What is Spravato?
Spravato is the brand name for esketamine, a medication closely related to ketamine. It works on glutamate, a different brain chemical from the ones most antidepressants target, and it can act faster than they do.
The FDA approved Spravato in 2019 for treatment-resistant depression in adults. It is also approved for depressive symptoms in adults with major depression who are having suicidal thoughts or actions. It can be prescribed together with an antidepressant taken by mouth, or on its own for treatment-resistant depression.
Because of the way it affects you in the first hours, Spravato is available only through a safety program called a REMS. It can be given only in a certified medical office, never taken home.
Who it is for
Spravato may be an option if you are an adult with depression that has not improved after at least two different antidepressants, each taken at an adequate dose for long enough. That is what treatment-resistant depression means.
It may not be suitable if you have certain blood vessel conditions, such as an aneurysm, a history of bleeding in the brain, or uncontrolled high blood pressure. Tell us if you are pregnant or planning to be. A clinician reviews your history and medications first.
What a visit is like
- Before you arrive. Avoid food for two hours and liquids for 30 minutes before your dose, and arrange a ride home.
- Check-in. We take your blood pressure.
- Your dose. You spray the medication into your nose yourself, with a clinician guiding you.
- Monitoring. You stay with us for at least two hours. We check your blood pressure again and make sure you are ready to leave. Most people rest, read or listen to music.
- Going home. Someone else drives. Do not drive or use machinery until the next day, after a full night's sleep.
The usual schedule is twice a week for the first four weeks, once a week for the next four, and then weekly or every other week. Your clinician reviews whether to continue.
Safety and side effects
The most common side effects happen shortly after the dose and usually ease within two hours:
- feeling disconnected from yourself or your surroundings (dissociation)
- dizziness or a spinning sensation
- nausea
- sleepiness
- a temporary rise in blood pressure
- numbness or tingling
Spravato carries warnings about sedation, dissociation, breathing problems, and misuse, and about suicidal thoughts in young people taking antidepressants. This is why every dose is supervised and why the monitoring period is required.
Insurance coverage
Many commercial plans and Medicare cover Spravato for treatment-resistant depression, usually with approval in advance and proof of the antidepressants you have already tried. We request the approval for you and tell you what you would pay before your first visit. Check your coverage or see cost.
Spravato vs ketamine
Spravato and ketamine are related and act on the same brain system. Spravato is FDA-approved for depression, is a nasal spray rather than an infusion or injection, and is often covered by insurance. Ketamine for depression is off-label and usually self-pay. See ketamine treatment or the full comparison.
Frequently asked questions
How does Spravato work?
Spravato acts on the brain's glutamate system, which is involved in mood and in how brain cells connect. Standard antidepressants work mainly on serotonin and related chemicals, which may be why Spravato can help when they have not.
How soon will I feel a difference?
Some people notice a change within the first few weeks. Others take longer, and Spravato does not help everyone. Your clinician reviews your progress during the first month.
Why do I have to stay for two hours?
It is a requirement of the Spravato safety program. Blood pressure can rise and you may feel sleepy or disconnected for a while after a dose, so we monitor you until that has passed.
Do I keep taking my antidepressant?
Follow your prescriber's advice. Spravato is often given alongside an antidepressant taken by mouth. Do not stop or change a medication without talking to them.