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ANESTHETIC/N-METHYL D-ASPARTATE (NMDA) RECEPTOR ANTAGONIST
Spravato (esketamine) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat adults with treatment-resistant depression (TRD). It can also be used with an oral antidepressant to treat depressive symptoms in adults with major depressive disorder (MDD) who have acute suicidal thoughts or actions.
These insights are based on 157 comments about Spravato from MyDepressionTeam members. These are the experiences of a small number of people and are not meant to be medical advice.
Spravato is a medicine that works on a brain receptor called the N-methyl-D-aspartate (NMDA) receptor. It affects a brain chemical called glutamate.
The exact way it helps depression is not fully known. In people with depression, it may help reduce symptoms that have not improved with other treatments.
Doctors prescribe Spravato for adults with treatment-resistant depression. It can also be used together with an oral antidepressant to treat depressive symptoms in adults with major depressive disorder who have suicidal thoughts or actions.
Spravato is given as a nasal spray in a clinic under the care of a healthcare provider.
The recommended starting dose of Spravato for adults with treatment-resistant depression is usually 56 milligrams or 84 milligrams, given twice a week for the first four weeks.
After that, it is given once a week during weeks 5 to 8, then either once every two weeks or once a week based on how well it is working.
The recommended starting dose of Spravato for adults with major depressive disorder who have suicidal thoughts or actions is 84 milligrams, given twice a week for four weeks, together with an oral antidepressant.
The dose may be lowered to 56 milligrams if needed.
Doctors adjust the dose based on how well the treatment works and how well it is tolerated.
This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.
These insights are based on 157 comments about Spravato from MyDepressionTeam members.Members who use Spravato often say it helps to plan ahead for treatment days, expect some side effects, and give the treatment time to work. Many also mention staying in close contact with their care team about scheduling, side effects, costs, and how well treatment is working.
Plan ahead for the treatment time, your transportation, and a recovery day.
“You need to plan for a caregiver or family member to drive you home after taking Spravato. You cannot drive.”
Be aware of side effects, and tell your doctor about them.
“Yesterday, I had my third Spravato treatment. It was awful. The taste, the nausea, and disassociation. It only lasts for an hour to an hour-and-a-half.”
Talk to your doctor about the dosing schedule and follow-up.
“Yes, Spravato is helping me. My anxiety is much better. My depression is taking longer to correct, but it is better than it used to be. So I now go every other week for maintenance therapy.”
Connect with others who understand life with depression. Join MyDepressionTeam for free.
In clinical studies of Spravato nasal spray used with an oral antidepressant to treat adults with treatment-resistant depression and major depressive disorder with acute suicidal thoughts or behavior, the most common side effects occurred in about 5 percent to 48 percent of people. These included:
Spravato can cause serious side effects that require immediate medical attention. These include:
Get medical help right away if you think you are having a serious reaction.
Johnson & Johnson, the manufacturer of Spravato, offers the Spravato withMe Savings Program. Eligible people with commercial insurance may pay as little as $10 per treatment for Spravato medicine costs.
The Spravato withMe Savings Program also provides help understanding insurance coverage (including transportation benefits where available), treatment preparation support, and ongoing resources. To learn more, visit the Spravato withMe site or call 844-479-8486.
Before starting Spravato, your doctor will check your blood pressure and review your medical history. They will also monitor you for any changes in mood, including suicidal thoughts or actions.
Tell your doctor if you have any allergies to esketamine, ketamine, or any ingredients in Spravato.
Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.
Do not take Spravato if you have certain blood vessel problems (aneurysmal vascular disease, including thoracic and abdominal aorta, intracranial and peripheral arterial vessels, or arteriovenous malformation), a history of bleeding in the brain (intracerebral hemorrhage), or an allergy to esketamine, ketamine, or any of the ingredients in Spravato.
Spravato has a risk of abuse and dependence. Tell your provider if you have ever had problems with alcohol or drugs.
Spravato can be used with an oral antidepressant to treat depressive symptoms in adults with major depressive disorder who have suicidal thoughts or actions. It is not approved for use in children.
Spravato is not used as an anesthetic (a medicine to prevent pain).
If you miss a dose, your provider will decide if you should continue your schedule or return to a previous one based on your symptoms.
If you are pregnant, planning to become pregnant, or breastfeeding while taking Spravato, talk with your doctor about the risks and benefits. Breastfeeding is not recommended during treatment.
A pregnancy registry is available to collect safety information for people taking Spravato during pregnancy. To learn more, visit the National Pregnancy Registry for Antidepressants or call 866-961-2388.
These answers are fact-checked by our editorial staff.
How effective is Spravato?
In a four-week study of adults with treatment-resistant depression, depression scores improved by 19.8 points with Spravato plus an oral antidepressant. Scores improved by 15.8 points with placebo (an inactive treatment) plus an oral antidepressant.
The scores were measured with a tool called the Montgomery-Asberg Depression Rating Scale (MADRS), which scores depression symptoms on a scale of 0 to 60. A higher score means more severe depression.
In a longer study, people who stayed on Spravato plus an oral antidepressant had a longer time before relapse than people who switched to placebo plus an oral antidepressant.
In adults with major depressive disorder and suicidal thoughts or actions, depression scores improved more with Spravato at 24 hours after the first dose. The differences versus placebo were 3.8 and 3.9 points in two studies.
How long does Spravato take to work for depression?
In clinical studies, adults with major depressive disorder who have suicidal thoughts or actions, differences from placebo were seen as early as four hours after the first dose. The main results were measured at 24 hours.
For treatment-resistant depression, doctors check how well Spravato works after the first four weeks. They may then change how often it is given based on how well it works and how you feel.
What tests or monitoring are needed with Spravato for depression?
Spravato is given in a certified healthcare setting under the care of a healthcare provider.
After each dose, you will be watched for at least two hours to make sure you are safe.
Your blood pressure will be checked before your dose and again about 40 minutes after. Your breathing will also be checked for at least two hours.
Before you leave, your healthcare provider will make sure you are stable and ready to go home.
On MyDepressionTeam, people share their experiences with depression, get advice, and find support from others who understand.
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