The Treatment Desk

Spravato, explained: what esketamine is and how a supervised session works

It is not a take-home prescription. Spravato is a monitored, in-clinic treatment for treatment-resistant depression, with a specific schedule and clear safeguards. Here is the plain-language version.

By the Midwest Health Dispatch Editorial Team St. Louis, MO · Updated July 1, 2026

ESKTreatment desk / Explainer

Illustration: The Midwest Health Dispatch. Spravato is administered and monitored on-site, never sent home.

Spravato is the brand name for esketamine, a nasal-spray medication the U.S. Food and Drug Administration approved for adults with treatment-resistant depression. It is derived from ketamine, and it works differently from the antidepressants most people have tried first. For readers across Missouri and the Midwest who keep hearing the name, here is what it is, and just as importantly, what it is not.

A different mechanism

Most common antidepressants act mainly on serotonin and related systems, and they typically take weeks to build an effect. Esketamine works through a different pathway in the brain involving the glutamate system and NMDA receptors. That difference is the whole point: when the usual mechanism has not helped, a treatment that works through a different one may reach depression that medications alone did not.

The safeguards are not fine print. The in-clinic setting and the monitoring period are the treatment, as much as the medication itself. On why Spravato is given on-site

Why it is only given in a certified clinic

Spravato is not dispensed at a pharmacy for home use. Because of how it can affect people in the hours right after a dose, it is available only through a restricted safety program and must be taken in a certified healthcare setting. That structure is designed to keep patients safe, and it shapes what an appointment looks like.

What a session involves

You self-administer the nasal spray in the clinic, under the supervision of the care team.
You stay and are monitored for at least two hours afterward, because the medication can cause temporary effects such as dizziness, a feeling of detachment, or a rise in blood pressure.
You do not drive yourself home on a treatment day, so arranging a ride is part of the plan.

The schedule

Esketamine is not a one-time treatment. It generally begins with an induction phase of sessions twice a week, followed by a maintenance phase that spaces appointments out over time based on how a person responds. It is typically prescribed together with a standard oral antidepressant rather than on its own. The exact plan is set by the treating clinician.

Who it is, and is not, for

Spravato is approved specifically for treatment-resistant depression in adults, generally meaning depression that has not responded to at least two antidepressants, and separately for depressive symptoms in adults with major depression and acute suicidal thoughts or behavior. It is not a first-line treatment, and it is not right for everyone. Certain medical conditions can make it unsuitable, which is why a careful screening comes first.

Important This article explains a treatment; it does not recommend one for you and makes no promise of results. No treatment is guaranteed to work. Whether esketamine is appropriate is a medical decision made with a qualified clinician after screening. If you are weighing it, our guides to finding local care and paying for it may help.

The bottom line

Spravato widened the map for treatment-resistant depression by offering a genuinely different mechanism, delivered with real medical oversight. The structure around it, the certified setting, the monitoring, the ride home, is not bureaucracy. It is what makes a powerful treatment a safe one.