What Is Spravato? A Patient's Guide to Esketamine Nasal Spray

Medically reviewed by The Medical Doctors at Hearthstone Psychiatry & Wellness | September 2026

For patients who have tried multiple antidepressants without meaningful relief, the search for an effective treatment can feel discouraging. Spravato® is one option that has changed the landscape for these patients. This guide explains what Spravato is, how it works, and who it may be right for.

What Is Spravato?

Spravato is the brand name for esketamine, a nasal spray medication approved for treatment-resistant depression. Unlike traditional oral antidepressants, Spravato is administered in a monitored clinical setting rather than taken at home, and it works through a different mechanism in the brain than most conventional antidepressants.

Spravato is typically used alongside an oral antidepressant, rather than as a standalone replacement for it, as part of a broader depression treatment plan. In some cases, Spravato may allow patients to reduce or even discontinue oral medications, but this should be part of an individualized treatment plan.

Understanding Treatment-Resistant Depression

Treatment-resistant depression generally refers to depression that has not adequately improved after trying at least two different antidepressant medications at appropriate doses and durations. This is more common than many patients realize, and it does not mean that depression is untreatable. It often means that a different approach is needed.

For patients in this situation, options beyond standard antidepressants become an important part of the conversation about what to try next.

How Spravato Works

Most traditional antidepressants target serotonin, norepinephrine, or similar neurotransmitters. Spravato works differently, acting on the brain's glutamate system, which is believed to play a role in how the brain forms and strengthens neural connections. This different mechanism is part of why Spravato can help some patients who have not responded to other treatments, and why it can sometimes work more quickly than traditional antidepressants.

Who May Be a Candidate for Spravato?

Spravato is generally considered for adults who:

• Have tried at least two other antidepressant medications without adequate improvement
• Continue to experience significant depression symptoms despite ongoing treatment
• Are already working with a psychiatric provider on an existing treatment plan

A thorough evaluation is necessary to determine whether Spravato is an appropriate fit, since it is not the right option for every patient with depression. If you have been managing depression for some time without the results you were hoping for, it may be worth discussing whether you meet the criteria.

What to Expect During Treatment

Spravato is administered as a nasal spray during an in-office visit, where patients are monitored for a period of at least two hours afterward due to potential short-term side effects such as dizziness, dissociation, or changes in blood pressure. Treatment typically starts at twice weekly for four weeks, then once weekly for four weeks. After eight weeks, you and your doctor can determine whether once weekly or every other week treatments are right for you.

Because Spravato® may temporarily affect alertness, coordination, and judgment, patients are expected to arrange transportation home after each treatment session and avoid driving or operating machinery for the rest of the day.

Frequently Asked Questions

How is Spravato different from traditional antidepressants?

Spravato is a nasal spray administered in a monitored clinical setting and works on a different brain pathway than most oral antidepressants. It is used alongside an oral antidepressant rather than in place of one, and it is specifically intended for depression that has not responded to standard treatment.

How quickly does Spravato work?

Some patients notice improvement sooner than they might with traditional antidepressants, though individual response varies. Your provider will discuss realistic expectations based on your specific situation during treatment planning.

Is Spravato the same as ketamine?

Esketamine, the active ingredient in Spravato, is derived from ketamine but is a distinct, FDA-approved formulation specifically studied and approved for treatment-resistant depression, with a defined dosing and monitoring protocol.

Will I need to continue taking my current antidepressant?

In most cases, yes. Spravato is approved for use alongside an oral antidepressant rather than as a replacement, so your provider will likely continue your current medication unless there is a specific reason to change it.

Common Questions About Getting Started

How do I know if my depression qualifies as treatment-resistant?

If you have tried two or more antidepressants at appropriate doses without adequate improvement, it is worth discussing treatment-resistant depression with your provider. An evaluation can help clarify whether this describes your situation.

Is Spravato covered by insurance?

Coverage varies by plan. Our office can help verify your specific benefits once an evaluation determines that Spravato may be an appropriate option for you. Visit our insurance page for general information.

What happens if Spravato is not the right fit for me?

If Spravato is not appropriate, your provider will discuss other options for treatment-resistant depression, which may include other medication strategies or additional treatment approaches. Learn more about our approach to care.

Take the Next Step

If antidepressants have not given you the relief you were hoping for, you may have more options than you realize. Schedule an appointment online or contact Hearthstone Psychiatry & Wellness to discuss whether Spravato could be part of your treatment plan.

Disclaimer: The information provided on this blog is for general informational purposes only and is not intended as, and should not be considered, medical advice. All information, content, and material available on this blog are for general informational purposes only. Readers are advised to consult with a qualified healthcare professional for medical advice, diagnosis, or treatment. The author and the blog disclaim any liability for the decisions you make based on the information provided. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.