For people whose depression has not responded to multiple antidepressants, Spravato (esketamine) represents a genuinely different approach. As the first nasal-spray medication approved by the FDA specifically for treatment-resistant depression, it works on the glutamate system rather than on serotonin — and for many patients, it can produce improvement far faster than traditional medications.
If you are considering Spravato, understanding the process ahead of time can ease a lot of the uncertainty. Here is what the treatment actually looks like.
How Spravato Differs from Other Antidepressants
Most antidepressants target serotonin, norepinephrine, or dopamine and can take four to six weeks to reach full effect. Spravato works on glutamate — the most abundant excitatory neurotransmitter in the brain — and is associated with improvement in symptoms within days to weeks for some patients. It is always taken alongside an oral antidepressant, not as a replacement for one.
What a Treatment Session Looks Like
Spravato is a prescription nasal spray you self-administer under clinical supervision. You will not give it to yourself at home — each dose is taken in the office while a trained staff member monitors you. After spraying the medication, you remain in a comfortable, quiet room for about two hours so your provider can observe how you respond and check your blood pressure before you leave.
Because Spravato can cause temporary drowsiness, dizziness, or a feeling of dissociation, you cannot drive yourself home afterward — you will need to arrange for a ride. These effects typically resolve within the monitoring period, but the sedation risk is precisely why in-office supervision is required.
The Treatment Schedule
Spravato follows a structured dosing schedule. During the first month, treatment is typically twice per week. In the second month, sessions reduce to once weekly. From the third month onward — if you and your provider decide to continue — sessions typically move to every two weeks. This tapering schedule is designed to sustain improvement while reducing the frequency of office visits over time.
Is Spravato Right for You?
Spravato is indicated for adults with treatment-resistant depression — meaning your symptoms have not adequately improved after trying at least two other antidepressants. It may not be appropriate for everyone, including people with certain cardiovascular conditions or a history of specific psychiatric concerns. A thorough evaluation with one of our providers is the only way to know whether it fits your situation. If you have been through several treatments without meaningful relief, asking about Spravato is a conversation worth having.