What Is Treatment-Resistant Depression?

Treatment-Resistant Depression (TRD) occurs when symptoms of Major Depressive Disorder continue despite trying at least two different antidepressant medications at appropriate doses and durations.

People living with TRD may continue experiencing:

• Persistent sadness or hopelessness

• Loss of interest in daily activities

• Fatigue or low energy

• Difficulty concentrating

• Changes in sleep or appetite

• Feelings of worthlessness

• Difficulty maintaining work, school, or relationships

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If depression continues despite treatment, additional options such as Spravato may be recommended after a comprehensive psychiatric evaluation.

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Who May Benefit from Spravato?

Spravato may be appropriate for adults who:

• Have Treatment-Resistant Depression (TRD)

• Have not responded adequately to two or more antidepressants

• Continue experiencing moderate to severe depressive symptoms

• Are currently taking or willing to take an oral antidepressant

• Can attend scheduled in-office treatment sessions

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In certain situations, Spravato may also be used for adults with Major Depressive Disorder (MDD) with acute suicidal thoughts or behaviors, when clinically appropriate and provided in a certified treatment center.

How Does Spravato Work?

Spravato works differently from traditional antidepressants.

Instead of targeting serotonin, Spravato affects the glutamate pathway, which plays an important role in learning, memory, and emotional regulation. By helping restore communication between damaged neural pathways, Spravato may improve depressive symptoms and support healthier brain function.

Because every patient's response is unique, your provider will carefully monitor your progress throughout treatment and adjust your care plan as needed.

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What to Expect During Treatment

Spravato treatments are performed in our office under the supervision of trained healthcare professionals.

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Each visit typically includes:

• Review of your current symptoms and medical status

• Blood pressure assessment before treatment

• Self-administration of Spravato nasal spray under supervision

• Monitoring for approximately two hours

• Ongoing assessment of your comfort and safety

• Discharge after your provider determines it is safe

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Because temporary side effects such as dizziness, sleepiness, or dissociation may occur, patients should arrange for someone to drive them home after each appointment.

Spravato Treatment Schedule

Your treatment schedule is individualized, but generally follows two phases.

Induction Phase

• Two treatment sessions each week for approximately four weeks

Maintenance Phase

• Weekly treatments

• Then every other week, depending on your response and your provider's recommendation

Your psychiatrist will regularly evaluate your progress and determine the most appropriate schedule for ongoing care.

Benefits of Spravato Therapy

For eligible patients, Spravato may provide several potential benefits, including:

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• Relief from treatment-resistant depression

• A different mechanism than traditional antidepressants

• Faster symptom improvement for some individuals

• Improved emotional functioning

• Better overall quality of life

• Personalized treatment alongside medication management and psychotherapy

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Treatment outcomes vary, and your provider will monitor your response throughout your care.

Is Spravato Safe?

Spravato has been extensively studied and is FDA-approved when administered according to established safety guidelines.

Because temporary side effects can occur, Spravato is only available through the Risk Evaluation and Mitigation Strategy (REMS) Program and must be administered in a certified healthcare setting where patients can be monitored after each treatment.

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Frequently Asked Questions

Is Spravato the same as ketamine?

No. Spravato contains esketamine, a specific form of ketamine that has been FDA-approved for certain types of depression and is administered under strict medical supervision.

Can I take Spravato at home?

No. Spravato must be administered in a certified treatment center where trained healthcare professionals monitor patients for approximately two hours following each treatment.

How quickly can Spravato work?

Some patients notice improvement earlier than with traditional antidepressants, although every person's response is different.

Will I still need my antidepressant?

Yes. Spravato is prescribed together with an oral antidepressant as part of a comprehensive treatment plan.

Does insurance cover Spravato?

Many insurance plans provide coverage for eligible patients. Our team can help verify your benefits, obtain prior authorization when needed, and answer questions about treatment costs.