The names are similar enough to create confusion. Spravato is made from esketamine, a medication related to ketamine, but that doesn’t mean every ketamine treatment is the same or that Spravato is simply recreational ketamine placed in a nasal spray.
Spravato is a prescription treatment with specific FDA-approved uses, dosing guidelines and safety requirements. It must be administered in a certified medical setting, where patients are monitored after every dose.
Understanding those distinctions can help you make a more informed decision about whether Spravato may fit your depression treatment plan.
Have questions about Spravato treatment? Contact Resiliency Mind + Body Medicine to request an evaluation with our clinical team.
The Bottom Line
- Spravato contains esketamine, which is related to ketamine but is not identical to it.
- Spravato is FDA-approved for specific forms of depression in adults.
- Ketamine is FDA-approved as an anesthetic, not as a psychiatric treatment.
- Spravato must be taken in a certified health care setting under clinical supervision.
- Insurance may cover Spravato when a patient meets the plan’s medical criteria.
Is Spravato the Same as Ketamine?
No, although the two medications are closely related.
Ketamine contains two molecular forms, sometimes described as mirror-image versions of the same molecule. Esketamine is one of those forms. Spravato is the brand name for an FDA-approved nasal spray containing esketamine.
Traditional ketamine is FDA-approved as an anesthetic. When ketamine is provided for depression, it is generally being used “off-label,” meaning the medication is being prescribed for a condition that is not included in its FDA-approved labeling.
Spravato, by comparison, has been specifically studied and approved for certain psychiatric uses. Current prescribing information includes treatment-resistant depression in adults, either by itself or with an oral antidepressant. It is also approved with an oral antidepressant for depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior.
Why Does FDA Approval Matter?
FDA approval doesn’t mean medication is right for every patient. It means the treatment has gone through a formal review process for particular uses, including evidence related to its effectiveness, dosing and safety.
Spravato treatment follows a defined protocol. The medication comes in predetermined nasal-spray doses and is administered under the direct supervision of a health care provider.
By contrast, off-label ketamine for depression may be delivered in several forms, including intravenous infusions, injections or compounded products. Those approaches may follow different dosing and monitoring practices depending on the provider.
The distinction is not that one medication is “real” and the other is not. It is that Spravato has a standardized, FDA-approved pathway for depression treatment.
What Happens During Spravato Treatment?
Spravato is not prescribed for patients to take home.
During an appointment, the patient administers the nasal spray while a health care professional observes. The clinical team monitors the patient for at least two hours afterward and determines when the patient is stable enough to leave.
Monitoring is required because Spravato may temporarily cause effects such as:
- Sleepiness or sedation
- Feeling detached from yourself or your surroundings
- Changes in perception
- Increased blood pressure
- Dizziness, nausea or headache
Patients should arrange transportation home and should not drive or operate machinery until the following day after a restful night’s sleep.
Spravato is available only through a restricted safety program known as the Spravato Risk Evaluation and Mitigation Strategy, or REMS. Participating clinics and pharmacies must meet specific certification requirements.
Who May Be Eligible for Spravato?
Spravato is often considered for adults with treatment-resistant depression. This generally describes depression that has not improved adequately after appropriate trials of other antidepressant treatments.
Eligibility is not based on diagnosis alone. A psychiatric evaluation may consider:
- Your current symptoms and diagnosis
- Which medications you have previously tried
- How long you took each medication
- Whether side effects affected treatment
- Your medical and psychiatric history
- Current medications and substance use
- Blood pressure and other safety considerations
A provider can then determine whether [Spravato therapy] or another treatment may be more appropriate.
Does Spravato Actually Work?
Yes. Real-world research shows that Spravato can produce meaningful improvement for many patients with treatment-resistant depression.
The 2025 INTEGRATE study evaluated 189 patients receiving esketamine nasal spray in routine clinical practice. Within the first four weeks, 80.4% of patients were considered to be in response or remission. Among patients who continued into the maintenance phase, 90% were in response or remission, and 28% experienced improvement in depressive symptoms within 24 hours of their first treatment.
These results are especially useful because they reflect how Spravato performs outside of tightly controlled clinical trials. At Resiliency Mind + Body Medicine, Spravato is one of several treatment options we may consider when medication alone has not provided enough relief, particularly for patients experiencing severe or treatment-resistant depression.
Will Insurance Cover Spravato?
Spravato may be covered by commercial insurance, Medicare or Medicaid plans when a patient meets the plan’s requirements.
Coverage often depends on documentation of treatment-resistant depression, previous medication trials and prior authorization. Individual benefits, copays and clinical criteria vary.
This is one area where Spravato can differ from off-label ketamine treatment, which is frequently paid for out of pocket. Resiliency Mind + Body Medicine can help patients understand the authorization process and available insurance options.
How Can You Learn Whether Spravato Is Right for You?
Spravato is related to ketamine, but calling them the same overlooks important differences in formulation, FDA approval, administration and clinical oversight.
The best way to understand those differences is through an individualized psychiatric evaluation. Resiliency Mind + Body Medicine provides physician-led psychiatric care and supervised Spravato treatment in Orange County, California.
Ready to explore another option for depression treatment? Contact Resiliency Mind + Body Medicine to request a Spravato consultation.