—including the FDA-approved formulation known as Spravato (esketamine)—is a fast-acting, prescription medication used primarily for adults with treatment-resistant depression (TRD) and major depressive disorder (MDD) with acute suicidal ideation or behavior235. It is also being explored for chronic pain management and certain anxiety disorders56.
Ketamine nasal spray targets NMDA (N-methyl-D-aspartate) receptors in the brain, modulating glutamate, a neurotransmitter involved in mood regulation and neuroplasticity256. This mechanism is distinct from traditional antidepressants, which act mainly on serotonin, norepinephrine, or dopamine pathways. The result is often a rapid improvement in depressive symptoms—sometimes within hours or days—compared to the weeks required for standard antidepressants25.
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: For adults who have not responded to at least two other antidepressant therapies234.
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: Some compounded ketamine sprays are prescribed for chronic pain or anxiety, but these uses are less common and not FDA-approved56.
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: Administered only in a healthcare setting under supervision. Patients self-administer the nasal spray while monitored by medical staff for at least two hours after dosing235.
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: May be prescribed for at-home use, with dosing and frequency tailored by the prescriber56.
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: Many patients experience improvement in depressive symptoms within hours to days25.
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: Offers hope for those who have not responded to conventional antidepressants235.
Common side effects include:
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Dissociation (out-of-body feelings, perceptual changes)
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Drowsiness or grogginess
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Increased blood pressure
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Nausea, dizziness, or headache
Most side effects are temporary and monitored in the clinical setting. Patients should not drive or operate heavy machinery until the day after treatment25.
: Not recommended for patients with certain cardiovascular or respiratory conditions. Blood pressure should be monitored before and after administration34. There is a potential for misuse, so ketamine nasal spray is only available via prescription and, for Spravato, only in certified healthcare settings.
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