Could a Nasal Spray Help with Depression?

pharmacist at a pharmacy telling a patient

Spravato® is a new treatment on the market for specific cases  of depression.  Its unique mechanism and fast results are promising. Long-term data is still pending, so individuals  should discuss their options with their healthcare providers.

Share This Post

Spravato® (esketamine), related to the older drug ketamine, is a nasal spray approved in 2019 for management t of treatment-resistant depression.

In August of 2020, the United States Food and Drug Administration (FDA) approved Spravato®, to be taken along with an oral antidepressant, for individuals with major depressive disorder (MDD) with acute suicidal ideation or behavior. 

What is the difference between ketamine and esketamine? Where does this drug fit in the treatment of depression? Read on to learn more! 

A Brief History of Ketamine

Ketamine is an old drug. It was originally introduced in the 1960s as an anesthetic that could rapidly be absorbed into the brain.

Ketamine was desirable in this role due to its ability to provide general anesthesia and sedation while not affecting the heart and lungs of the patient. 

In fact, initial studies in the 1960s showed that ketamine worked for a limited time, and it could safely be given repeatedly to extend the effect.

Some limited studies have been done to assess the effects of ketamine on depression and post-traumatic stress disorder (PTSD). 

The drug was noted to have profound hallucinogenic properties in both human and animal subjects leading to ketamine becoming a popular street drug, sometimes referred to as “Special K,” in the 1970s and 1980s.

Getting to Esketamine from Ketamine

Spravato® (esketamine) is what is called an enantiomer of ketamine.

Ketamine is a drug that is composed of molecules that are mirror images of one another.

Spravato® is composed of the S-enantiomer, thus giving it the name esketamine. 

So, What’s the Difference?

Ketamine is normally required to be administered intravenously (IV). It can be taken by mouth or rectally, but the amount of medication that ultimately makes it to the bloodstream is greatly reduced.

Additionally, treating patients with frequent IV infusions might not be an ideal regimen for those struggling with depression.

Spravato® is a nasal spray rather than an infusion. It is a controlled substance, but you cannot purchase it at a pharmacy. Instead, each dose must be administered at your healthcare provider’s office under their supervision

Both ketamine and Spravato® can cause short-term sleepiness and impaired thinking.

They also both block N-methyl-D-aspartate (NMDA) receptors in the brain, which is a  different mechanism compared to  most other antidepressants. 

Spravato® misuse or abuse can have negative long-term effects on thinking and memory.

No such effect was seen during the one-year safety study for Spravato®, but  additionallong-term data is needed. 

It should be noted that Spravato® is a brand name medication that can be expensive. In 2019, Jannsen set a cash price of $590 to $885 per treatment session.

Insurance coverage cannot be guaranteed, but the company does have financial assistance options available. 

YouTube player

How is Spravato® Taken?

Depending on your circumstances, Spravato® should be taken while you are also taking an oral antidepressant.

Spravato® comes as a nasal spray that has to be sprayed into your nostrils under the supervision of a healthcare professional.

Each device contains enough solution to provide a total of 28 mg of Spravato via two sprays.

Depending on your individualized therapy course, you will most likely use two or three devices in a single visit with a 5-minute wait between devices. 

Some patients will have Spravato® sessions twice a week while others are once weekly. The length of treatment depends on the individual person and their response.

Because of the risk of impairment with treatment, it would be wise to have someone else drive you to and from your appointment.

What Should I Expect If I Take Spravato®?

Spravato® is only intended for people who have tried and failed multiple medications for managing their depression, or for those with major depressive disorder with suicidal ideation.

This will not be a first treatment option for people newly diagnosed. Due to fetal risk, pregnant and nursing mothers should not use Spravato®.

While some hoped for rapid results, Janssen has said that patients can expect results in about four weeks when Spravato® is taken with an oral antidepressant. 

In trials, patients experienced a variety of common side effects, including: dissociation, dizziness, nausea, sedation, spinning sensation, reduced sense of touch and sensation, anxiety, lack of energy, vomiting, and feeling drunk.

Acommon concern with Spravato® administration is use in people with high blood pressure. Spravato raises blood pressure to a high point about forty minutes after the dose is taken, returning to normal levels at the two-hour mark.

In trials Janssen saw no higher chances for heart-related issues as a result of this temporary increase. Expect to have your blood pressure checked before you take the medication, at forty minutes, and then as needed to track it coming down. 

Janssen does mention that there was an increase in suicidal thoughts and behaviors in people 24 years old and younger. The medication currently is not approved for anyone below the age of 18.

What is Dissociation?

The Sidran Institute defines dissociation as a “disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is.” They describe mild examples as  daydreams or getting lost in a book.

One study of ketamine showed that individuals  experienced misperceptions of time, along with “heightened, dulled, and distorted perception.” 

Dissociation symptoms may occur after each session. The possibility of long-term effects require additional studies. 

References, Studies and Sources:

1. SPRAVATO – Overview. Janssen CarePath. https://www.janssencarepath.com/hcp/spravato. Published 2020. Accessed September 14, 2020.

2. FDA approves new nasal spray medication for treatment-resistant depression; available only at a certified doctor’s office or clinic. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified. Published 2020. Accessed September 14, 2020.

3. SPRAVATO® (esketamine) | SPRAVATO® HCP. SPRAVATO® (esketamine). https://www.spravatohcp.com/resources#Frequently_Asked_Questions. Published 2020. Accessed September 14, 2020.

4. Esketamine may solve depression need, but not be cost-effective – STAT. STAT. https://www.statnews.com/pharmalot/2019/03/22/antidepressants-cost-effective-johnson-and-johnson/#:~:text=Known%20as%20esketamine%20and%20marketed,which%20can%20vary%20by%20patient. Published 2020. Accessed September 14, 2020.

5. Janssenlabels.com. http://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/SPRAVATO-pi.pdf. Published 2020. Accessed September 14, 2020.

6. Fda.gov. https://www.fda.gov/media/121379/download. Published 2020. Accessed September 14, 2020.

We are committed to providing our readers with only trusted resources and science-based studies with regards to medication and health information. 

Disclaimer: This general information is not intended to diagnose any medical condition or to replace your healthcare professional. If you suspect medical problems or need medical help or advice, please talk with your healthcare professional.

Share This Post

Pharmacists.org Discount Club

Get Started for $1.

  • Cheapest cash pay option at your retail pharmacy
  • 1,000s of drugs below $10.00 that can beat your co-pay
  • Start for $1 for your first month. Cancel anytime. 
  • Tell us your meds, we tell you the cheapest options.

Popular Destinations

Recent Articles

trusted pharmacists giving patient information

Does Taking Effexor Cause Weight Gain?

Taking Effexor may cause weight gain in some patients. Weight gain is a common side effect of Effexor and other antidepressant medications, and more than half of patients on newer classes of antidepressants report experiencing weight gain.

Read More »

Cerebral Review: Online Depression & Anxiety Treatment

Today, we’re deep diving with a Cerebral review to give you some insider info to help you narrow down your choices.


We review and include products we think are useful for our community. If you buy through links on this page, we may earn a commission. For more info, please read our ad policy, content principles and vetting policy.

Read More »

Share On:

More To Explore

Does Taking Effexor Cause Weight Gain?

Taking Effexor may cause weight gain in some patients. Weight gain is a common side effect of Effexor and other antidepressant medications, and more

How Long Does Lexapro Take To Work?

If you are considering taking Lexapro for your depression or anxiety, you might be wondering how long it takes to work.

Zoloft and Weight Loss: Everything You Need To Know

When it comes to Zoloft and weight loss, here’s everything you need to know.

Cerebral Review: Online Depression & Anxiety Treatment

Today, we’re deep diving with a Cerebral review to give you some insider info to help you narrow down your choices.

We review and include

What are the signs of Depression?

In this article, we will discuss the signs and symptoms of depression as well as some treatment options for this condition.

Can You Use Gabapentin For Anxiety?

While Neurontin is the most common brand name for gabapentin, other forms (such as Horizant and Gralise) may be prescribed depending on the specific

What is Zoloft?

If you have been recently diagnosed with depression and are given Zoloft, you may want to know how the medication works, what common side

What is Venlafaxine HCL ER?

The prescription drug belongs to a class of drugs called selective serotonin norepinephrine reuptake inhibitor antidepressants (SNRIs), which are commonly used to treat mental

Using Prozac With Alcohol: What Are the Risks?

Prozac can be used to treat many different mental health conditions, is associated with a relatively low risk of side effects, and causes the

How Long Does Clonazepam Stay in Your System?

This fast-acting medication is known for being effective at panic attacks, but how long does clonazepam stay in your system?

What is Sertraline and What are the Side Effects?

Sertraline is the generic form of Zoloft, a medication that belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). SSRIs like

Turn On, Tune In, and…. Heal Your Brain? Psychedelics Return as Potential Therapy for Mental Health Disorders

Before they fell out of favor over half a century ago, psychedelic drugs, like psilocybin and LSD, were studied for various psychiatric diseases such

How Long Does Alprazolam Stay in Your System?

Alprazolam is a fast-acting medication, but exactly how long alprazolam stays in your body varies tremendously based on the form of the medication taken,

Paxil vs Zoloft: Differences, Similarities and Which is Better

When it comes to Paxil vs. Zoloft, which is better?

A Supplement for Stress? The Science Behind Adaptogens

Stress is part of all our lives. Adaptogens are a group of herbal supplements studied throughout history as a way to improve the body’s

Does Buspirone Cause Weight Gain?

Many antidepressants can cause weight gain as a side effect. Buspirone may cause an altered appetite as a side effect, which can lead to

Duloxetine Withdrawal: Symptoms, Timeline, and Treatment

Duloxetine withdrawal is very common and well documented, affecting nearly half of all patients. Common withdrawal symptoms include dizziness, headaches, and nausea, and symptoms

Cymbalta vs. Prozac: Comparison Guide

Cymbalta and Prozac are commonly prescribed medications to treat mental health conditions such as major depressive disorder. The medications are similarly effective, although one

How Long Does Ativan Stay in Your System?

If you use Ativan to manage your health but are curious about how long Ativan lasts in your system, we have all the information

Why is Mental Health Important?

As the saying goes, “There is no health without mental health,” but why is mental health so important? The reality is that although we

What is BuSpar? Uses, Costs, Benefits, and Doses

If you’re one of 40 million American adults suffering from an anxiety disorder or experiencing symptoms of anxiety, you might think that your battle

What are Long-Acting Injectable Antipsychotics? 

Long-acting injectable (LAI) antipsychotics have been shown to prevent psychosis relapse in patients with schizophrenia. To combat poor medication adherence, LAIs are a great

Cymbalta vs Effexor: Differences and Side Effects

Effexor and Cymbalta are antidepressants used for the treatment of major depressive disorder and generalized anxiety disorder. Although both medications are FDA-approved, Effexor and

Celexa vs Lexapro: Which is Better For Depression?

Both are regarded as equally effective drugs for treating depression. Find out the core difference between Celexa vs. Lexpro now!

What is Ativan? Uses, Costs, Benefits, Doses

More than 40 million adults in the United States are diagnosed with an anxiety disorder, making it the most common mental illness in the

Lexapro Overdose: Signs, Symptoms, and Precautions

We’ve put together a list of the signs and symptoms to look out for when it comes to Lexapro overdose and some of the

Panic Attacks: The Story of an Overpowering Fear

Panic attacks are when you experience a sudden feeling of intense fear with no apparent threat or danger.  This triggers a "fight or flight"

Using Lorazepam with Alcohol: What Are the Risks?

Using lorazepam with alcohol is incredibly dangerous but can be a common occurrence, and is associated with potentially life-threatening side effects, which are outlined

Using Citalopram with Alcohol: What Are the Risks?

Mixing antidepressants with alcohol is always potentially dangerous, but using citalopram with alcohol is particularly unsafe due to the high potential for life-threatening side

Brightside Health Review: Is This Depression & Anxiety Care Useful?

Brightside is an online mental healthcare company that provides treatment services for a range of issues related to anxiety and depression. These conditions include