Esketamine (Spravato) is authorised in the European Union for adults with treatment‑resistant major depressive disorder as an adjunct to an oral antidepressant; the EMA marketing authorisation was granted on 18 December 2019. Access in Sweden is limited to specialist psychiatric settings where the product is administered under direct supervision because of safety (blood pressure elevation, dissociation) and risk‑management requirements. The Swedish Tandvårds- och läkemedelsförmånsverket (TLV) produced a health‑economic assessment to inform regional decision‑makers about Spravato for treatment‑resistant depression; regions (landsting/regioner) and specialist clinics determine local implementation, purchasing and whether/when the medicine is provided within publicly funded specialist services. As a centrally authorised medicine Spravato is legally available, but public reimbursement and availability have been handled via regional procurement and budget decisions rather than an automatic national, universal outpatient pharmacy subsidy. Clinical initiation typically requires a psychiatrist, monitoring before/after each administration, and facility capability for at‑least short observation. [1]EMA Spravato EPAR — authorisation details, indications and safety measures. [2]TLV — health‑economic assessment of Spravato (esketamine) to inform regional decisions