Modalities
Intranasal Esketamine (Spravato)
Esketamine (Spravato) is the S-enantiomer of ketamine, FDA-approved for TRD in 2019 and depression with suicidality in 2020.
Medically reviewed by: Pending medical review(draft)Last updated: June 4, 2026Evidence: FDA label; Daly 2018; Fedgchin 2019
Profile
- Active ingredient: esketamine (S-ketamine).
- Bioavailability: ~48% intranasal.
- Onset: 10–20 minutes.
- Setting: REMS-certified clinic, 2-hour observation.
- FDA approval: TRD (2019), MDD with acute suicidality (2020).
Strengths
- Insurance often covers a meaningful portion after prior authorization.
- Standardized dosing and monitoring across certified clinics.
- Strongest regulatory and registration-trial backing.
Trade-offs
- Limited to certified clinics — geographic access varies.
- 2-hour observation window every session, twice weekly initially.
- Cost without insurance can exceed off-label racemic ketamine.
Educational use only. The content on this page is provided for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Ketamine and related therapies carry risks and are appropriate only under qualified medical supervision. Always consult a licensed healthcare professional about your individual situation. Information may change as research evolves.