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.
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What is Spravato?
Spravato is the brand name for esketamine nasal spray, a fast-acting relative of ketamine approved for adults with treatment resistant depression, meaning depression that has not responded to at least two adequate antidepressant trials. It is also approved for depressive symptoms in major depression with acute suicidal thoughts or behavior. Unlike a daily pill, Spravato is an event: you self-administer the nasal spray in a certified healthcare setting, then stay for at least 2 hours of monitoring before staff decide you are stable enough to leave. That structure exists because of its boxed warning: sedation, dissociation (feeling detached from reality), respiratory depression, abuse potential (it is a Schedule III controlled substance), and suicidal thoughts. Because of those risks, it is only available through a restricted program called REMS; you cannot pick it up at a regular pharmacy, and you cannot drive until the day after a session. Blood pressure is checked before and after dosing, since esketamine can spike it temporarily. Treatment typically starts at twice a week for the first month, then tapers in frequency. It works on the brain's glutamate system rather than serotonin, which is why it can help when SSRIs have failed, and it is usually given alongside an oral antidepressant.