What Is Spravato? An Evidence-Based Overview for 2026

Treatment-resistant depression affects millions of people who have tried multiple antidepressants without finding lasting relief. Spravato — the brand name for esketamine nasal spray — represents a meaningful shift in how clinicians can approach this difficult condition. If you or someone you care about has been stuck in a cycle of medications that don’t work, this overview is a place to start.

What Spravato Is and How It Got Here

Spravato is a nasal spray formulation of esketamine, which is the S-enantiomer of ketamine. The U.S. Food and Drug Administration approved Spravato in March 2019 for adults with treatment-resistant depression — defined as depression that has not responded adequately to at least two different antidepressants taken at adequate doses and duration.

In August 2020, the FDA expanded the approval to cover adults with major depressive disorder (MDD) who are experiencing acute suicidal ideation or behavior. This second indication reflects the speed at which esketamine can produce an effect, which differs from traditional antidepressants that may take weeks to show results.

The manufacturer is Janssen Pharmaceuticals, a Johnson & Johnson company. The approval relied on a series of clinical trials that demonstrated efficacy in reducing depressive symptoms compared to placebo, with an effect observed within hours to days for many participants.

You can review the full prescribing information on the FDA drug label page at FDA.gov.

How Spravato Is Administered

Spravato is not a medication you take at home. Because of its potential for misuse and the possibility of sedation, dissociation, and blood pressure changes after dosing, it must be administered under direct supervision in a certified healthcare setting. Patients self-administer the nasal spray under a clinician’s observation, then remain in the facility for at least two hours.

The treatment schedule typically follows this pattern:

Induction phase (weeks 1–4): Two sessions per week
Maintenance phase (weeks 5–8): One session per week
Ongoing maintenance (month 3 and beyond): One session every one to two weeks

Each device contains 28 mg of esketamine. Most patients use two devices per session (56 mg) or three devices (84 mg), depending on the prescribing clinician’s judgment and the patient’s response.

The requirement for in-office administration is part of the REMS (Risk Evaluation and Mitigation Strategy) program that the FDA requires for Spravato. REMS programs exist for medications where the benefits are meaningful but the risks require structured oversight. Every certified treatment site must register with the Spravato REMS program before dispensing the medication.

Who May Be a Candidate

Spravato is indicated for adults. The two approved uses are:

Treatment-resistant depression (TRD): Adults who have not responded to at least two adequate antidepressant trials. This corresponds to ICD-10 codes F32.9 (major depressive disorder, single episode, unspecified) and F33.2 (major depressive disorder, recurrent, severe without psychotic features).
MDD with acute suicidal ideation or behavior (MDSI): Adults with major depressive disorder who are experiencing suicidal thoughts or behaviors at the time of treatment. This is treated as a short-term acute intervention, not a standalone long-term treatment for suicidal ideation.

Clinicians conduct a thorough evaluation before prescribing. Some conditions may make Spravato less appropriate, including a history of psychosis, certain cardiovascular conditions, active substance use disorders, or pregnancy. A full psychiatric evaluation — often billed under CPT code 90791 — and ongoing evaluation and management visits (CPT 99213 or 99214, depending on complexity) are part of the standard care process.

What to Expect at a Spravato Session

Many patients feel understandably uncertain before their first visit. Here is a general picture of what a session involves.

You arrive at the certified clinic and complete a brief pre-dose assessment. A clinician reviews your symptoms, blood pressure, and overall status. You then self-administer the nasal spray, alternating nostrils as directed.

For the next two hours, you rest in a supervised setting. During this time, some patients experience dissociation — a sense of detachment from one’s surroundings or sense of self. Others notice perceptual changes, dizziness, or nausea. These effects are temporary and resolve before you leave. You cannot drive yourself home; a responsible adult must accompany you.

After the two-hour monitoring period, a clinician reassesses you before discharge. Many patients describe feeling somewhat different — sometimes calmer, sometimes more emotionally available — in the hours and days that follow. Individual responses vary considerably.

Spravato and the Broader Treatment Plan

It is important to understand that Spravato is intended to be used alongside an oral antidepressant, not as a stand-alone treatment. The clinical trials studied esketamine in conjunction with ongoing antidepressant therapy. A prescribing clinician will discuss how Spravato fits within your existing or adjusted medication regimen.

The goal of treatment is remission — a meaningful reduction in depressive symptoms and a return to everyday functioning. Some patients find significant relief after the induction phase. Others may need adjustments to dose frequency or concurrent medications. Regular follow-up appointments are essential to monitor response and make adjustments.

If you want to explore whether Spravato might be relevant to your situation, the first step is speaking with a licensed psychiatrist or other qualified prescriber. Reach out to our clinical team to ask questions or request a consultation.

This content is for educational purposes only and does not constitute medical advice. Consult a licensed clinician about your specific situation.

Drafted by AI and reviewed by our editorial team. Last updated 2026-05-30.