SPRAVATO® · Guide
How Well Does SPRAVATO® Work? Success Rates and What the Research Shows
A plain-language look at the esketamine research — what the numbers mean, what treatment actually involves, and the questions worth asking.
For people whose depression hasn't responded to antidepressant medication, SPRAVATO® (esketamine) is one of the few treatments approved specifically for that situation. It's also one of the most asked-about: how well does it actually work? Here's what the research shows, in plain language.
What SPRAVATO® is approved for
SPRAVATO® is a prescription nasal spray form of esketamine, approved by the FDA in 2019 for treatment-resistant depression — generally meaning depression that hasn't responded adequately to at least two oral antidepressants — and also approved for depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or actions, used alongside an oral antidepressant.
In January 2025, the FDA expanded the approval: SPRAVATO® can now also be used on its own, as a standalone treatment, for adults with treatment-resistant depression. It is the first medication approved as a monotherapy for that condition. That matters for people who can't tolerate daily oral antidepressants or haven't benefited from them.
What the trial numbers show
In the placebo-controlled trial supporting the monotherapy approval, 22.5% of patients taking esketamine reached remission at four weeks — defined as a score of 12 or below on the MADRS depression scale, meaning few or minimal remaining symptoms — compared with 7.6% of patients taking placebo. Improvements were observed across all ten symptom areas the MADRS measures, and some patients experienced improvement within the first 24 hours after a dose.
Two things are worth holding at once about those numbers. First, a 22.5% remission rate at four weeks may sound modest — but this is a population that has already tried at least two antidepressants without adequate relief, where each additional medication attempt tends to bring diminishing returns. Against that backdrop, roughly one in five patients reaching remission in a month, and nearly three times the placebo rate, is a meaningful result. Second, four weeks is early. Longer-term maintenance research found that patients who reached stable remission and continued esketamine treatment went significantly longer without relapse than those switched to placebo — which is why treatment is typically structured as an ongoing course rather than a fixed number of sessions.
Why "success" looks different person to person
Clinical trials report averages; individual experiences vary around them. Some people respond quickly and strongly, some respond partially, and some don't respond — the same pattern seen with every depression treatment. Response can also build over the first weeks rather than arriving all at once. A clinic that measures symptoms at every visit, using standard scales like the PHQ-9 or MADRS, can tell you objectively whether treatment is working for you rather than relying on impressions — and that measurement cadence is a reasonable thing to ask any prospective provider about.
What treatment actually involves
SPRAVATO® is never taken at home. Under the FDA's safety program (called a REMS), it is administered only at certified treatment centers, with each session followed by an observation period of at least two hours while temporary effects — commonly dissociation, sedation, dizziness, or elevated blood pressure — wear off. Patients don't drive afterward, so each visit needs a ride home. Dosing typically starts twice weekly, then steps down in frequency over time as symptoms improve.
The certification requirement is worth understanding as a feature: it means every clinic offering SPRAVATO® has enrolled in the federal safety program, and treatment always happens with clinical staff present.
Cost and insurance
Because SPRAVATO® is FDA-approved for specific indications, it is covered by many commercial insurance plans and Medicare when criteria are met — typically documentation that oral antidepressants were tried first. Coverage details and prior-authorization requirements vary by plan, and most treatment centers verify benefits before starting. It's a fair question to ask any clinic how they handle benefits verification and what out-of-pocket costs to expect.
Questions worth asking a prospective provider
If you're considering SPRAVATO®, a few questions can tell you a lot: Is the clinic a certified SPRAVATO® treatment center? Who is present during sessions and the observation period? How is symptom change measured over the course of treatment? What does the schedule look like in the first month, and how is the decision made to continue, adjust, or stop? Any experienced provider can answer these directly.
Finding a certified treatment center
Certified SPRAVATO® centers can be found through provider directories — our sister directory findtmstherapy.com lists verified providers including SPRAVATO® treatment centers by state. TMS Therapy Centers Colorado in Aurora, a certified SPRAVATO® treatment center, is part of the same network as this publication (see our disclosure page).