What is Spravato (Esketamine)?

Spravato is an FDA-approved nasal spray derived from ketamine. It was approved in 2019 for adults with treatment-resistant depression (TRD) and in 2020 for major depressive disorder with active suicidal ideation. Unlike traditional antidepressants that target serotonin, esketamine acts rapidly on the brain's NMDA glutamate system — many patients feel relief within hours to days rather than weeks.

Spravato must be administered in a REMS-certified clinic under medical supervision. After self-administering the nasal spray, you remain at the clinic for at least 2 hours of monitoring for blood pressure changes, sedation, and dissociation. It is taken alongside an oral antidepressant.

• Schedule: Twice weekly for 4 weeks (induction), then weekly or every other week (maintenance).
• Insurance: Covered by most major insurers and Medicare for TRD when criteria are met.
• Cost: ~$590–$885 per dose retail; copays often $10–$75 with insurance.