What is Spravato? | Neuro Wellness Spa

Depression is a significant public health concern in the United States, affecting individuals of all ages and backgrounds. According to a 2025 Gallup Poll, approximately 18% of U.S. adults currently have or are currently being treated for major depressive disorder (MDD).¹ Additionally, suicide is the second leading cause of death for people aged 10 to 34 in the U.S.² These statistics underscore the ongoing need for effective depression treatment options, including options for those with treatment-resistant depression (TRD).

While traditional treatments like therapy and antidepressant medication help many manage their depression symptoms, some individuals need additional support. Recent advancements in medical research have led to the development of new, alternative treatments and medicines, including a novel medication called eketamine — better known by its brand name, Spravato. For those who haven’t found relief from conventional approaches — or who need more immediate symptom relief — Spravato may offer hope.

Here’s an exploration of what Spravato is and how it can help you or a loved one with depression.

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Spravato Explained Understanding Spravato and Its Applications

Spravato — also known by its generic name esketamine — is a new, FDA-approved antidepressant designed to alleviate symptoms of TRD in adults. It’s a nasal spray formulation of esketamine, a specially formulated derivative of ketamine.

Unlike traditional antidepressants, Spravato works by targeting a different mechanism in the brain called the NMDA receptor. It helps restore connections between brain cells and increases the release of mood-regulating chemicals like serotonin and dopamine, which can help relieve depressive symptoms.

A brief overview of ketamine as an antidepressant

Ever since the failed D.A.R.E. program, ketamine has been commonly known as a “horse tranquilizer.” However, ketamine’s medical use came long before its association with recreational drug use — it was first developed in the 1960s as an anesthetic for soldiers in the Vietnam War. At low doses, it provided pain relief without slowing the central nervous system, and quickly gained popularity due to its safety and effectiveness in both human and animal medicine.

Since then, ketamine has been used daily in hospitals nationwide for various medical purposes, including anesthesia during surgical procedures and sedation in pediatric settings. Its fast-acting and dissociative effects make it particularly valuable in emergency situations.

Only in the last decade has ketamine resurged as a treatment for mental health conditions like depression, anxiety, and post-traumatic stress disorder (PTSD). Research has shown that ketamine’s effectiveness depends on both dosage and method of administration, with studies demonstrating treatment response rates of 60% to 64% in patients with clinical depression.³

In 2019, the FDA approved Spravato — a new formulation using only the “S” molecule found in ketamine — specifically for TRD. Like traditional ketamine, Spravato works rapidly, with symptoms often improving within hours after the first dose compared to the six to 12 week onset period of conventional medications.

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How Does Spravato Work?

Unlike traditional antidepressants, Spravato works by targeting a different mechanism in the brain called the NMDA receptor. Glutamate is a neurotransmitter that plays a crucial role in brain function, including learning and memory, and the NMDA receptor is involved in the regulation of glutamate activity. By modulating glutamate — a neurotransmitter involved in neural communication — Spravato helps to restore synaptic connections and increase the release of other mood-regulating neurotransmitters such as serotonin and dopamine.

In addition, Spravato boosts the amount of BDNF — a protein that helps brain cells grow for lasting mood improvements. This can lead to structural changes in the brain and contribute to the long-term effects of ketamine therapy.

What is Spravato treatment like?

The Spravato administration process is straightforward: sessions typically last about two hours and are scheduled twice weekly during the initial treatment phase. Upon receiving an assessment that confirms you’re ready to receive a ketamine prescription, your provider will guide you through assembling and self-administering the Spravato nasal spray device. After using the nasal spray in each nostril, you will then rest in a comfortable, medically-supervised setting.

You will be required to remain at the clinic for observation following administration, as monitoring for side effects is a required part of treatment. The environment is designed to be calming and supportive, helping you feel at ease during their session. Additionally, because Spravato can cause dizziness and drowsiness, you will need to arrange transportation home and should avoid driving or operating machinery for the remainder of the day.

Spravato vs. SSRIs

Selective serotonin reuptake inhibitors (SSRIs) and Spravato differ in their mechanisms of action and overall approach. Spravato works by targeting the NMDA receptor in the brain, modulating glutamate, and promoting the release of mood-regulating neurotransmitters. In contrast, SSRIs and other antidepressants primarily work by increasing the availability of serotonin by inhibiting its reuptake — a process that often takes weeks or even months to reach their full therapeutic effects. Conversely, Spravato treatment can take effect in minutes.

This unique approach makes Spravato an exciting addition to the existing treatment options for depression.

Related: Spravato FAQ

What Does Spravato Treat?

Spravato is FDA-approved to treat two conditions: TRD and MDD with acute suicidal ideation or behavior. Here’s how Spravato works for both of these conditions.

Treatment-resistant depression (TRD)

Spravato is indicated for adults with TRD — a type of depression where individuals have not experienced a satisfactory improvement in depressive symptoms with at least two different antidepressant medications in their current depressive episode. Research shows that around 76% of patients with TRD achieved response or remission after six months on Spravato, with only 3% discontinuing treatment due to side effects.⁴

Major depressive disorder (MDD) with acute suicidal ideation or behavior

For adults with MDD and acute suicidal ideation or behavior, Spravato demonstrates rapid and significant benefits. Within 24 hours of the first treatment, around 20% achieved remission and 35% showed response. By day 25 of treatment, these outcomes improved substantially: approximately 50% achieved remission and 65% showed response.⁵

Spravato must be used in conjunction with an oral antidepressant and is administered under medical supervision in a healthcare setting due to safety considerations. Treatment sessions are closely monitored to ensure patient well-being, and the medication is not available for at-home use.

Efficacy and Benefits of Spravato

The benefits of Spravato are well-documented and include:

Rapid symptom relief: Spravato can work within hours of administration, compared to traditional antidepressant medications, which can take four to six weeks to reach full effect.
Rapid reduction of depressive symptoms in acute crisis: Studies show Spravato can significantly improve depressive symptoms within hours in patients with acute suicidal ideation or behavior, which is why the FDA granted it fast-track and breakthrough therapy designations for this population.
Non-invasive administration: Delivered as a nasal spray without the need for injections or IV infusions.
Temporary, manageable side effects: Most side effects are mild and temporary — generally lasting around two hours — and include dissociation and dizziness.
Sustained effects with less frequent dosing: Unlike traditional oral antidepressants that must be taken daily, Spravato’s benefits can be maintained with weekly or bi-weekly dosing when used alongside an oral antidepressant.

These benefits are reinforced by years of clinical research. For example, studies show that 65% of patients experience a 50% or greater decrease in depression scores by day 74, and there is around a 50% reduction in relapse risk compared to placebo after 16 weeks of achieving remission.⁶

Other studies demonstrate the rapid reduction of depressive symptoms in acutely suicidal patients — often within hours — and its favorable side effect profile. While traditional antidepressants commonly cause sexual dysfunction, affecting 30% to 70% of individuals on SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs), Spravato is associated with rates of less than 1% for treatment-emergent sexual dysfunction.⁷

Who shouldn’t take Spravato?

Spravato is not appropriate for children and teenagers. For adults thinking about trying Spravato, it’s typically reserved for those who have tried at least two other antidepressants in their current depressive episode and have not experienced relief from depression symptoms. Additionally, Spravato has minor addiction potential due to its chemical relationship to ketamine — a chemical that does have potential for addiction and misuse — which is why it’s classified as a Schedule III substance.

Before starting Spravato, tell your healthcare provider about all medications, including over-the-counter products and supplements, as there are significant drug interactions with certain substances. It’s also critical to provide a complete physical and mental health history before starting Spravato, especially if individuals have certain conditions, including:

Currently have or have ever had a history of psychosis.
Allergy to ketamine, esketamine, or other ingredients in Spravato.
History of vascular conditions in the brain or other body parts, such as aneurysmal vascular disease or arteriovenous malformation.
Cardiovascular, cerebrovascular disease, or heart disease.
History of substance use.
Hypertension or stroke.
Moderate to severe liver disease.
History of brain injury, including changes in pressure in the brain or bleeding in the brain.
If you are pregnant or planning to become pregnant.

Related: Fast-Acting Antidepressants

Side Effects of Spravato Treatment

Like any medication, Spravato can cause mild side effects that typically resolve quickly. It’s important to discuss potential side effects with mental health professional before starting treatment.

Common side effects

As discussed, Spravato has a relatively mild side effect profile and includes:

Dissociation — which some studies show affects up to 40% of people — characterized by a temporary feeling of detachment from reality or your surroundings.⁸ While disorienting, this passes quickly.
Dizziness and nausea often occur together and are mild. Your provider will have you sit or lie down during and after administration to minimize these effects.
Slight increase in blood pressure, which is often temporary and is closely monitored during treatment sessions.
Reduced sense of touch or taste are also temporary and sensory changes typically resolve after treatment.

Less common but serious side effects

While rare, some patients may experience more serious side effects that require careful monitoring, including:

Significant blood pressure elevation: About 8% to 17% of patients experience clinically significant increases in blood pressure, which can be dangerous for those with cardiovascular conditions.⁷
Urinary issues: Around 13% in long-term studies report lower urinary tract symptoms such as increased frequency or painful urination.⁷
Sedation and impaired function: This can affect your ability to drive or operate machinery, requiring two-hour monitoring and arranged transportation after sessions.
Risk of misuse: As a Schedule III controlled substance, Spravato has potential for misuse, which is why it must be administered under direct medical supervision.
Psychiatric symptoms: Rare cases of severe agitation, panic attacks, or exacerbation of underlying psychotic symptoms have been reported.

If you experience any concerning symptoms, contact your healthcare provider immediately. Never stop taking Spravato suddenly without medical guidance, as this can increase the risk of a depression relapse.

How Neuro Wellness Spa Can Help You Determine if Spravato Is Right for You

Spravato treatment continues to rise in popularity because of the groundbreaking results that it offers individuals struggling with mental health conditions. At Neuro Wellness Spa, we are committed to helping you regain your confidence, health, and life. We offer in-person and online psychiatry for medication management, and alternative treatments like TMS therapy, and integrative brief talk therapy program.

If you or somebody that you know could benefit from mental health treatment — or you want to learn more about Spravato — don’t wait any longer to contact us. Our care team of psychiatrists and therapists are here to answer any questions you may have and give you more information on the best mental health treatment for you.