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Spravato is for adults whose depression has not responded to at least two antidepressants. It is also approved for adults with major depressive disorder who have active suicidal thoughts. You take it alongside an oral antidepressant, not instead of one.
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Updated August 2026 · Reviewed by Nefretiri Abat, PMHNP-BC
Pregnancy and breastfeeding need a separate conversation. Uncontrolled high blood pressure usually needs to be managed first, not ruled out permanently.
You spray it yourself, under supervision, in our office. Then you stay about two hours while we monitor blood pressure and how you are doing. You cannot drive for the rest of the day.
The usual schedule is twice a week for four weeks, then weekly, then every one to two weeks depending on response.
This is the FDA-approved form of esketamine given under the REMS safety programme. It is not IV, intramuscular, or compounded ketamine.
Most commercial plans, Medicare, and Medi-Cal cover Spravato for treatment-resistant depression with prior authorisation, typically after documented antidepressant trials. See Spravato cost in California, Medi-Cal and Spravato, and fees and insurance.
In the trial supporting approval, adults who added esketamine to a newly started antidepressant improved more than those who took the antidepressant alone (Popova 2019). Response varies and is not guaranteed.
Both treat the same problem differently. Spravato tends to suit people who need faster relief or have struggled to tolerate pills. TMS suits people who want no sedation, no transport arrangements, and no medication exposure. Many people are candidates for both. See TMS therapy and treatment-resistant depression.
If you are having thoughts of hurting yourself, say so at your appointment. If you are in danger now, call or text 988.
Adults whose depression has not responded to two antidepressants, and adults with depression and active suicidal thoughts.
People with a history of aneurysm or brain bleeding, certain vascular conditions, or ketamine allergy.
Yes. You cannot drive for the rest of the day.
About two hours.
Usually, with prior authorisation.
Medically reviewed by Nefretiri Abat, J.D., PMHNP-BC, board-certified Psychiatric-Mental Health Nurse Practitioner.
Adults whose depression has not responded to at least two antidepressants, and adults with major depressive disorder who have active suicidal thoughts. It can be given as a standalone monotherapy for treatment-resistant depression, approved by the FDA in January 2025, or alongside an oral antidepressant. For depressive symptoms in major depressive disorder with acute suicidal ideation or behavior, it is given with an oral antidepressant.
People with a history of aneurysm or bleeding in the brain, certain vascular conditions, or an allergy to ketamine or esketamine. Pregnancy and breastfeeding require a separate discussion.
Yes. You cannot drive for the rest of the day, so you need a ride or rideshare arranged in advance.
About two hours. You take the spray yourself and stay for monitoring afterward.
Most commercial plans, Medicare, and Medi-Cal cover it for treatment-resistant depression with prior authorisation.
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