This page is for general education and is not medical advice. It is not a substitute for diagnosis or treatment by a qualified professional. If this is an emergency, call 911 or 988.
Spravato is the brand name for esketamine, a nasal spray that the U.S. Food and Drug Administration has approved — used together with an oral antidepressant — for treatment-resistant depression and for depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. It is closely related to ketamine, an older medication FDA-approved as an anesthetic that is sometimes used off-label for depression. These are medication treatments that are prescribed and administered by clinicians, and they are generally considered when other treatments have not worked well enough — not as a first step.
Key facts
- Spravato (esketamine) is FDA-approved, alongside an oral antidepressant, for specific forms of depression (NIMH).
- It is given under medical supervision in a certified healthcare setting, with monitoring after each dose.
- Ketamine itself is FDA-approved as an anesthetic; its use for depression (often IV) is off-label.
- These are options for treatment-resistant depression, not first-line treatments, and require a prescriber.
What it is
Most antidepressants act on brain chemicals like serotonin and can take weeks to work. Esketamine and ketamine work through a different mechanism (the brain’s glutamate system), and research has focused on their potential for faster relief in depression that has not responded to other treatments.
- Spravato (esketamine) is a nasal spray, taken in a clinic or certified setting and used together with an oral antidepressant.
- Ketamine for depression is most often given as an IV infusion in specialized clinics; because this is off-label, practices and protocols vary.
Both are administered and monitored by clinicians. Because esketamine can cause sedation, dissociation, and increases in blood pressure, the FDA requires it to be given in a certified setting where patients are observed for a period after each dose. A prescriber is the right person to explain the specifics, benefits, and risks.
What it helps with
These treatments are used for treatment-resistant depression — depression that has not improved enough with other approaches — and, in the case of esketamine, for depressive symptoms with acute suicidal thoughts or behavior. They are typically used alongside, not instead of, other depression treatment such as therapy and standard medication. Only a qualified prescriber can determine whether they are appropriate for you.
What to expect
- Treatment happens in a clinic or certified healthcare setting, not at home.
- After a Spravato dose, you are monitored for a period of time (you cannot drive yourself home afterward).
- Treatment usually involves a series of sessions over weeks, with the schedule set by your prescriber.
- Your clinician will monitor effects and side effects and adjust the plan; these treatments are used as part of a broader depression-care plan.
Is it right for you
These options may be worth discussing if depression has persisted despite other treatments, including therapy and one or more antidepressants. They are not a starting point, and they are not for everyone — eligibility, safety screening, and ongoing monitoring all matter, and decisions should be made with a qualified prescriber who knows your history. If you have not yet tried first-line treatments, those are usually the place to begin. If you are having thoughts of suicide, call or text 988 (Suicide & Crisis Lifeline) any time, or call 911.
From our clinical review. I see a lot of hope and a lot of marketing around these treatments, and both deserve a clear head. They can matter for depression that has not budged — but they are clinician-administered, monitored, and meant for specific situations, not a quick fix you arrange on your own. The right first move is an honest conversation with a prescriber about whether you are a candidate.
If you want to understand your options for hard-to-treat depression, you can talk to someone about what fits. Start with Find Help by State for care near you, and read about depression treatment and treatment-resistant depression. For a non-medication option, see TMS.
Frequently asked questions
What is Spravato (esketamine)?
Spravato is the brand name for esketamine, a nasal spray that the U.S. Food and Drug Administration has approved, used together with an oral antidepressant, for treatment-resistant depression and for depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. It is given under medical supervision in a certified healthcare setting.
Is ketamine the same as Spravato?
They are related but not the same. Spravato is esketamine, an FDA-approved nasal spray for specific forms of depression. Racemic ketamine itself is FDA-approved as an anesthetic; its use for depression — often as an IV infusion in clinics — is considered off-label. A prescriber can explain the differences and the evidence.
Is this a first-line treatment for depression?
No. These approaches are generally considered for treatment-resistant depression — when other treatments have not worked well enough — and are prescribed and administered by clinicians. They are not a starting point, and decisions should be made with a qualified prescriber who weighs the benefits and risks for you.
Sources
- Depression — National Institute of Mental Health (NIMH)
- Depression — MedlinePlus, U.S. National Library of Medicine
- Depression — American Psychological Association (APA)
Reviewed against the sources above. This page is educational and is not medical advice.
Talk to someone about treatment options
Reach the free, confidential SAMHSA National Helpline for treatment referrals and information.
This is the free, confidential SAMHSA National Helpline, operated by the U.S. government. Get Mental Help is not affiliated with it and is not compensated for these calls. How this site is funded.