What is Spravato?

Spravato is a brand-name prescription medication that’s prescribed for treatment-resistant depression (TRD). TRD is depression that hasn’t improved after treatment with two or more antidepressants.

Spravato contains the drug esketamine. It’s approved for use in adults, but not in children.

Spravato comes as a nasal spray. It’s taken under the supervision of a healthcare provider at a certified medical facility. Spravato should be used in combination with at least one other antidepressant medication that’s taken by mouth.

​

In a clinical study lasting four weeks, Spravato improved symptoms of depression in people taking the drug. One group was given Spravato and an oral antidepressant. The other group was given a placebo (no treatment) and an oral antidepressant. Depression symptoms were measured on a scale of zero to 60 (with higher scores meaning worse depression symptoms).

People taking Spravato had fewer depression symptoms than people taking the placebo. Scores for people taking Spravato improved by 4 points more than scores for people taking the placebo. The greatest improvement in symptoms was seen in the first 24 hours after people took Spravato.

​

FDA approval

Spravato was approved by the Food and Drug Administration (FDA) in March 2019.

Its approval is considered controversial by some people for a few reasons:

​

• Similarity to ketamine. Spravato is similar to ketamine (an anesthetic drug), which is sometimes used as a party drug. However, Spravato and ketamine aren’t the same drug. They have some similar effects in the body, but they are different drugs.

• Fast action. During clinical studiesTrusted Source, Spravato lessened depression symptoms within hours after it was taken. This is unlike many other depression medications, which can take weeks to start working.

• Side effects. Possible side effects of Spravato include dissociation (feeling “out of body”) and sedation (sleepiness, trouble thinking clearly, inability to drive or use heavy machinery). Sometimes, these side effects can become severe. Because of this, the FDA requires that Spravato be given by specially trained healthcare providers at certified medical facilities. People who take Spravato are monitored at the facility for at least two hours after they take the drug.

• Potential for misuse. Spravato has the potential to be misused. This risk is greater in people who have a history of drug misuse or unhealthy drug use.

Long-term studies are still being done regarding how safe and effective Spravato is. The results of these studies will be helpful for doctors managing TRD.