For many people living with depression, medications can help, but not always. About one-third of patients with major depression find that standard antidepressants don’t bring meaningful relief. When this happens, options can feel limited.
That’s where Spravato® (esketamine) comes in. Approved by the US Food and Drug Administration (FDA), Spravato is a prescription nasal spray designed for adults with treatment-resistant depression (TRD) or major depressive disorder (MDD) with suicidal thoughts.
Many patients may ask what is Spravato used for? Here’s who may benefit from this innovative treatment and why it’s different from traditional antidepressants.
What is Spravato used for?
Spravato is designed for patients who haven’t improved with at least two rounds of antidepressants. It’s always administered under medical supervision to ensure the safest and most effective outcome.
Spravato is approved by the FDA to treat adults diagnosed with:
Treatment-resistant depression (TRD)
TRD is one of the most common reasons doctors recommend Spravato. TRD is diagnosed when a person’s depression does not improve after trying at least two different antidepressants.
Spravato is approved as a standalone treatment for TRD, meaning it does not need to be combined with an antidepressant.
Major depressive disorder (MDD)
Spravato is approved for adults with MDD who are experiencing suicidal thoughts or behaviors when taken in combination with an antidepressant.
For people in crisis, time is critical. Spravato acts quickly to reduce depression symptoms and suicidal thoughts within hours of administration. It’s an important tool for psychiatrists treating patients who need rapid relief to stabilize their mood and reduce immediate risk.
How Spravato works in the brain
Spravato offers a new approach for these patients by targeting the glutamate system, which plays a key role in mood regulation and brain plasticity.
Spravato blocks certain receptors in the brain’s glutamate system, which increases glutamate activity. This in turn boosts communication between brain cells and supports the growth of new neural connections.
This process of neuroplasticity essentially helps the brain “rewire” itself, restoring communication in areas affected by depression. Many patients experience clearer thinking, improved mood, and a greater sense of emotional flexibility soon after starting treatment.
What to expect during Spravato treatment
Spravato is given under medical supervision in certified treatment centers as part of a special Risk Evaluation and Mitigation Strategy (REMS) program.
Here’s what to expect during treatment:
- Before treatment: Patients receive a thorough evaluation to discuss their medical history, medications, and any recent changes in mood or overall health.
- During treatment: Patients self-administer the nasal spray under supervision. They then rest comfortably for about two hours while staff monitor blood pressure and overall wellbeing.
- Aftercare: Patients will need to schedule a ride home as they cannot drive or operate machinery until the next day.
Spravato can reduce symptoms within hours. More than one-third of participants in one study felt noticeably better after four weeks of treatment with Spravato and an antidepressant.
Most patients begin with two sessions per week for the first four weeks, then gradually move to weekly or every-other-week maintenance sessions based on progress.
Safety and side effects
Like all medications, Spravato has potential side effects and safety considerations. As a Schedule III controlled substance, it must be administered in a healthcare setting.
Common side effects include:
- Dizziness or lightheadedness
- Dissociation, a feeling of being“disconnected” or “dreamlike”
- Nausea or vomiting
- Sleepiness or fatigue
- Temporary increase in blood pressure
These effects usually resolve within a few hours after treatment. Patients are monitored closely during and after each session to ensure safety.
Spravato also carries FDA boxed warnings for:
- Sedation and dissociation
- Potential for misuse or abuse
- Increased risk of suicidal thoughts in young adults
For most patients, side effects are mild, especially when treatment is carefully managed by trained professionals.
Who is (and isn’t) a candidate for Spravato?
Spravato may be appropriate for adults who:
- Have treatment-resistant depression (TRD)
- Are diagnosed with major depressive disorder with suicidal thoughts
- Have tried at least two antidepressants without success
- Can commit to regular clinic visits and post-treatment monitoring
Spravato may not be suitable for people with:
- Certain cardiovascular conditions or aneurysms
- Uncontrolled high blood pressure
- A history of substance misuse
- Pregnancy or plans to become pregnant
A mental health provider can determine if Spravato is the right option after a full evaluation.
Frequently asked questions
How quickly does Spravato start working?
Many people begin to feel relief within hours or days of treatment. Most notice their biggest improvements after several weeks of consistent sessions.
Can Spravato treat anxiety or bipolar disorder?
Currently, Spravato is only approved for treatment-resistant depression and major depressive disorder with suicidal thoughts. It is not FDA-approved for anxiety or bipolar disorder.
Is Spravato the same as ketamine?
Spravato contains esketamine, a more refined version of ketamine. It’s delivered as a nasal spray in certified clinics, while ketamine infusions are typically intravenous and used off-label for depression.
Is Spravato covered by insurance?
Most insurance plans cover Spravato for its FDA-approved uses. Coverage may require prior authorization.
Key takeaways
- Spravato (esketamine) is an FDA-approved nasal spray used to treat adults with treatment-resistant depression (TRD) and major depressive disorder (MDD) in adults who have suicidal thoughts or behaviors.
- Unlike traditional antidepressants that focus on serotonin or norepinephrine, Spravato targets the brain’s glutamate system, providing relief in hours or days instead of weeks.
- Spravato must be administered in a certified healthcare clinic where patients are monitored for about two hours after each dose.
- Common side effects include dizziness, feeling disconnected, and drowsiness.
Looking for Spravato or ketamine treatment near you?
Pacific Mind Health offers Spravato (esketamine) and ketamine therapy for treatment-resistant depression, major depressive disorder, and more. Our experienced clinicians provide compassionate, evidence-based care to help you feel better.
Ready to take the next step? Schedule a free consultation today to see if Spravato or ketamine is right for you.
