Esketamine nasal spray is a prescription treatment used for certain adults with depression that has not responded adequately to conventional antidepressants. It is the active medication in Spravato and works differently from many traditional antidepressants. Because it can temporarily affect alertness, perception, and blood pressure, esketamine must be administered under medical supervision rather than used independently at home.
Esketamine is a form of ketamine that belongs to a group of medications called NMDA receptor antagonists. Spravato delivers esketamine through a nasal spray, allowing the medication to be absorbed through the nasal passages.
The FDA has approved Spravato for adults with treatment-resistant depression. It is also approved, in combination with an oral antidepressant, for depressive symptoms in adults with major depressive disorder accompanied by acute suicidal ideation or behavior.
Esketamine is different from simply taking an antidepressant at home. Treatment takes place in a certified healthcare setting where patients can be observed following administration.
Esketamine works primarily by affecting the brain’s glutamate system. More specifically, it blocks NMDA receptors, which influences the activity of glutamate, one of the brain’s major neurotransmitters.
This process can increase signaling through another group of receptors called AMPA receptors. These changes may help improve communication between nerve cells and support adaptations in neural connections involved in mood regulation.
Traditional antidepressants often work by influencing serotonin, norepinephrine, or dopamine systems. Esketamine takes a different approach, which is particularly relevant for people who have not experienced sufficient improvement with conventional antidepressant treatments.
Researchers continue to study exactly how these changes translate into improvements in depression symptoms and why some patients respond differently than others.
Esketamine may be considered for adults with treatment-resistant depression. This generally means that depression has continued despite adequate attempts with conventional antidepressant treatment.
At Scottsdale TMS & Spravato, patients undergo an evaluation before treatment. The clinical team considers symptoms, previous treatment history, medical history, and other factors when determining whether Spravato may be appropriate.
Esketamine is not intended to be a universal treatment for everyone experiencing depression. A comprehensive evaluation helps determine whether its potential benefits and risks are appropriate for an individual patient.
Spravato is administered as a nasal spray under the supervision of a healthcare professional. Patients remain in the treatment setting after administration rather than immediately returning home.
The clinical team monitors the patient’s response and watches for potential effects such as dizziness, sleepiness, nausea, dissociation, and temporary increases in blood pressure.
The FDA prescribing information requires patients to be monitored for at least two hours following administration and assessed before leaving the healthcare setting.
Because esketamine can temporarily affect attention, judgment, and coordination, patients should arrange transportation home and follow their provider’s post-treatment instructions.
One feature that distinguishes esketamine from many traditional antidepressants is its potential for relatively rapid improvement in depressive symptoms for some patients. However, individual responses vary, and treatment should not be viewed as an instant solution.
Spravato is provided according to a structured schedule that begins with more frequent treatments and can become less frequent during the maintenance phase. Your provider evaluates your response over time to determine whether continuing treatment is appropriate.
Progress may involve changes in mood, motivation, daily functioning, and other symptoms associated with depression.
Esketamine can cause temporary changes in perception and awareness. Some patients experience dissociation, which may feel like being disconnected from their surroundings, thoughts, or body. Sedation and dizziness may also occur.
These effects are one reason the observation period is an essential part of Spravato treatment. Your healthcare team can monitor your condition while these temporary effects resolve.
At Scottsdale TMS & Spravato, treatment is provided in a structured environment with professional monitoring throughout the appointment. The goal is to make the process as safe and organized as possible while your response to spravato treatment is evaluated.
Esketamine is generally used as part of a broader treatment strategy rather than as a replacement for every other form of depression care. Depending on your individual needs, your provider may consider medication management, psychotherapy, or other evidence-based approaches alongside Spravato.
Dr. Michael Vines and Our Team can explain how esketamine works, discuss potential benefits and risks, and determine whether Spravato may fit your treatment history and goals.
Esketamine nasal spray is the active medication in Spravato and works through the brain’s glutamate system rather than primarily targeting the neurotransmitters affected by many traditional antidepressants. Its different mechanism makes it an option for certain adults with treatment-resistant depression.
Because esketamine can cause temporary dissociation, sedation, dizziness, and blood pressure changes, it must be administered under medical supervision with a post-treatment monitoring period. Scottsdale TMS & Spravato provides supervised Spravato treatment as part of an individualized approach to depression care.
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 31, 2026
