Is Spravato Treatment Right for Everyone With Depression?
- 2 days ago
- 5 min read
When depression has not improved with traditional medication, hearing about a different option can bring a sense of hope. Spravato treatment has received growing attention for its ability to help certain adults with difficult-to-treat depression. But while Spravato may be an important option for some people, it is not designed for everyone who experiences depression.
Understanding who may qualify, what treatment involves, and which health factors require additional consideration can help you have a more informed conversation with a psychiatric provider.
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 depression. Esketamine is related to ketamine, but Spravato is a specific medication with its own dosing, approval requirements, and safety protocols.
Unlike many traditional antidepressants, which primarily affect chemicals such as serotonin or norepinephrine, Spravato acts on the brain’s glutamate system. This different mechanism may be helpful for people whose symptoms have not meaningfully improved with other treatments.
Spravato is administered only at a certified healthcare facility. Patients use the nasal spray under supervision and remain at the facility for monitoring after each session. It is not prescribed for patients to take home.
Who May Be a Candidate for Spravato Treatment?
Spravato is most commonly considered for adults with treatment-resistant depression. This generally describes depression that has not improved enough after trying at least two appropriate antidepressant treatments during the current depressive episode.
A person may be considered for Spravato if they:
Have been diagnosed with major depressive disorder
Have tried multiple antidepressants without sufficient relief
Continue to experience symptoms that interfere with everyday life
Have been consistent with previous treatment recommendations
Are medically able to participate in monitored treatment sessions
Can arrange transportation home after appointments
Are willing to attend treatment regularly and follow a broader care plan
Spravato is also approved, when used with an oral antidepressant, to treat depressive symptoms in adults with major depressive disorder who are experiencing acute suicidal thoughts or behaviors. However, it has not been proven to prevent suicide, and it does not replace hospitalization or emergency care when immediate safety support is needed.
For treatment-resistant depression, Spravato may now be prescribed either by itself or with an oral antidepressant, depending on a provider’s clinical judgment and the individual patient’s needs.
Does Trying Two Antidepressants Automatically Make You Eligible?
Not necessarily.
A history of unsuccessful antidepressant treatment is an important part of the evaluation, but it is only one piece of the picture. A provider will usually want to understand which medications you tried, how long you took them, whether the doses were appropriate, what side effects occurred, and whether there were any periods of improvement.
They may also look more closely at your diagnosis. Symptoms that appear to be treatment-resistant depression can sometimes be influenced by another condition, such as bipolar disorder, a sleep disorder, substance use, a medical issue, trauma, or an untreated anxiety disorder.
This does not mean that your symptoms are not real. It means that choosing the right treatment begins with understanding the full picture, rather than focusing on a single symptom or medication history.
Who May Not Be a Good Candidate?
Spravato is not recommended for people with certain medical conditions. According to its prescribing information, it should not be used by people with aneurysmal vascular disease, an arteriovenous malformation, a history of bleeding in the brain, or a known allergy to esketamine, ketamine, or one of the medication’s ingredients.
Other health concerns do not always rule out treatment, but they may require additional
evaluation.
These can include:
Uncontrolled or significantly elevated blood pressure
Certain heart or blood vessel conditions
A history of psychosis
Bipolar disorder or possible manic symptoms
A history of substance misuse
Pregnancy, plans to become pregnant, or breastfeeding
Significant liver-related concerns
Medications that may increase sedation or blood pressure
Be open with your provider about your medical history, medications, supplements, substance use, and previous mental health experiences. The goal is not to disqualify you. It is to determine whether the potential benefits outweigh the risks and whether treatment can be provided safely.
What Happens During a Spravato Appointment?
Before receiving Spravato, your provider will check your blood pressure and review how you are feeling that day. You will then administer the nasal spray yourself while a trained healthcare professional supervises the process.
Some people experience temporary effects such as:
Feeling disconnected from themselves or their surroundings
Dizziness or lightheadedness
Sleepiness
Nausea
Changes in perception
An unpleasant taste
A temporary increase in blood pressure
Because sedation, dissociation, breathing changes, and increases in blood pressure can occur, patients must be monitored at the treatment center for at least two hours. Your provider will decide when it is safe for you to leave.
You cannot drive yourself home after treatment. You should also avoid driving, operating machinery, or performing tasks that require full alertness until the following day, after you have had a restful night of sleep.
Is Spravato a One-Time Treatment?
Spravato is generally not a one-time intervention. Treatment often begins with more frequent appointments, followed by less frequent maintenance sessions if the medication is helping. The exact schedule is determined by the prescribing provider.
Progress is assessed over time. Your care team may monitor changes in your mood, energy, motivation, concentration, sleep, daily functioning, and overall safety. Some people notice improvement relatively quickly, while others need several sessions before they can tell whether treatment is making a meaningful difference.
Spravato also does not need to exist in isolation. Depending on your needs, a comprehensive care plan may include psychotherapy, medication management, sleep support, nutrition, movement, social connection, and treatment for other health conditions.
What If Spravato Is Not the Right Fit?
Learning that Spravato is not recommended for you does not mean you are out of options. Depression treatment is not one-size-fits-all, and there are several possible reasons why a particular approach may not be appropriate at a particular time.
Your provider may recommend adjusting a current medication, trying a different medication class, reviewing your diagnosis, addressing a physical health issue, or exploring another evidence-based treatment. What matters is continuing the conversation and finding an approach that reflects your symptoms, health history, goals, and comfort level.
The Right Decision Begins With a Thoughtful Evaluation
Spravato can be a meaningful option for some adults with treatment-resistant depression, but the decision requires more than checking a few boxes. A careful evaluation helps determine whether the treatment is appropriate, whether it can be administered safely, and how it might fit into your broader mental health care.
If you are considering Spravato treatment, Goodwin Health Cafe can help you better understand your options and whether an evaluation may be an appropriate next step. You deserve a treatment plan built around your individual history, needs, and well-being.
5625 N. Wall St., Suite 100Spokane, WA 99205
This article is for educational purposes only and is not a substitute for individualized medical advice. If you or someone you know is in immediate danger or experiencing a mental health emergency, call 911 or contact the 988 Suicide & Crisis Lifeline.
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