When standard antidepressants fail to help, severe depression can become difficult to treat. Spravato is a nasal spray form of the medication esketamine. The FDA approved it in 2019 for treatment-resistant depression, and its approved uses have since expanded. Here is more information on its speed, its effects on the brain, and the treatment process:
Providing Rapid Relief
Most oral antidepressants take four to six weeks to reach their full effect. That wait feels long during a severe episode, and many people struggle to stay on track. Spravato works on a different timeline because it acts on a separate brain system.
Some patients have changes on the first day, but responses vary widely. Your provider tracks your symptoms closely so that you both understand your body’s response. Not everyone experiences fast results. Some people need several sessions before they notice a shift.
Since speed matters during a crisis, Spravato also has approval for adults with depression and acute suicidal thoughts or actions. It does not replace emergency care or hospitalization. Crisis hotlines can answer calls, and your provider needs to know about worsening thoughts.
Utilizing Different Pathways
Antidepressants like SSRIs and SNRIs target serotonin and norepinephrine. Spravato takes another route because it blocks NMDA receptors, which respond to the brain chemical glutamate. This difference matters for treatment-resistant depression, and providers may pair Spravato with an oral antidepressant. Here is a quick comparison:
- SSRIs and SNRIs: Daily pills that adjust serotonin or norepinephrine over several weeks
- Spravato: A nasal spray that targets glutamate signaling through NMDA receptors
- Setting: You take most antidepressants at home, but Spravato requires a certified treatment center
Influencing Glutamate
Glutamate is one of the brain’s signaling chemicals, and it helps nerve cells communicate. Depression may disrupt this signaling in key brain regions. When Spravato blocks NMDA receptors, glutamate shifts toward other receptors. These receptors play a role in learning and memory.
Researchers believe this shift triggers a burst of activity that supports mood regulation. The science is still developing, and experts continue to study the exact process. Your provider explains the details for your situation. Treatment works best alongside therapy and steady daily routines.
Growing Neural Connections
Chronic stress and depression may weaken connections between brain cells. Studies link depression to fewer synapses in the prefrontal cortex, and this loss affects mood and focus. After Spravato triggers glutamate activity, the brain releases a protein.
This protein supports the growth of new synapses, and these connections may help restore healthier communication. Since these changes take time, providers follow a structured schedule. A typical schedule looks like this:
- Weeks 1–4: Two sessions per week
- Weeks 5–8: One session per week
- Week 9 onward: One session every one or two weeks
Try Spravato for Severe Depression
Each Spravato session takes place at a certified treatment center. Staff monitor you after each dose, and you need a ride home afterward. Side effects may include dizziness, nausea, higher blood pressure, and feeling detached, which usually fade the same day. If other treatments have not helped, talk with a psychiatrist about whether Spravato fits your plan.
