Spravato® is the brand name for esketamine (a version of ketamine) nasal spray, which is prescribed as a fast-acting treatment for treatment-resistant depression. 

Although the exact mechanism of action is not yet known, Spravato® is thought to create new connections in the brain by targeting the glutamate system, which is responsible for facilitating communication between nerve cells. This is referred to as neuroplasticity — the ability of the brain to change and adapt. By increasing neuroplasticity, Spravato® appears to help behavioral and cognitive changes occur more rapidly in patients with treatment-resistant depression.

There are several differences between Spravato® and ketamine.

On a basic level, Spravato® is the brand name for the compound esketamine, which is derived from isolating one component of ketamine. Ketamine has a longer history, as well, though it’s not FDA-approved to treat depression. That brings us to a key difference in terms of access and cost: Spravato® is covered by insurance, while ketamine is not.

The most common side effects of Spravato®, which can occur both during and after treatment, include: feelings of dissociation (disconnectedness from your body/thoughts/feelings); lack of energy or fatigue; dizziness; increased blood pressure; feeling drunk or excited; nausea or vomiting. Unlike the side effects associated with oral antidepressants, which are persistent and systemic, side effects from Spravato® typically go away within hours of treatment. To avoid nausea and vomiting, it’s recommended that you avoid eating two hours before your treatment.

After your initial consultation, Spravato® sessions are typically scheduled twice a week for the first month. In the second month, sessions are reduced to once a week. After this two month period, you and your provider can discuss whether or not to continue Spravato® treatment (and at what frequency) based on your progress. Each session lasts about minimum 2 hours required for this treatment.