Spravato: What It Is, How It Works, and What You Need to Know

When you’ve tried multiple antidepressants and still feel stuck, Spravato, a nasal spray containing esketamine, approved by the FDA for treatment-resistant depression. Also known as esketamine, it’s not just another pill—it’s a different kind of treatment that works fast, often within hours or days, unlike traditional meds that take weeks. Spravato isn’t for everyone. It’s meant for adults with depression that hasn’t improved after at least two other antidepressants. It’s used alongside an oral antidepressant, not alone. And it’s only available through a restricted program because of its potential for abuse and serious side effects like dizziness, high blood pressure, and dissociation.

What makes Spravato different is how it acts on the brain. Most antidepressants target serotonin or norepinephrine. Spravato works on glutamate, a brain chemical linked to mood, learning, and memory. This is why it can work quickly—some people feel better after the first dose. But it’s not a magic fix. You have to take it under medical supervision, usually twice a week at first, then less often. You can’t drive yourself home after the dose—you need someone to take you. And you’re monitored for at least two hours afterward because of the risk of sedation or hallucinations.

People who’ve tried everything else often turn to Spravato because they’re desperate for relief. It’s not a cure, but for many, it’s the first real sign of progress in years. It’s also being studied for other conditions like PTSD and suicidal thoughts, but right now, its main use is for treatment-resistant depression. If you’re considering it, talk to your doctor about your full medical history—especially if you’ve had heart problems, high blood pressure, or a history of substance use. The FDA requires a Risk Evaluation and Mitigation Strategy (REMS) program, which means your provider must be certified to give it, and you must agree to the rules.

You’ll find posts here that dig into what Spravato really feels like, how it compares to other depression treatments, what side effects to watch for, and how it fits into long-term care. Some stories come from people who’ve used it. Others explain the science behind it. There’s also info on how it’s administered, what to expect during your clinic visits, and why insurance sometimes fights to cover it. Whether you’re a patient, a caregiver, or just trying to understand this newer option, the articles below give you real, practical details—not marketing hype.