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Spravato and PTSD: what the research shows so far.

Spravato isn’t approved for PTSD itself. But depression that hasn’t responded to treatment often comes with PTSD, and Spravato is approved for that depression. Here’s what small studies show, and what a session can feel like with trauma in your history.

Medically reviewed by David Boguslavsky, MD on · Published · 3 min read

A woman in a cream sweater sitting on a couch with her eyes closed and one hand on her chest, breathing slowly.

Post-traumatic stress disorder and depression travel together often. When the depression hasn’t responded to antidepressants, people understandably ask whether Spravato could help with both.

The answer has two parts. Spravato isn’t approved to treat PTSD. But it is approved for treatment-resistant depression, and many people with that depression also live with PTSD.

Is Spravato approved for PTSD?

No. Spravato (esketamine) is FDA-approved for adults with treatment-resistant depression, and for depressive symptoms in adults with major depression who have acute suicidal thoughts or behavior.1 There’s no large trial of Spravato for PTSD itself. So the realistic route is this: if you have treatment-resistant depression and also have PTSD, you may qualify for Spravato because of the depression.

What the studies so far show

  • Ketamine has one small randomized trial in PTSD. In a 2021 trial, people with chronic PTSD who received six infusions of intravenous ketamine (a close relative of esketamine, not Spravato itself) over two weeks had a larger drop in PTSD symptoms than those given a comparison drug, and the infusions were well tolerated.2
  • Esketamine helped depression in people who also had PTSD. In a small French pilot study of patients with treatment-resistant depression and chronic PTSD, depression improved significantly over six months, with no serious adverse reactions.3
  • PTSD symptoms improved for some, too. A later case series from the same group saw improvement in PTSD symptoms as well as depression in a share of patients.4

These are small studies, mostly without comparison groups. They’re a reason for hope and for a careful conversation, not a promise.

Trauma memories during a session

Spravato commonly causes dissociation, a temporary feeling of being detached or that things are unreal; most people feel it to some degree.1 For someone with PTSD, that altered state can sometimes bring trauma memories to the surface. In the French case series, some patients had moments of re-experiencing their trauma during treatment sessions. For most, these faded as sessions went on, and they didn’t stop the treatment from helping, though a few people chose to stop because of them.4

That’s something to plan for, not a reason to avoid treatment. You’re never alone during a session: a clinician is nearby for the full two hours. It helps to tell us about your trauma history before you start, so we can talk through what might come up, agree on what helps you feel safe, and adjust your space, the music and the pace.

Depression and PTSD, and nothing has worked?

Talk it through with us before you decide anything.

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What we don’t know

What we don’t know

There’s no randomized trial of Spravato for PTSD. We don’t know how much it helps PTSD symptoms themselves, who is most likely to benefit, or how it compares with trauma-focused therapy, which remains the core treatment for PTSD. Spravato, if it helps, works alongside that care, not instead of it.

Common questions

Can Spravato help with PTSD?

Spravato is approved for treatment-resistant depression, which many people with PTSD also have. If your depression hasn’t responded to at least two antidepressants, you may qualify because of the depression, and in small studies some people’s PTSD symptoms improved too.

Will insurance cover Spravato if I also have PTSD?

Coverage is based on the treatment-resistant depression. We handle the prior authorization and check your plan before you start.

Could a session bring up trauma memories?

Sometimes. In one case series, some patients briefly re-experienced trauma during sessions, and for most it faded as treatment went on. A clinician is nearby for the full two hours, and telling us your history beforehand lets us plan what helps you feel safe.

Do I have to stop trauma therapy?

No. Trauma-focused therapy remains the core treatment for PTSD. Spravato works alongside it.

How soon can I be evaluated?

Most patients are evaluated within one business day of their first call.

If you’re having thoughts of harming yourself, please call or text 988 now. Veterans can press 1 after dialing 988.

Sources

  1. SPRAVATO® (esketamine) nasal spray, Prescribing Information. Janssen Pharmaceuticals.
  2. Feder A, et al. A randomized controlled trial of repeated ketamine administration for chronic posttraumatic stress disorder. Am J Psychiatry 2021;178(2):193–202.
  3. Rothärmel M, et al. Efficacy and safety of intranasal esketamine in patients with treatment-resistant depression and comorbid chronic post-traumatic stress disorder: open-label single-arm pilot study. Front Psychiatry 2022;13:865466.
  4. Rothärmel M, et al. Trauma re-experiencing episodes during esketamine treatment in patients with treatment-resistant depression and comorbid PTSD: a retrospective case series. Eur J Psychotraumatol 2026;17(1):2609425.
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