You've tried antidepressants. Maybe two, three, or more. And you're still struggling. If that sounds familiar, you are not alone — and you are not out of options. Spravato (esketamine) has emerged as one of the most significant breakthroughs in depression treatment in decades, offering rapid relief for people with treatment-resistant depression. But does it actually work? And what is the experience really like? Here is an honest, research-backed look.
The Evidence: How Effective Is Spravato?
Spravato's effectiveness has been demonstrated across multiple rigorous clinical trials, including the landmark TRANSFORM-2, SUSTAIN-1, and ASPIRE I/II studies. These trials showed that esketamine provides rapid antidepressant effects — often within hours — and improves both remission and response rates in patients with treatment- resistant depression.
Real-world data reinforces these findings. A retrospective study using the Komodo database found that the median time to substantial clinical improvement among Spravato patients was 4.4 months, and the probability of achieving meaningful improvement at 12 months was 71%. Another real-world analysis found clinically meaningful improvement in depression scores after 32 treatment sessions, including in patients with more severe baseline depression and those with comorbid anxiety.
Perhaps most notably, the 2025 FDA approval of Spravato as a monotherapy was based on clinical trial data showing that it achieved remission in 15 percent more patients than placebo at 28 days, and demonstrated measurable improvement in depressive symptoms as early as 24 hours after the very first dose — something traditional antidepressants simply cannot do.
How Fast Does Spravato Work?
This is one of Spravato's most significant advantages over conventional antidepressants. Traditional SSRIs and SNRIs typically take 6 to 8 weeks to show meaningful results. Spravato, by contrast, can produce noticeable relief within hours of the first treatment for some patients.
This rapid onset makes Spravato particularly valuable for two groups of patients: those with treatment-resistant depression who have been suffering for years without relief, and those experiencing major depressive disorder with acute suicidal ideation, where speed of response is critical.
What Are the Side Effects?
Spravato's side effects are real, well-documented, and manageable — especially in a supervised clinical setting like Oasis. The most common side effects include:
- Dissociation: A temporary feeling of detachment from one's surroundings or sense of self, experienced by approximately 69% of patients during treatment sessions. This effect is transient and resolves within the two-hour monitoring period.
- Sedation: Feelings of sleepiness or drowsiness, reported by approximately 61% of patients. This is why patients must remain monitored for at least two hours after each session.
- Nausea and dizziness: Reported by some patients, particularly in earlier sessions.
- Headache: Some patients experience mild headaches following treatment.
It is important to note that these side effects are temporary — they typically peak during the session itself and resolve before patients leave the clinic. Because Spravato does not cause the systemic side effects associated with traditional antidepressants (such as weight gain, sexual dysfunction, or insomnia), many patients find it to be better tolerated over the long term.
Due to the risk of sedation and dissociation, patients must have a driver take them home after each session and cannot drive on the day of treatment.
What Do Patients Say About Their Experience?
Patient experiences with Spravato vary, but many describe it as a turning point after years of struggling. Real-world patient reports describe feelings of emotional lightening, reduced suicidal thoughts, and a sense of calm that they had not experienced in years. One patient described finally not dreading their existence and future after completing their first month of treatment. Another, who had not responded to any antidepressants in 45 years, described experiencing genuine hope for the first time.
The dissociative experience itself is described differently by different patients — some find it disorienting, others describe it as pleasant or even restful. Clinical staff at Oasis are trained to support patients through every session, making the process as comfortable as possible.
How Long Do Spravato Results Last?
Durability of response is a key consideration for any treatment. Real-world data from the ECHO study, presented at the European Psychiatric Association Congress in March 2026, demonstrated that Spravato's treatment effects are durable — with meaningful benefits maintained across six months after treatment discontinuation in a real-world setting.
That said, some patients require ongoing maintenance sessions to sustain their response. After the initial induction phase, maintenance dosing is typically once weekly or once every two weeks, and your treating psychiatrist at Oasis will work with you to find the schedule that keeps you feeling well.
Spravato vs. Other Treatment Options for Treatment-Resistant Depression
For patients who haven't responded to antidepressants, several options exist. Here's how Spravato compares:
- Additional antidepressants: Success rates for additional medication trials in treatment- resistant depression are approximately 20-30%, and they still take weeks to work.
- TMS therapy: A non-invasive option with response rates of 50-60% for treatment- resistant depression. Does not carry dissociation side effects and does not require a driver. Oasis offers TMS as well.
- Spravato: Rapid onset within hours; FDA-approved; strong real-world evidence base; covered by most major insurance plans; requires in-clinic administration with monitoring.
- ECT (electroconvulsive therapy): Highly effective but requires anesthesia and carries a higher risk profile. Generally reserved for severe, life-threatening cases.
For many patients, Spravato and TMS can be considered complementary options, each suited to different clinical situations. Our psychiatrists will help you determine which path — or combination of approaches — makes the most sense for your specific history and goals.
Start Your Journey at Oasis
At Oasis Behavioral Health Center in Norwood, MA, we have been offering Spravato as part of our comprehensive, evidence-based treatment program since its FDA approval. We are fully REMS-certified, accept most major insurance plans including Medicare, and our board-certified psychiatrists oversee every treatment personally.
If you are ready to explore whether Spravato is right for you, we invite you to reach out. Call us at (617) 401-7700 or visit obhi.org to schedule a consultation. Real hope and lasting relief are possible — and we have seen it happen for patients who thought they had run out of options.
Works Cited
Janik, A., et al. (2024). SPRAVATO (esketamine nasal spray) as a monotherapy for treatment-resistant depression (TRD). American Society of Psychopharmacology Annual Meeting; May 28-31, 2024. Poster W80.
PMC / National Library of Medicine. (2025). Spravato for Treatment-Resistant Depression: Efficacy and Sexual Side Effect Profile. PubMed Central.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12450024/
Janssen Medical Connect. (2025, August). Real World Evidence – Effectiveness and Safety of SPRAVATO Therapy.
https://www.jnjmedicalconnect.com/products/spravato/medical-content/real-world-evidence-effectiveness-and-safety-of-spravato-therapy
Johnson & Johnson. (2026, March 28). New SPRAVATO (esketamine nasal spray) data support robust effectiveness and show durable effect for treatment-resistant depression in a real-world setting. Globe Newswire.
https://www.globenewswire.com/news-release/2026/03/28/3264172/0/en/New-SPRAVATO-esketamine-nasal-spray-data-support-robust-effectiveness-and-show-durable-effect-for-treatment-resistant-depression-in-a-real-world-setting.html
Power (withpower.com). (2026, February). Esketamine Hydrochloride (Spravato) Side Effects Guide.
https://www.withpower.com/guides/esketamine-hydrochloride-spravato-side-effects
Psychiatric Times. (2026, March). Esketamine CIII Nasal Spray: First and Only Monotherapy for Treatment-Resistant Depression.
https://www.psychiatrictimes.com/view/esketamine-ciii-nasal-spray-first-and-only-monotherapy-for-treatment-resistant-depression
Psych Education. (2025, June). Esketamine (Spravato) Patient Guide: Benefits, Dosing, and Side Effects Explained.
https://psycheducation.org/esketamine-spravato-patient-guide-benefits-dosing-and-side-effects-explained/
Lumin Health. (2025, December). Is Spravato Covered by Insurance? Plans, Costs & How to Check.
https://www.lumin.health/blog/navigating-insurance-for-spravato-ketamine-therapy-costs-and-tms-coverage
WebMD. (2025). Spravato (esketamine) Reviews & Ratings by Patients.
https://reviews.webmd.com/drugs/drugreview-spravato-esketamine
