Esketamine nasal spray (under the brand name Spravato) is a prescription medication used in certain adults with depression who didn’t get enough relief from other antidepressant medications. It’s associated with an ingredient of the drug Ketamine, but the drugs are not the same. Spravato is licensed for use in treating some types of major depressive disorder and can only be administered by a health care provider.
The primary concern for those in the UK is the accessibility of Spravato via the National Health Service (NHS). However, there isn’t a simple answer as esketamine is a licensed drug in the UK but is not recommended for regular use in the NHS for treatment-resistant depression by NICE. That access will be very unlike the private treatment may be. This guide explores the information about what Spravato is, how it is used, side effects, current NHS and private situation.
What Is Spravato?
Spravato is an injection that comes in a nasal spray that contains the drug esketamine (also called ketamine). Unlike many conventional antidepressant medications that act on serotonin, it acts on a different part of the brain. It is used in combination with an antidepressant drug, for the treatment of adults with treatment-resistant major depression. According to the UK product information, it is designed for adults who have not responded to at least two antidepressant medications within the current moderate to severe depressive episode.
Taking Spravato at home or anywhere other than under a doctor’s care is not associated with Spravato. It’s a prescription medicine that has essential package directions, monitoring and safety requirements. This separation becomes relevant when viewing information related to the use of ketamine as an antidepressant, as there are instances of off-label use of ketamine within clinical practice.
Esketamine vs Ketamine
But, one part of the ketamine molecule is called “esketamine. Spravato is a nasal spray that contains esketamine to treat a medical condition.
Ketamine has long since been employed as an anaesthetic agent and for pain relief. It can also be used off-label for depression, in some certain mental health services. For instance, Oxford Health states that ketamine is not licensed for depression use; another example is Spravato, which has a licence in treatment-resistant depression (in combination with an SSRI or SNRI).
This does not imply that any medicine is necessarily appropriate for all people. Decision is based on diagnosis, treatment history, medical history and the experience of a skilled physician.
What Condition Is Spravato Licensed For?
In the UK Spravato is licensed for use in adults who have not responded to at least two antidepressant treatments in the current moderate to severe major depressive episode when added to an SSRI or SNRI.
The current UK product information also includes an indication for short-term treatment of a moderate to severe major depressive episode when rapid reduction of depressive symptoms is needed because the situation is considered a psychiatric emergency. This use occurs in conjunction with antidepressant use via the mouth and as part of a comprehensive clinical management.
If a medicine is licensed, it doesn’t necessarily mean that everyone who is eligible for it will get the medicine. Treatment decisions will still need to be made by clinical staff to determine appropriateness and safety.
How Is Spravato Administered?
Spravato is given as a nasal spray. Never take at home without medical supervision. The nasal spray is administered by the patient but under supervision of a healthcare professional during a treatment session.
The typical treatment regimen for treatment-resistant depression is a high-dose of the treatment for the first four weeks. Once this occurs, treatment may be reduced to every 2 weeks and, eventually, every week (after clinical response and treatment plan are determined).
The dose and frequency depend on the psychiatrist prescribing the drug. The treatment takes place in an appropriate clinical environment after which the patient can be monitored.
Why Does Spravato Need Supervision?
A key component of Spravato treatment is being supervised. Esketamine may result in temporary effects like dizziness, sleepiness, sedation and dissociation which can cause a person to feel disconnected with what’s going on around them or disconnected from themselves. It also may briefly increase blood pressure.
A person’s blood pressure is measured before treatment and after treatment. The information on the product indicates that blood pressure should be checked approximately 40 minutes after when taken and continuing if necessary. Patients will continue to be monitored until the health care practitioner deems them to be clinically stable.
Patients should also avoid driving or operating machinery until the next day after a restful night’s sleep because Spravato can affect attention, judgement, reaction speed and motor skills.
Side Effects and Monitoring
As with all medicines, Spravato may have side effects. Increased blood pressure, altered taste, sleepiness, vertigo, nausea, dizziness and dissociation are commonly reported effects.
Part of the reason for the treatment to be conducted in a clinical setting is because of these effects. Some effects occur at around the time of dosing and tend to resolve during the observation period. The changes in blood pressure can persist for about 1 to 2 hrs.
Even longer-term treatment may also require continued clinical monitoring. The UK product information states that urine and urinary bladder symptoms should be monitored during treatment and that medical assessment should be sought if these symptoms persist.
Is Spravato Available on the NHS?
The situation in the UK is, however, more complex. Spravato is registered in the UK but not recommended for regular use in the NHS for treatment-resistant depression by NICE. However, NICE’s technology appraisal (TA854) found the evidence and cost-effectiveness estimates to be too uncertain to support the NHS use of this treatment.
NICE’s current depression guidance also states that esketamine nasal spray is not recommended for treatment-resistant depression under its technology appraisal guidance.
This does not imply that a person is entitled to access Spravato on the NHS as a matter of right if he or she has treatment-resistant depression. The availability of services may also be influenced by local NHS arrangements.
What is the NICE Position?
In December 2022, the National Institute for Health and Care Excellence (NICE) issued a technology appraisal recommendation for esketamine nasal spray. The recommendation was that esketamine with an SSRI or SNRI should not be used within its marketing authorisation for adults with treatment-resistant depression who had not responded to at least two different antidepressants in the current moderate to severe depressive episode.
One of the uncertainties NICE took into account was the evidence regarding the benefits in the long term and the costs. It also took into account the practical implications of treatment as the patients must travel to an appropriate healthcare facility on a regular basis and are unable to drive post treatment.
This does not mean that Spravato is not a registered drug. The decision about its UK licence and NICE’s funding recommendation is different.
Private Access to Spravato in the UK
Specialist services may offer the opportunity for private access to esketamine treatment. But the level of availability, assessment criteria, treatment costs and treatment follow-up is different in each provider.
There are medical requirements for treatment with Spravato that do not differ with private treatment. It still requires the proper prescribing and administration under direct healthcare supervision. Patients should also be monitored following each dose.
Everyone who is thinking of using private treatment should want to find out who’s prescribing the medicine for them, how evaluations are carried out, how patients are monitored, and what will happen should there be side effects. Additionally, it is essential to know the amount of treatment sessions in the schedule and the overall price of treatment and not just the cost of one session.
Key Takeaway
Spravato is a licensed esketamine nasal spray for certain adults with treatment-resistant depression in the UK. For these reasons it should be used only under medical supervision and is known to cause dissociation, dizziness and an increase in blood pressure. NICE recommends that NHS use of licensed products is not routine in general but local arrangements or private treatment may be required.
References
https://www.nice.org.uk/guidance/ta854
https://www.nice.org.uk/guidance/ng222
Evidence last checked: 28 September 2026
