Spravato is a prescription nasal spray containing esketamine, a medication used as part of treatment for adults with treatment-resistant depression. Unlike many traditional antidepressants, which primarily affect serotonin, norepinephrine, or dopamine pathways, esketamine works through a different system in the brain. This unique mechanism is one reason Spravato has become an option for people who have not received enough relief from conventional antidepressant treatment.
Spravato is the brand name for esketamine nasal spray. It belongs to a class of medications known for affecting the brain’s glutamate system, particularly through NMDA receptors.
Spravato is not intended to replace every other form of depression care. Depending on the patient’s needs, it may be used alongside an oral antidepressant and other forms of psychiatric treatment. Before treatment begins, a healthcare professional evaluates the patient’s symptoms, medical history, previous treatments, and overall suitability.
The medication is administered in a certified healthcare setting rather than taken independently at home. This allows the clinical team to monitor the patient’s response during and after treatment.
Esketamine works differently from conventional antidepressants. It influences the brain’s glutamate system, which plays an important role in communication between nerve cells.
By acting on NMDA receptors, esketamine can increase glutamate activity through another type of receptor called AMPA. This process may help strengthen or restore connections between certain brain cells involved in mood regulation.
Depression can involve changes in how brain circuits communicate and adapt. Esketamine’s effects on these pathways may support changes in neural connections and signaling that are associated with improvements in depressive symptoms.
The exact reasons some people respond strongly to treatment while others respond less remain an active area of research.
Spravato is particularly relevant for people whose depression has not improved adequately after trying conventional antidepressant treatments.
Treatment-resistant depression can be frustrating because a person may continue experiencing low mood, loss of interest, fatigue, hopelessness, or other symptoms despite previous treatment efforts. Spravato provides another therapeutic approach that works through a different mechanism.
A provider may consider Spravato when a patient’s history suggests that additional treatment is appropriate. The decision is individualized rather than based on symptoms alone.
At Scottsdale TMS & Spravato, treatment begins with an evaluation to determine whether esketamine may be an appropriate part of a patient’s overall depression care.
Spravato is administered as a nasal spray under the supervision of a healthcare professional. Patients do not simply use the medication and leave the clinic immediately.
After administration, the patient remains at the spravato treatment center for observation. The healthcare team monitors the patient’s condition and watches for temporary effects such as dizziness, sleepiness, nausea, changes in perception, or dissociation.
Blood pressure may also increase temporarily after treatment, making clinical monitoring an important part of the process.
Because Spravato can temporarily affect alertness, coordination, and perception, patients need to follow their provider’s instructions regarding transportation and activities after the appointment.
One of the reasons Spravato is different from many traditional antidepressants is its potential for relatively rapid effects in some patients. Conventional antidepressants often require several weeks before their benefits become noticeable, while esketamine may begin affecting depressive symptoms sooner for some people.
However, rapid does not mean immediate or guaranteed. Patients can respond differently, and meaningful improvement may require repeated treatments as part of an ongoing treatment plan.
Your provider will assess your response over time rather than judging the effectiveness of Spravato after a single appointment. Changes in mood, motivation, sleep, functioning, and other symptoms can help guide continued care.
Temporary effects can occur after Spravato administration. Some patients may experience a dreamlike or disconnected feeling, dizziness, drowsiness, nausea, or changes in sensory perception. These effects generally occur during the treatment and observation period and gradually resolve.
Because of these potential effects, the monitored recovery period is an important part of each appointment. Patients should plan ahead rather than expecting to resume all normal activities immediately.
Spravato is also only one component of comprehensive depression care. Your provider may recommend continuing other treatments, including an oral antidepressant, psychotherapy, or additional supportive strategies.
There is no single treatment approach that works for every person with depression. Your provider considers your symptoms, previous medications, treatment response, medical history, and treatment goals before recommending Spravato.
Dr. Michael Vines and Our Team at Scottsdale TMS & Spravato can help patients understand how esketamine works, what the treatment process involves, and whether it may fit within their broader depression care plan.
Understanding the medication’s mechanism and the supervised treatment process can help patients make informed decisions about their options.
Spravato works differently from traditional antidepressants by targeting the brain’s glutamate system and influencing NMDA and AMPA receptor activity. These effects may help support changes in neural communication associated with depression. Because esketamine can cause temporary changes in alertness, perception, blood pressure, and coordination, it is administered under professional supervision with a monitored recovery period. Scottsdale TMS & Spravato provides a structured setting where patients can be evaluated and monitored as part of a personalized treatment approach.
Dr. Vines has practiced psychiatry in Arizona for for over 25 years and has experience working with diverse populations that include children, adolescents, adults, geriatrics, SMI patients, and the chemically dependent.
August 21, 2026
