Spravato is the brand name for esketamine, a nasal spray approved by the FDA for adults with depression that has not responded to other treatments, and for depressive symptoms accompanied by suicidal thoughts. It is related to ketamine, a medication used safely in medicine for decades, and it works on a brain system, the glutamate system, that standard antidepressants do not directly touch. That different mechanism is why it can help some people for whom other treatments have not.
Why it is given in a clinic, not at home
Esketamine is not a prescription you fill and take on your own. It is administered in a certified healthcare setting and you are monitored for about two hours afterward, because it can cause temporary effects like drowsiness, a floaty or dissociated feeling, or a rise in blood pressure. This supervision is a feature, not a hurdle. A clinician is with you the whole time, and the experience is designed to be calm and controlled.
What it is not
This is not a psychedelic retreat and not a recreational experience. In a medical setting, at medical doses, with monitoring, it is a treatment, taken seriously and delivered carefully. Any temporary sensations fade before you leave.
What a session actually looks like
Sessions follow a predictable rhythm, which many people find reassuring:
- You arrive at the clinic and settle into a quiet, comfortable room.
- Under supervision, you self-administer the nasal spray, following the clinician's guidance.
- You rest for about two hours while staff monitor how you are doing. Many people simply relax, listen to music, or sit quietly.
- Because you cannot drive afterward, you arrange a ride home and take the rest of the day gently.
Treatment usually starts with two sessions a week, then tapers to less frequent visits as things stabilize. Your clinician sets the schedule based on how you respond.
Who it is for
Esketamine is generally considered when other treatments have not brought enough relief, which clinicians call treatment-resistant depression. It can also be considered when depression comes with suicidal thinking and faster relief matters. It is often used alongside an oral antidepressant rather than instead of one. Whether it fits you is a medical decision, made with a clinician who knows your history.
For some people the value is speed: relief that arrives in days or weeks, at a moment when months feel impossibly far away.
Honest expectations
Esketamine helps many people, but not everyone, and it is not a cure. Some notice improvement early, others more gradually, and some do not respond and move on to another option. Side effects are usually short-lived and pass during the monitoring period. The only way to know if it is right for you is a conversation with a qualified provider who can weigh it against your situation.
If your depression has not responded to the first things you tried, esketamine is one of several modern options worth asking about by name.