Spravato for depression

Spravato (esketamine) is a nasal spray approved by the FDA for depression that hasn't improved enough with other treatment. It can ease depression quickly, sometimes within hours or days, rather than the weeks most antidepressants take. You use the spray yourself at a certified clinic and stay to be monitored for at least two hours. Many insurance plans and Medicare cover it, usually with prior authorization.

How does Spravato work?

Most antidepressants work on serotonin or norepinephrine and take weeks to help. Esketamine works on a different brain chemical, glutamate, which is involved in how brain cells form new connections. That's thought to be why it can work much faster. Esketamine is one half (the "S" form) of the ketamine molecule; see the ketamine therapy guide for how the two differ.

Who is Spravato for?

Spravato is FDA-approved for adults with:

• Treatment-resistant depression, usually meaning depression that hasn't improved enough after trying at least two antidepressants. Since 2025 it can be used on its own or with an oral antidepressant.
• Depressive symptoms with suicidal thoughts or actions in major depression, alongside an oral antidepressant.

It isn't a first treatment for depression. People with certain blood vessel conditions, a history of bleeding in the brain, or uncontrolled high blood pressure usually can't take it. A history of substance use is something to discuss openly with your clinician.

If you're not sure how much depression is affecting you, the free depression self-check takes about three minutes.

What is a Spravato session like?

You use the nasal spray yourself at a certified clinic, under supervision. Then you stay at least two hours while staff check your blood pressure and how you feel. Many people feel dissociated (detached, dreamy or "floaty"), sleepy or dizzy for a while; this usually fades within the two hours.

You can't drive or operate machinery until the next day after a night's sleep, so you need a ride home.

A typical schedule is twice a week for the first four weeks, then once a week for four weeks, then once a week or every other week for as long as it keeps helping.

How well does Spravato work?

In clinical trials, Spravato improved depression more than a placebo, with some people feeling better within a day. In the study that led to its approval on its own, about 1 in 5 people taking Spravato had their depression lift fully (remission) after four weeks, compared with about 1 in 13 taking a placebo. Many more improved without full remission. The benefit usually needs ongoing treatment to last.

What are Spravato's side effects?

Most side effects happen during the first hour or two after a dose and fade by the end of the visit:

• Feeling dissociated, detached or "out of body"
• Dizziness, or a spinning feeling (vertigo)
• Nausea, sometimes vomiting
• Sleepiness
• A temporary rise in blood pressure
• Feeling anxious, numb, or a bit "drunk" or "high"

Because of the risks of sedation, dissociation, slowed breathing, and misuse, Spravato carries boxed warnings and is only available through a restricted program (REMS). That's why it's always given in a certified clinic, where staff can watch for these effects.

How much does Spravato cost?

Without insurance, Spravato is expensive. The medication alone averages about $1,059 per treatment at the 56 mg dose and about $1,663 at the 84 mg dose, according to SingleCare's 2025 price data, and the clinic charges separately for the visit and monitoring. With twice-weekly treatments in the first month, the medication alone can cost several thousand dollars a month.

Most people don't pay that. If you have commercial insurance, the manufacturer's savings program (Spravato withMe) can lower what you pay for the medication. It isn't available with Medicare or Medicaid.

Does insurance cover Spravato?

Many insurance plans and Medicare cover Spravato for treatment-resistant depression when you meet their criteria, usually having tried at least two antidepressants. Coverage almost always needs prior authorization, which the clinic typically requests for you. Ask the clinic:

• Do you take my insurance, and will you handle the prior authorization?
• What will I pay per treatment, including the monitoring visit?
• Can you check whether I qualify for the savings program?

See how much does therapy cost for how copays and deductibles work.

How do I get Spravato?

Spravato is prescribed by a psychiatrist or other qualified prescriber and given at a certified treatment center. Many TMS clinics and psychiatry practices offer it. Ask your psychiatrist whether it's right for you, or contact a certified clinic directly. Our guide on how to find a psychiatrist can help you find a prescriber taking new patients.