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Spravato® (Esketamine) Treatment for Depression
Spravato®, an FDA-approved nasal spray administered in a clinical setting, offers a new treatment option for patients with treatment resistant depression who have not responded to other forms of treatment.
What is Spravato® and who might benefit from it?
Spravato® is a prescription nasal spray used in adults with treatment-resistant depression (TRD). This means it’s for people whose depression has not improved after trying at least two other antidepressant medications. Spravato® may be used together with an oral antidepressant.
How does Spravato® work and when will I notice changes?
Unlike most antidepressants that act on serotonin or norepinephrine, Spravato® affects a brain chemical called glutamate, which plays a role in mood and thinking. Some people feel better within a day of their first dose, but the response is different for everyone.
What does the treatment schedule look like?
Treatment happens in two phases:
• Weeks 1–4 (Induction phase): 2 sessions per week
• Weeks 5–8 (Maintenance phase): 1 session per week
• Week 9 onward: Usually 1 session every 1–2 weeks, depending on progress
Your doctor will adjust this schedule to fit your needs.
What side effects should I know about?
The most common effects during or shortly after treatment include:
• Feeling detached or “spaced out”
• Dizziness, nausea, or vomiting
• Temporary rise in blood pressure
• Feeling drowsy, anxious, or mildly intoxicated
Because of these effects, patients stay in the clinic for at least 2 hours after each session so medical staff can monitor them.
Less common but more serious risks include:
• Breathing difficulties
• Bladder problems (with long-term misuse)
• Suicidal thoughts, especially in younger adults
Spravato® is a controlled medication and is only available through a special safety program called REMS. It should not be used during pregnancy or while breastfeeding.
Will I be monitored during treatment?
Yes. Every treatment is done in a certified clinic with trained staff. Your blood pressure, oxygen level, and overall well-being will be checked before and after dosing. You cannot drive home afterward—arrange a ride in advance.
Where is Spravato® given?
It is only available at REMS-certified clinics. You self-administer the nasal spray under medical supervision.
Is it covered by insurance?
Most health insurance plans cover Spravato® if other antidepressants have not worked, but approval depends on your plan and your medical history.
How long does it stay in my system?
• Spravato® reaches its highest level in the body within 20–40 minutes.
• Mood improvements may last for several days or longer.
• Most of the medication leaves the body within 12 hours.
Can Spravato® help with anxiety or PTSD?
At this time, Spravato® is FDA-approved only for treatment-resistant depression and for depression with suicidal thoughts or behaviors. It is not approved for anxiety, PTSD, OCD, bipolar disorder, or chronic pain.
Who should not take Spravato®?
Spravato® may not be safe if you:
• Have certain blood vessel conditions (such as aneurysms)
• Have a history of bleeding in the brain
• Are allergic to esketamine, ketamine, or ingredients in the spray
• Are pregnant or breastfeeding
Be sure to tell your doctor if you have heart, liver, or brain problems, psychosis, or high blood pressure.
How will I know if it’s helping?
Your provider will regularly ask about your symptoms and side effects. Improvement is judged not only by rating scales but also by how you feel and function in your daily life.
Can I take Spravato® if I have high blood pressure?
Possibly—but it requires caution. Spravato® can cause a short-term increase in blood pressure, so your provider will measure it before and after each session.
How should I prepare for a session?
• Wear comfortable clothing
• Arrange for someone to drive you home
• Avoid eating for 2 hours before treatment and drinking liquids for 30 minutes before
• Plan to rest afterward—do not drive or operate machinery until the next day
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