thoughtscape NP Psychiatry · Patient education
Esketamine
Spravato
A supervised nasal-spray treatment for depression. This sheet is about Spravato, not compounded ketamine.
Draft for review · Clinical content has not been revalidated for this website.
The diagram's sigma-1 action remains unverified; no clinical benefit is assigned.
What it is used for
For adults whose depression has not improved enough with other treatments. For this use, Spravato may be prescribed alone or with an oral antidepressant.
Also used with an oral antidepressant for symptoms of major depression in adults with acute suicidal thoughts or actions. It is not proven to prevent suicide.
How it works
Esketamine blocks NMDA channels involved in glutamate signaling. How these changes produce an antidepressant effect is not fully understood.
Feeling detached or 'spacey' is a side effect, not proof that treatment is working. Improvement does not replace hospitalization when it is needed.
What to expect over time
AT THE VISIT
Sleepiness, dizziness, or detachment can start quickly. Tell the team how you feel; stay until they clear you to leave.
EARLY TREATMENT
Some people improve quickly, but benefit is not guaranteed. Your team reviews mood and function across visits.
OVER TIME
Visits often start twice weekly. Your team reviews benefit at four weeks and sets the ongoing schedule for your indication.
Taking your medication
Use the spray only under clinic supervision. The team chooses your dose and teaches the device; never take it home or add doses yourself.
No food for at least 2 hours or liquids for at least 30 minutes before dosing. Use a required nasal steroid or decongestant at least 1 hour before.
Arrange a ride home. No driving, machinery, or hazardous tasks until the next day after a restful night's sleep, even if you feel normal.
When to get help
Tell staff now: trouble breathing, faintness, inability to stay awake, or frightening detachment. After discharge, severe breathing trouble needs 911.
Emergency help: chest pain, sudden severe headache, vision change, seizure, one-sided weakness, or trouble speaking. Do not drive yourself.
Call promptly: worsening mood, suicidal thoughts, agitation, or unusual energy with little sleep. Immediate danger: 911; U.S. crisis support: 988.
Early side effects
Dizziness, sleepiness, nausea, vomiting, numbness, anxiety, headache, or an altered sense of self may occur. Ask for help standing or walking.
Other effects to discuss
Report new memory problems, painful or frequent urination, blood in urine, or cravings. Supervision reduces risk; it does not make harm impossible.
What to keep track of
Staff check blood pressure, alertness, and breathing, including oxygen level. Observation lasts at least 2 hours and longer if needed. Keep follow-up visits and report mood changes between sessions.
Before you start
Tell the team about aneurysms, abnormal blood-vessel connections, brain bleeding, heart or liver disease, high blood pressure, psychosis, bipolar symptoms, substance use, and ketamine/esketamine allergies. Some conditions rule out treatment. Avoid Spravato in pregnancy; call immediately if pregnant and discuss prevention or alternatives. Do not breastfeed during treatment. Antidepressants can increase suicidal thoughts or actions, especially through age 24; close follow-up matters.
Medicines & interactions
Alcohol, opioids & sedatives
Avoid alcohol. Sleep medicines, benzodiazepines, and opioids can worsen sedation or breathing risk. Ask which medicines to take on treatment days.
Stimulants & MAOIs
These can add to blood-pressure effects. Give the clinic your full medication list; do not change doses on your own.
Naltrexone
Do not stop it to try to improve Spravato's effect. Ketamine studies do not establish a rule that everyone must avoid this combination.
Benzodiazepines
Do not abruptly stop a regular benzodiazepine. If timing or dose needs to change, your prescriber will make a safe plan.
New medicines & substances
Check prescription, nonprescription, and herbal products with the team. Do not substitute compounded ketamine, infusions, or another nasal product.
Everyday tips
Plan transport and enough time for monitoring before each appointment.
Keep prescribed oral medicines and therapy on the agreed treatment plan.
Ask for a calm setting and tell staff if the experience feels frightening.
Track mood and daily functioning, not just how a session feels.
Your questions, answered
What if I miss a visit?
Call the clinic to reschedule and report any worsening symptoms. The team may adjust your schedule. There is no dose to make up at home.
Will I need an oral antidepressant?
For major depression with acute suicidal thoughts or actions, an oral antidepressant is part of treatment. For treatment-resistant depression, Spravato can be used with or without one.
Can I become dependent on it?
Spravato is a Schedule III controlled medicine with misuse and dependence risks. Share any substance-use history or cravings; monitoring is part of care.
How long will treatment last?
It is individualized. Plan follow-up and ongoing depression care before stopping or spacing visits. There is no one taper schedule for everyone.
Storage & safety
Spravato is supplied through a restricted safety program (REMS). Outpatients must enroll. It is administered and stored by certified healthcare settings, not kept at home.
About this information
For general information only; not a substitute for individualized medical advice. This sheet does not cover every risk or interaction. Ask your prescriber or pharmacist before changing how you take this medication.
Sources
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.