Esketamine: What It Is, How It Works, and What You Need to Know

When standard antidepressants don’t work, esketamine, a nasal spray form of ketamine approved for treatment-resistant depression. Also known as Spravato, it’s one of the first new depression treatments in decades that acts differently than SSRIs or SNRIs. Unlike pills that take weeks to show results, esketamine can lift severe depressive symptoms in hours or days — especially for people who’ve tried multiple meds without relief.

This isn’t a drug you take at home. Esketamine is only given under medical supervision because of its potential for dissociation, dizziness, or increased blood pressure. You sit in a clinic, receive the spray, and stay for at least two hours while staff monitor you. It’s not a party drug — it’s a tightly controlled medical tool used alongside an oral antidepressant. The FDA approved it after studies showed it significantly outperformed placebos in people with treatment-resistant depression, a condition where at least two different antidepressants failed to help. And while it’s not for everyone, for those stuck in deep depression, it’s been life-changing.

It’s also linked to ketamine therapy, a broader category of treatments using ketamine’s chemical properties to reset brain circuits tied to mood. But esketamine is different from IV ketamine infusions offered in some private clinics — it’s FDA-approved, standardized, and comes with strict safety rules. The nasal spray delivers a precise dose of the S-isomer of ketamine, which is more potent for depression than the racemic mix used in IV form.

Side effects are real — you might feel detached, nauseous, or dizzy after use. That’s why you can’t drive yourself home. Long-term risks are still being studied, but so far, the biggest concern is abuse potential. That’s why it’s only available through certified clinics, and you must be enrolled in a risk management program.

What you’ll find below are real, practical guides from people who’ve navigated this path. You’ll read about how to prepare for your first esketamine session, what to expect during and after treatment, how it compares to other options like TMS or electroconvulsive therapy, and why some people stop using it despite early success. You’ll also see warnings about counterfeit versions sold online and how to avoid scams that prey on desperation. These aren’t theoretical articles — they’re grounded in the same concerns you have: safety, cost, effectiveness, and how to stay in control when your brain feels broken.