The short version
- FDA-approved for adults whose depression has not improved after at least two antidepressants
- May be used alone or with an oral antidepressant
- Given only at certified treatment centers with at least two hours of monitoring
- Boxed warnings include sedation, dissociation, and suicidal thoughts and behaviors
What treatment-resistant depression means
Depression is generally considered treatment-resistant when an adult has not responded adequately to at least two different antidepressants, each taken at an adequate dose and duration during the current depressive episode. It is a common situation — not a personal failure — and it is one of the two FDA-approved uses of SPRAVATO®.
How SPRAVATO® fits
SPRAVATO® is a prescription nasal spray containing esketamine. For TRD, it may be used on its own or together with an oral antidepressant. Every dose is self-administered under supervision at a certified treatment center, followed by at least two hours of monitoring, and patients cannot drive until the next day after a restful sleep.
Important limitations
SPRAVATO® carries boxed warnings for sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors. It is not approved for children or adolescents. This page is general information, not medical advice — whether SPRAVATO® is appropriate is a decision for you and your prescriber.
Source: FDA prescribing information for SPRAVATO® (esketamine) nasal spray, NDA 211243.
What a course of treatment looks like
- 1
Consultation and eligibility
A qualified healthcare professional reviews your diagnosis, treatment history, medicines, and safety risks before determining whether SPRAVATO® is appropriate.
- 2
Insurance authorization
If required, the clinic submits clinical documentation to the insurer. Requirements and timing vary by plan and are not guaranteed.
- 3
A monitored treatment visit
You self-administer the prescribed nasal spray under direct observation in a certified healthcare setting.
- 4
Observation and transportation
The clinic monitors you for at least two hours after each dose. Arrange a ride home and do not drive until the next day after restful sleep.
- 5
Individualized follow-up
The prescriber assesses benefit, tolerability, and ongoing need. Dose and frequency depend on the labeled indication and individual response.
Eligibility
Could SPRAVATO® be an option to discuss?
A clinic confirms all of this at your consultation. Use it to see whether a consultation is worth booking.
- Adults 18 and older
- Major depressive episode not responding to at least two adequate antidepressant trials
- Able to attend in-clinic dosing and arrange transportation home
Questions people ask
Does treatment-resistant depression mean nothing works?
No. It means the first treatments tried were not enough. SPRAVATO® is one of several options studied specifically for this situation.
Can I take SPRAVATO® at home for TRD?
No. SPRAVATO® is only available through a restricted program and must be taken at a certified treatment center under supervision.
Other conditions we cover
SPRAVATO® treatment centers near you
Browse clinics by town or county, or read more about treatment in United States.
This guide is general information, not medical advice. Only a prescriber who knows your history can say whether SPRAVATO® is right for you. If you are in crisis, call or text 988.