Spravato® (esketamine) is a prescription nasal spray derived from ketamine — a medication originally used safely in anesthesia for decades. In 2019, the U.S. Food and Drug Administration (FDA) approved Spravato® as the first medication of its kind to treat:

Treatment-Resistant Depression (TRD) – for adults who haven’t responded to at least two prior antidepressants
Major Depressive Disorder (MDD) with Suicidal Thoughts or Actions

In 2025, the FDA also approved Spravato® as a stand-alone (monotherapy) treatment for TRD — offering new hope to individuals who have not found relief with traditional antidepressants. Spravato® is administered only in certified medical settings under the REMS (Risk Evaluation and Mitigation Strategy) program. At Blue Lotus Wellness, our trained clinicians monitor clients throughout their sessions to ensure comfort and safety.

How Spravato® Works in the Brain

Unlike traditional antidepressants, which target serotonin, dopamine, and norepinephrine, Spravato® works on the brain’s glutamate system — the main chemical messenger responsible for learning, memory, and emotional regulation.

Esketamine blocks NMDA receptors on inhibitory neurons, leading to increased glutamate release — the brain’s most abundant excitatory neurotransmitter. This surge in glutamate stimulates AMPA receptors, triggering the release of Brain-Derived Neurotrophic Factor (BDNF) and activating the mTOR pathway, both essential for creating new synaptic connections (enhanced neuroplasticity). These changes promote synaptogenesis (the growth of new connections) in areas like the prefrontal cortex — helping restore and re-wire healthy communication between brain cells that regulate mood, motivation, and stress response. By strengthening these neural circuits, Spravato® can alleviate depressive symptoms within hours to days, rather than the several weeks often required with traditional antidepressants.

The Research Behind Spravato®

Spravato® is one of the most well-studied modern antidepressant innovations. Major clinical trials have shown that many individuals with treatment-resistant depression can experience rapid relief within 24–48 hours, and that Spravato®, when combined with an oral antidepressant, leads to a significantly greater reduction in depressive symptoms compared to placebo. Research has also found higher remission rates—one study reported that 22.5% of participants achieved remission after four weeks of Spravato®, compared to 7.6% in the placebo group—along with a reduced risk of relapse for those who continue with maintenance treatment. Studies further suggest improved mood and functioning in adults experiencing suicidal thoughts. To date, more than 140,000 patients worldwide have received Spravato® therapy, supporting it as a well-established option backed by real-world data.

What to Expect During Treatment

At Blue Lotus Wellness, Spravato® treatments are offered in a calming, supportive environment designed to promote healing and safety. Each client begins with a comprehensive assessment to determine whether Spravato® is appropriate based on their history and current symptoms. During treatment, the nasal spray is self-administered under the supervision of a clinician, and sessions typically last about two hours, including observation time. Clients are welcome to read, rest, or listen to music while they relax in a small group room with up to three people. Throughout the session, clinicians closely monitor for temporary effects such as dizziness, nausea, fatigue, dissociation, or sedation, which typically resolve before discharge. Many clients also choose to pair their Spravato® treatments with therapy or coaching to help integrate the emotional and cognitive shifts that may arise during the healing process.