If you or someone you love is in crisis, call or text 988 (the Suicide and Crisis Lifeline) any time.
You’ve probably heard esketamine described as one of the faster ways out of a depression that has dragged on for months. And then, when you started reading, every source seemed to say something a little different about whether you can keep breastfeeding while you take it. That’s exactly the question this page answers: is Spravato safe while breastfeeding, what the measurements actually show, and why the label reads the way it does. This isn’t medical advice, and it doesn’t replace your prescriber or your baby’s pediatrician. It’s meant to help you walk into those conversations already knowing what the evidence does and doesn’t say.
A quick note before we start. We won’t re-explain postpartum depression here; if you want that, see our overview of ketamine for postpartum depression. And Spravato is approved for treatment-resistant depression, which just means depression that hasn’t lifted after two different antidepressants. A first postpartum episode may not meet that bar, so our Spravato eligibility guide covers who qualifies.
What are we actually asking when we ask about Spravato and breastfeeding?
The worry usually sounds like one question, but it’s really three. How much of the medicine reaches your breast milk? What does that amount mean for a baby? And do you need to wait a while after a dose before you feed?
To make sense of the numbers, it helps to know one term. Relative infant dose is a way of measuring how much of the mother’s medicine a nursing baby would get, written as a percentage of her dose adjusted for body weight. Researchers use a rough rule of thumb: a relative infant dose under 10% is generally considered low enough to be unlikely to cause harm for most medicines. It’s not a magic line, but it gives the figures below something to stand against.
One more piece of plain language. Esketamine is the active ingredient in Spravato, a nasal spray. It’s the more potent half of the molecule found in ketamine, the anesthetic that’s been used for decades.
What do the measurements show, and what does the label say?
Start with the numbers, because they’re more reassuring than the label sounds. In the small amount of published data on ketamine and its close relatives in breast milk, the relative infant dose has come in well under 1%. The U.S. National Institutes of Health’s LactMed entry for ketamine reports a relative infant dose ranging from 0.34% to 0.57%. That’s far below the 10% rule of thumb.
There’s a straightforward reason the amount is so small. The medicine leaves the body quickly. Esketamine’s half-life is only a matter of hours, so most of it clears well before the next dose, which is typically days later. Little lingers in the bloodstream, so little reaches milk.
Now the honest part. The research here is thin. There are only a handful of studies, they involve small numbers of women, and almost none follow the babies over months or years to see how they do. The NIH’s LactMed entry for esketamine says the plainest version of this: esketamine nasal spray “has not been studied during breastfeeding,” and until more data exists, repeated doses “should probably be avoided.”
This is where the label can feel misleading if you read it in isolation. The Spravato prescribing information advises women not to breastfeed during treatment. It’s easy to read that as “we know this is harmful.” It isn’t. When there aren’t enough studies in breastfeeding mothers, a label is written cautiously by default. The absence of proof of safety is not the same as proof of harm. Both things are true at once: the measured amount in milk is very low, and the label advises against it because no one has studied it enough to say more. It helps to hold both of those facts at the same time, rather than letting one erase the other.
What about the risk of not treating the depression?
This decision has two sides, and the second one is easy to overlook. There is real trial evidence that esketamine around childbirth can help. In a 2024 randomised trial published in the BMJ, 364 mothers across five hospitals were given either a single low dose of esketamine after delivery or a placebo. By day 42, a depressive episode had developed in 6.7% of the esketamine group, compared with 25.4% of the placebo group.
To be clear about what this study does and doesn’t show: it’s prevention research, a single dose given to mothers with prenatal depression symptoms to head off a postpartum episode, not a study of ongoing Spravato treatment while nursing. It shows the medicine can matter here. It doesn’t stretch to cover every situation.
There’s another side that most sources skip. Untreated postpartum depression carries its own well-documented risks, for both mother and baby. About 1 in 8 women report symptoms of depression after giving birth, according to the CDC. “Do nothing” is not a neutral, risk-free option. It’s one choice on the scale, with weight of its own.
How does this decision actually get made?
There’s no single right answer here, and any page that gives you one is overpromising. The real decision happens in conversation, between you, your prescriber, and your baby’s pediatrician. Together you can weigh how severe things are, what other treatments are available, how old your baby is, and what matters most to you.
Timing and pumping come up often. Because esketamine clears fairly quickly, some families ask about spacing feeds or expressing and discarding milk for a window after a dose. Whether that helps, and for how long, is something to talk through with your prescriber and pediatrician based on your specific situation. There’s no single interval that fits everyone.
And here’s the sentence that clinical pages rarely say out loud: choosing to stop breastfeeding so that you can be treated is not a lesser choice. A mother who is well is not a consolation prize for her baby. If feeding is deeply important to you, that matters, and it belongs in the conversation. If stepping back from it is what lets you get the care you need, that’s a valid and loving decision too.
At Nushama’s Manhattan location (515 Madison Avenue, 21st floor, Midtown), our care team supports postpartum members with close medical oversight and preparation and integration around every session, because the medicine works best inside a plan, not on its own. Spravato sessions happen in private, serene rooms designed to feel calm rather than clinical, with continuous monitoring by our nursing staff throughout.
Aftercare doesn’t stop when the session ends. Post-session vitals are taken before you leave, and each visit includes time with a therapist or integration coach to process what came up while it’s still fresh. Spravato members also receive complimentary psychotherapy sessions with Columbia Advanced Clinical Interns who specialize in psychedelic therapy. Between appointments, you have access to bi-weekly integration circles open to all current and past members, plus supportive offerings like sound baths and breathwork. The goal is to help you carry what you gain in session into your daily life, during the treatment window and well beyond it.
We can also talk through how Spravato compares with other options, including how Spravato compares with IV ketamine, so the path you choose fits your body and your life.
Questions worth bringing to your appointments
Two short lists you can screenshot or print. One for the person who prescribes, one for your baby’s doctor.
For your prescriber:
- Given how severe my symptoms are, what do you recommend, and why?
- What are the alternatives, and how do they compare for someone who’s breastfeeding?
- If I continue nursing, what would you watch for in me and in my baby?
- Would spacing feeds or pumping after a dose change anything?
For your pediatrician:
- What signs in my baby would you want me to call about?
- Does my baby’s age or health change how you’d weigh this?
- How would we keep an eye on feeding, weight, and sleep if I’m treated?
If you’d like to talk any of this through with people who do it every day, we’re here. Our Manhattan center is steps from the E/M subway entrance on 53rd Street and a short walk from Grand Central. Speak with our care team or call (646) 394-9996 whenever you’re ready. There’s no pressure, just a conversation.
And once more, because it matters most: if you’re having thoughts of harming yourself or your baby, call or text 988 now, or go to your nearest emergency room.
Medically reviewed by the Nushama Clinical Team. Last updated: February 2026.
