Spravato (Esketamine): A Patient's Guide5 min read

What is Spravato?

Spravato is the brand name for esketamine, a nasal spray approved by the FDA for adults with treatment-resistant depression and for depression with acute suicidal ideation. It works differently from traditional antidepressants — instead of targeting serotonin, it acts on the glutamate system, promoting rapid changes in mood and cognition.

Why it must be given in the office

Spravato is only available through a certified REMS (Risk Evaluation and Mitigation Strategy) program. That means you self-administer the nasal spray at our clinic, then stay for a two-hour monitoring period. You cannot drive yourself home the same day.

What a visit looks like

1. Check-in and vitals — blood pressure, heart rate, brief symptom review.

2. Self-administration — you spray the medication into each nostril under a nurse's supervision.

3. Observation — you rest in a quiet, low-stimulation room for 2 hours. Vitals are checked at 40 minutes and again at 120 minutes.

4. Discharge — a friend, family member, or rideshare takes you home. No driving for the rest of the day.

Common experiences

• A dreamy, floating, or dissociative feeling for 30–60 minutes
• Temporary blood pressure elevation
• Mild nausea (we can pre-treat this)
• Sedation

Most people describe it as unusual but manageable — and often report mood improvement within hours or days.

Treatment schedule

• Induction: twice weekly for 4 weeks
• Consolidation: weekly for 4 weeks
• Maintenance: every 1–2 weeks based on response

You'll continue an oral antidepressant during treatment. We track outcomes with standardized rating scales so decisions about frequency are data-driven, not guesswork.