Esketamine Nasal Spray: What It Is and What to Expect
Medically reviewed by Sumiran Racherla, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor provides Esketamine Nasal Spray?
A psychiatrist is the usual lead doctor for esketamine nasal spray. You use the spray in a medical facility. A doctor or other healthcare professional watches you. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What it is
Esketamine is a medicine approved by the U.S. Food and Drug Administration (FDA) for treatment-resistant depression. Treatment-resistant depression means a person does not get better after trying at least two antidepressants. It comes as a liquid that you spray into the nose.
Why a doctor might recommend it
Esketamine nasal spray is used to manage treatment-resistant depression in adults. It is used alone or with an antidepressant taken by mouth. It is also used along with an antidepressant taken by mouth. This is to treat depressive symptoms in adults with major depressive disorder and suicidal thoughts or actions. Children should not use esketamine.
How to prepare
- Do not eat for at least 2 hours before the spray. Do not drink liquids for at least 30 minutes before it.
- Tell your doctor and pharmacist about all medicines, vitamins, supplements, and herbal products you take.
- Plan for a caregiver or family member to drive you home.
- Unless your doctor tells you otherwise, continue your normal diet.
- Ask your doctor or pharmacist if you have any questions.
- Tell your doctor if you are pregnant or plan to become pregnant.
- You should not breastfeed while using the spray.
- You, your doctor, and your pharmacy must all be enrolled in a special program first.
What happens during it
You will use the spray by yourself in a medical facility. Your doctor will monitor you before, during, and for at least 2 hours after your treatment. Your doctor will check your blood pressure before and for at least 2 hours after you use it.
Recovery
After you use the spray, do not drive a car, operate machinery, or do anything where you need to be completely alert. Wait until the next day after a restful night's sleep. The spray may temporarily increase your blood pressure, which may last for about 4 hours. Keep all appointments with your doctor and the laboratory. If you miss a treatment session, contact your doctor right away to schedule an appointment.
Risks and side effects
It may cause sleepiness, dizziness, anxiety, a spinning sensation, or feeling disconnected from your body. Tell your doctor right away if you have extreme tiredness or sleepiness, or dizziness. The spray may be habit-forming. Children, teenagers, and young adults under 25 years may have more suicidal thoughts or behavior when taking antidepressants. This is most true in the first few weeks after starting or when the dose is changed.
If you are struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988. You can also chat at 988lifeline.org. In life-threatening situations, call 911.
Call 911 or go to the emergency room if you have trouble breathing, chest pain or discomfort lasting two minutes or more, fainting, coughing up or vomiting blood, or bleeding that will not stop.
In case of overdose, call the poison control helpline at 1-800-222-1222. If the person has collapsed, had a seizure, has trouble breathing, or cannot be awakened, call 911 right away.
Who performs it
You use the spray yourself in a medical facility. A doctor or other healthcare professional watches you.
Common questions
Can I use esketamine nasal spray at home?
No. The spray must be used in a medical facility.
How long will I be watched after a treatment?
Your doctor will monitor you before, during, and for at least 2 hours after your treatment.
Can I drive after esketamine nasal spray?
No. After you use esketamine nasal spray, do not drive a car, operate machinery, or do anything where you need to be completely alert. Wait until the next day after a restful night's sleep.
Do I need a ride home after esketamine nasal spray?
Yes. You will need to plan for a caregiver or family member to drive you home after using the spray.
How does a direct primary care or concierge doctor fit in?
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
Sources
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
