Could Spravato Treatment Be an Option After Traditional Treatments?

When depression does not improve after trying traditional treatments, it can be difficult to know what to do next. You may wonder whether you need to give your current medication more time, try another antidepressant, or explore a different approach entirely. For some adults with treatment-resistant depression, Spravato treatment may be one option worth discussing with a qualified psychiatric provider.

Reaching this point does not mean that you have failed treatment. Depression is complex, and people can respond very differently to the same medication or therapy. Sometimes, finding the right approach requires looking beyond the treatments that are usually tried first.

What Does Treatment-Resistant Depression Mean?

Treatment-resistant depression generally describes depression that has not improved enough after adequate trials of multiple antidepressant medications. This does not necessarily mean that treatment had no effect at all. You may have experienced limited improvement, temporary relief, or side effects that made it difficult to continue.

You may also still be struggling with symptoms such as:

• Low mood that does not seem to lift

• Loss of interest or pleasure

• Low energy or persistent fatigue

• Difficulty concentrating

• Changes in sleep or appetite

• Feelings of guilt, hopelessness, or worthlessness

• Difficulty managing work, relationships, or everyday responsibilities

Before identifying depression as treatment-resistant, a psychiatric provider will usually take a closer look at your treatment history. This may include which medications you have tried, how long you took them, the dosages prescribed, any side effects you experienced, and whether other health conditions may be affecting your symptoms.

This review matters because treatment decisions are not based only on the number of medications you have tried. Your provider should also consider your overall health, diagnosis, symptoms, preferences, and previous response to care.

What Is Spravato?

Spravato is the brand name for esketamine, a prescription nasal spray approved by the U.S. Food and Drug Administration for certain adults with treatment-resistant depression. It may be prescribed on its own or together with an oral antidepressant, depending on the individual treatment plan.

Spravato works differently from many traditional antidepressants. Commonly prescribed antidepressants typically affect neurotransmitters such as serotonin, norepinephrine, or dopamine. Esketamine primarily acts on the brain’s glutamate system through N-methyl-D-aspartate, or NMDA, receptors.

This different mechanism is one reason Spravato may be considered when standard antidepressant medications have not provided enough relief. However, a different mechanism does not mean that it is automatically the right treatment for everyone. A careful psychiatric evaluation is needed to determine whether the potential benefits are appropriate for your needs and medical history.

When Might Spravato Treatment Be Considered?

Spravato may be considered when an adult has been diagnosed with treatment-resistant depression and has not experienced sufficient improvement with previous antidepressant medications.

A provider may ask questions such as:

• Which antidepressants have you taken?

• How long did you take each medication?

• Did your symptoms improve at all?

• Did you experience difficult side effects?

• Have you participated in psychotherapy?

• Are you currently taking other medications or supplements?

• Do you have a history of substance use or certain medical conditions?

• How is depression affecting your ability to function?

These questions help create a more complete picture of your experience. They also give your provider an opportunity to identify factors that may influence whether Spravato treatment can be used safely.

You do not have to decide for yourself whether you “qualify.” An evaluation is meant to help you understand your options, ask questions, and make an informed decision with a psychiatric provider.

What Happens During a Spravato Appointment?

Spravato is not taken home like a traditional prescription nasal spray. Because of the possibility of sedation, dissociation, changes in blood pressure, and other effects, it must be administered in a certified healthcare setting under appropriate supervision.

During an appointment, you self-administer the nasal spray while a healthcare professional monitors you. Your blood pressure is checked as part of the process, and you remain at the clinic for observation for at least two hours. Your provider will determine when it is safe for you to leave.

You will need to arrange transportation home after each appointment. Patients should not drive, operate machinery, or perform activities requiring complete alertness until the following day after a restful night’s sleep.

The treatment schedule is generally more frequent at the beginning and may become less frequent over time. Your exact schedule will depend on your provider’s recommendations, your response to treatment, and whether continuing Spravato remains appropriate.

What Can Spravato Feel Like?

People can have different experiences during and after a Spravato session. Some may notice temporary changes in perception, a sense of detachment, dizziness, nausea, sleepiness, or an unusual taste. Blood pressure may also rise temporarily.

These effects are part of why monitoring is required. The clinical team is there to observe how you respond and support your safety throughout the appointment.

It can be helpful to ask the clinic what the treatment space is like, what you may bring with you, and how you can prepare. Wearing comfortable clothing and planning for a quiet remainder of the day may help the experience feel more manageable.

Is Spravato the Same as Ketamine?

Spravato and ketamine are related, but they are not the same treatment.

Spravato contains esketamine, which is one component of the ketamine molecule. It is delivered as a nasal spray and is FDA-approved for specific uses. Ketamine may be provided in other forms, including intravenous infusions, but its use for depression is generally considered off-label.

The treatment setting, dosing process, insurance considerations, and monitoring requirements may differ. If you are comparing these options, ask a qualified provider to explain the differences based on your symptoms and treatment history.

Questions to Ask During an Evaluation

Learning that another treatment option exists may bring up both hope and uncertainty. You deserve clear information before making a decision.

Consider asking:

• Why do you think Spravato may or may not be appropriate for me?

• What benefits could I realistically expect?

• What are the possible side effects and risks?

• Could any of my medications or health conditions affect treatment?

• How will we measure whether it is helping?

• How often would I need to attend appointments?

• What happens if I do not respond?

• Does my insurance cover treatment?

• What transportation arrangements will I need?

There is no pressure to make a decision immediately. A thoughtful evaluation should leave room for your questions, concerns, and preferences.

Finding a Different Path Forward

Living with depression that has not responded to previous treatments can feel discouraging. It may seem as though you have already tried everything, especially when each new medication brings another period of waiting and uncertainty.

But needing a different approach is not the same as being out of options. Newer treatments have expanded the ways psychiatric providers can respond to treatment-resistant depression. The next step is not about finding a quick fix. It is about taking a closer look at your history and determining which available option makes sense for you.

If traditional antidepressants have not provided enough relief, a professional evaluation can help you learn whether Spravato treatment could be part of your next treatment plan.

Goodwin Health Cafe provides individualized psychiatric care for treatment-resistant depression in a calming, nonjudgmental environment. To learn more about Spravato and becoming a patient, visit Goodwin Health Cafe.

Goodwin Health Cafe

5625 N. Wall St. Suite 100Spokane, WA 99205