Spravato (esketamine) is a prescription nasal spray that treats certain types of depression in adults. Its mechanism of action is not fully understood, but it may affect brain chemicals that influence mood. Its effectiveness may vary based on your medical history and diagnosis.

Boxed warnings

This drug has boxed warnings about the following risks. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Risk of sedation, dissociation, and respiratory depression: Spravato can cause sedation (excessive sleepiness), temporary dissociation (an “out-of-body” experience), and respiratory depression (slow, shallow breathing). With sedation, you may not think clearly or be able to operate heavy machinery, including driving a car.

Due to these risks, a healthcare professional will monitor you for at least 2 hours after you receive Spravato at the healthcare facility. They’ll determine when it’s safe for you to leave the facility.

Risk of suicidal thoughts and behaviors: Like other antidepressants, Spravato may increase the risk of suicidal thoughts or behaviors in children and young adults ages 24 years and younger. Spravato is not approved for use in children.

If you have thoughts of suicide during Spravato treatment, call 911 or your local emergency number. In the United States, you can also call or text the Suicide and Crisis Lifeline at 988 or text HOME to the Crisis Text Line at 741741. You can also refer to this suicide prevention support article.

To learn more about these warnings, talk with your doctor or pharmacist.

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Spravato belongs to a class of medications called N-methyl-D-aspartate (NMDA) receptor antagonists. Although scientists do not fully understand how this drug class works for depression, they think Spravato works by affecting the activity of neurotransmitters in the brain, which helps balance mood and mental well-being.

The way a drug works is known medically as its mechanism of action.

Spravato (esketamine) is approved by the Food and Drug Administration (FDA) for treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal thoughts or behaviors. For MDD (also called depression), you will use Spravato along with an oral antidepressant. For TRD, you can use Spravato with or without an oral antidepressant. Spravato is approved for these uses in adults.

Depression is a complicated mood disorder. It’s thought to be caused in part by imbalanced levels of neurotransmitters in your brain. Neurotransmitters are chemical messengers in your body that help nerves communicate. Examples of neurotransmitters include dopamine and serotonin.

An increase or decrease in neurotransmitter activity levels can cause an imbalance. This imbalance can interfere with the body’s ability to function correctly and affect mood and mental well-being. These imbalances may also be related to depression.

It is unknown exactly how Spravato helps ease depression symptoms. It may be related to how Spravato interacts with neurotransmitters.

Spravato blocks a neurotransmitter called glutamate from binding to a certain receptor (attachment site) on your nerves. The blocked receptor is called an NMDA receptor. Blocking glutamate from attaching to this receptor may help regulate communication between nerve cells in the brain. This may help reduce symptoms of depression.

Spravato starts working very quickly. In clinical studies, many people who received Spravato treatment experienced improved depression symptoms within 4 hours of taking the drug.

But how long Spravato takes to work likely varies between people depending on certain factors. These may include your specific condition, your dosage, and other medications you take (including antidepressants).

For more information, talk with your doctor about what to expect with Spravato treatment.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.