option for people who have genuinely failed multiple antidepressants, not a first-line treatment.
What to do
- Confirm the criteria first: it is for depression that failed 2 or more adequate antidepressant trials.
- Plan the logistics: every session means a clinic visit, 2-plus hours of monitoring, and a ride home.
- Expect dissociation: detachment during the session is common and passes under observation.
- Blood pressure matters: it is checked before and after each dose.
- No driving until the next day: plan transport accordingly.
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