What Is Spravato? Uses, Dosage, and What You Need to Know in 2026

Spravato (esketamine) is a breakthrough prescription nasal spray for adults with treatment-resistant depression (TRD). It represents a fundamentally different approach to treating depression — working faster, through a different brain pathway, and requiring a completely different administration model than any oral antidepressant. Here's everything patients and families need to know in 2026.

What Is Spravato?

Spravato is the brand name for esketamine hydrochloride nasal spray, manufactured by Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson. It was first approved by the FDA on March 5, 2019 — becoming the first truly novel antidepressant mechanism approved in decades.

Esketamine is the S-enantiomer (a specific molecular form) of ketamine — a well-known anesthetic that has been used off-label for depression for many years. While ketamine contains two mirror-image molecules (enantiomers), Spravato contains only the S-form, which is believed to be more potent and better tolerated for antidepressant use.

What Is Spravato FDA-Approved For?

As of 2026, Spravato has three FDA-approved indications:

Treatment-resistant depression (TRD) as monotherapy — approved January 2025. For adults who have had an inadequate response to at least 2 oral antidepressants. This is the newest and most significant expansion — Spravato can now be used alone, without a concurrent oral antidepressant.

TRD in conjunction with an oral antidepressant — original 2019 approval. For adults who have not responded to at least 2 oral antidepressants.

MDD with acute suicidal ideation or behavior (MDSI) — added in 2020. For adults with major depressive disorder who have active suicidal thoughts or have recently attempted suicide, used in conjunction with an oral antidepressant.

What Is Treatment-Resistant Depression?

Treatment-resistant depression is defined as major depressive disorder that has not responded adequately to at least two different antidepressant medications taken at the right dose for long enough (typically 6–8 weeks each). It affects approximately 30% of people with MDD — representing roughly 6 million adults in the U.S. who live with depression that standard medications don't adequately control.

Spravato Dosage: How Is It Given?

Spravato comes as a nasal spray device, with each device containing 28 mg of esketamine in 2 sprays. Doses are:

56 mg dose: 2 devices (4 sprays total); 5-minute rest between each device

84 mg dose: 3 devices (6 sprays total); 5-minute rest between each device

The treatment schedule is:

TRD Induction (Weeks 1–4): 56 mg or 84 mg twice weekly

TRD Maintenance (Weeks 5–8): 56 mg or 84 mg once weekly

TRD Maintenance (Week 9+): 56 mg or 84 mg once weekly OR once every 2 weeks (individualized to least frequent effective dose)

MDD with suicidal ideation: 84 mg twice weekly for 4 weeks (may reduce to 56 mg for tolerability)

How Is Spravato Administered?

Unlike most medications, Spravato is not taken at home. It must be administered at a REMS-certified healthcare facility under the direct observation of a healthcare provider. Here's what a typical session looks like:

Don't eat for 2 hours or drink liquids for 30 minutes before your appointment

Gently blow your nose to clear the nostrils before the first device only

Self-administer the nasal spray while a healthcare provider watches — using 2 or 3 devices with 5-minute rest periods between each

Remain at the facility for at least 2 hours of post-dose monitoring for sedation, dissociation, and blood pressure changes

When cleared by your provider, be picked up by a caregiver — no driving until the next day after a restful sleep

Who Makes Spravato?

Spravato is made by Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson based in Titusville, NJ. Janssen received the original FDA approval in March 2019, the expanded MDSI indication in 2020, and the TRD monotherapy indication in January 2025. To date, Spravato has been administered to more than 140,000 patients worldwide and is approved in 77 countries.

Key Facts About Spravato at a Glance

Generic name: Esketamine

Drug class: NMDA receptor antagonist

Schedule: Schedule III controlled substance

Dosage forms: 56 mg kit (2 devices) and 84 mg kit (3 devices)

Onset: Antidepressant effects may begin within 24 hours of first dose

Administration: In-clinic only; REMS program required; 2-hour monitoring after each session

Finding Your Medications With medfinder

While Spravato is administered at certified centers, your other depression medications — antidepressants, sleep aids, or supportive medications — still come from pharmacies. When those are hard to find, medfinder calls local pharmacies to find which ones have your prescriptions in stock.

Want to go deeper? Read: How Does Spravato Work? Mechanism of Action Explained in Plain English.