For many people, the initial phases of antidepressants don't work. For such severe cases, mental health specialists use other options such as Spravato. It is only given in a certified healthcare setting under direct medical supervision. It can reduce symptoms in as little as 24 hours after the first dose.
What Is Spravato and How Does It Work?
Spravato is the brand name for esketamine hydrochloride. It comes as a nasal spray device. The active molecule is the S-enantiomer of ketamine, meaning it is a more refined, targeted version of the compound that has been used as an anesthetic for decades.
The way Spravato acts on the brain is fundamentally different from other medicines. Most antidepressants work on monoamine neurotransmitters, serotonin, dopamine, and norepinephrine. Spravato instead blocks NMDA receptors in the glutamate system.
What Is Spravato Treatment Actually Like?
A Spravato treatment session takes place in a certified clinic. You self-administer the nasal spray while a healthcare provider monitors you for at least two hours afterward. During that time, you may experience temporary dissociation, and that's completely expected. It usually peaks around 30 to 40 minutes in, and resolves before you leave.
The Treatment Schedule
Induction Phase: Two doses per week, administered in-clinic
Maintenance Phase: One dose per week
Maintenance Phase: One dose every one to two weeks, based on clinical response
What Happens During a Session?
You arrive at the clinic, and a healthcare provider supervises as you self-administer the nasal spray device. The device has specific instructions: you tilt your head slightly, press the plunger, and alternate nostrils. After the dose, you rest in the clinic for two hours while staff monitors you for side effects. You cannot drive or operate machinery that day.
Is Spravato a High-Risk Drug? Understanding the Safety Profile
Spravato does carry a potential for misuse and dependence, which is precisely why it cannot be taken home. However, when used in a properly supervised clinical setting, the risk profile is carefully managed.
Who Is Spravato Used For?
Spravato is not the first line of treatment for depression. It is specifically for people who have already tried and not responded to conventional antidepressants.
Factors That Make Someone a Suitable Candidate
Diagnosis of major depressive disorder confirmed by a licensed clinician
Failure to respond to initial antidepressant treatments
No history of psychosis
Ability to attend regular in-clinic sessions and have a reliable transportation plan
No active or recent substance use disorder
What Are the Benefits and Risks of Spravato?
Spravato's main benefits are speed and reach. It can reduce depression symptoms within 24 hours. On the other hand, its main risks include dissociation, sedation, temporary blood pressure elevation, and a small potential for misuse.
Benefits at a glance:
Rapid antidepressant effect
Higher response and remission rates
Promote neuroplasticity and break the continuous pattern of negative thoughts
Many commercial insurance plans cover Spravato treatment
Common side effects to know:
Dissociation (feeling detached from your body or surroundings)
Nausea
Temporary increase in blood pressure
Headache or altered taste
Connect with Mental Health Experts to Get Treatment for Depression
Boston Neurobehavioral Associates provides evidence-based care for complex mental health conditions, including depression. If you or someone you love has not found relief through standard antidepressants, you do not have to keep waiting. BNBA offers Spravato treatment to help you find a cure for depression.
Frequently Asked Questions About Spravato
How quickly does Spravato start working?
Many patients notice a shift in mood or mental heaviness within hours of their first dose or within the first couple of sessions.
Can Spravato be the only treatment for depression?
Yes. As of January 2025, the U.S. FDA has approved Spravato (esketamine) nasal spray as a standalone (monotherapy) treatment for adults with treatment‑resistant depression (TRD).
Does insurance cover Spravato treatment?
Coverage varies by insurer and plan. Many major insurance providers cover Spravato.
What are the side effects of Spravato?
The most frequently reported side effects include dissociation, dizziness, nausea, sedation, and a feeling of numbness.