When depression has not improved after several medication trials, another treatment conversation can feel exhausting. You may wonder whether anything has been overlooked, whether you qualify for something different, or how you would fit more appointments into your life.
At Eudaimonia Psychiatric Mental Health Clinic, we offer SPRAVATO® for treatment-resistant depression. We begin by understanding what you have experienced, what you have already tried, and what you need from care now. You do not have to arrive knowing whether you qualify. That is something we work through together.
This guide explains the questions we consider, the monitoring treatment requires, and the practical steps involved in accessing care through our clinic.
What does treatment-resistant depression mean?
Treatment-resistant depression generally describes major depression that has not improved enough after at least two antidepressant treatments during the current episode. Each trial needs to have been at an adequate dose and lasted long enough to assess its effect. The details matter more than the number alone.
A prescription stopped after a few days because of side effects tells us something different from one taken consistently for several weeks without enough improvement. Partial improvement matters, too. Perhaps you returned to work but still struggle to shower, eat regularly, or feel connected to anyone.
When we discuss your experience with depression, we ask about both symptoms and daily life. Treatment resistance describes your treatment history, not a personal failure.
What SPRAVATO® is, and what it is not
SPRAVATO® is a prescription esketamine nasal spray that is FDA-approved for treatment-resistant depression in adults. For this use, it may be prescribed alone or with an oral antidepressant. It is not a take-home nasal spray.
Esketamine and ketamine are related, but they are not interchangeable. A recent comparison of ketamine and esketamine examines the evidence for these distinct treatments (Elmosalamy et al., 2025). Ketamine use for psychiatric conditions is off-label. That differs from SPRAVATO® treatment under its FDA-approved indication.
A newer review of ketamine research explores its pharmacology and clinical evidence (Tayal et al., 2026). Research about ketamine does not, by itself, tell us whether SPRAVATO® is right for you. We need to review your own history and the requirements for this specific medication.
What we review before deciding whether you qualify
Eligibility is an individual clinical decision. We consider your diagnosis, past treatment, current symptoms, physical health, and ability to attend monitored visits.
Your diagnosis and medication history
Bring whatever records you have, even if they are incomplete. A useful starting list includes:
- Medication names, approximate doses, and how long you took them.
- Any improvement, including benefits that did not last.
- Side effects and reasons for stopping.
- Previous hospitalizations and other mental health treatment.
- Current prescriptions, supplements, alcohol use, and other substance use.
We also ask about periods of unusually elevated mood, reduced need for sleep, or psychotic symptoms. These experiences may change how we understand your diagnosis. You do not need to decide which details are medically important before telling us.
Your health and safety history
We review blood pressure, heart and blood vessel conditions, breathing concerns, pregnancy or pregnancy plans, and substance use history. Certain conditions can rule out treatment. These include aneurysmal vascular disease, arteriovenous malformation, and a history of bleeding in the brain. An allergy to esketamine, ketamine, or the medication’s ingredients also rules it out.
Before recommending treatment, we discuss risks such as deep sleepiness, feeling disconnected from your body or surroundings, slowed breathing, and increased blood pressure. We review your medications and explain which concerns matter most for you.
You can also learn about our care team before arranging that conversation.
What happens during a monitored appointment?
SPRAVATO® is given in person in a certified healthcare setting under a required safety program called REMS. You use the nasal spray yourself under direct supervision. It cannot be given through a video visit or taken home.
Plan for at least two hours of observation after each dose. You may need longer monitoring. We monitor breathing, including oxygen levels with a pulse oximeter, and check blood pressure. We assess whether you are clinically stable before you leave.
You may feel sleepy, dizzy, nauseated, or temporarily disconnected from your surroundings or body. These effects are reasons for supervised care, not something you are expected to manage alone.
Arrange transportation home. Do not drive, operate machinery, or do activities requiring full alertness until the next day after a restful sleep. Treatment usually begins with twice-weekly visits for four weeks. Later visits depend on your response and clinical assessment. We discuss that time commitment before treatment starts.
How insurance and scheduling affect access
Clinical eligibility and insurance approval are separate decisions. Your plan may require prior authorization, records of past medication trials, or other coverage criteria. We can discuss what information is needed. We cannot promise approval or a particular out-of-pocket cost.
Practical barriers deserve attention early. Research has examined how social circumstances affect treatment initiation, highlighting why access involves more than a prescription (Clemens et al., 2025).
Before committing to a schedule, consider:
- Who can drive you home after each visit?
- Can you protect time for treatment, monitoring, and recovery afterward?
- Will work, caregiving, or transportation require advance planning?
- What coverage and cost questions need answers first?
If one of these feels difficult, please contact our team. Naming a barrier gives us a clearer starting point.
How we think about progress and urgent symptoms
We ask about symptoms and everyday life while checking side effects and safety. Research has also examined disability days and costs among people starting esketamine or conventional treatments (Jha et al., 2025). For your care, we want to know what changes you notice at home, at work, and in your relationships. Treatment does not help everyone.
SPRAVATO® has not been shown to prevent suicide. A recent study of self-harm outcomes looked back at patient records rather than randomly assigning treatment. That design cannot establish that treatment prevents suicide (Wang et al., 2026).
If you are having suicidal thoughts or feel unable to stay safe, call or text 988 to reach the suicide and crisis lifeline (988 Suicide & Crisis Lifeline, n.d.). Call 911 or go to the nearest emergency department for immediate danger. Do not wait for an eligibility appointment.
When you are ready, you can book an appointment with Eudaimonia Psychiatric Mental Health Clinic. We will start with your history, make room for your questions, and discuss whether SPRAVATO® is an appropriate next step.
Works Cited
1. Elmosalamy A, et al. Intravenous ketamine versus esketamine for depression: a systematic review and meta-analysis. Ther Adv Psychopharmacol. 2025. https://pubmed.ncbi.nlm.nih.gov/41244961/
2. Tayal P, et al. Therapeutic Potential of Ketamine in Major Depressive Disorder: Pharmacological Insights and Clinical Evidence. Curr Pharm Des. 2026. https://pubmed.ncbi.nlm.nih.gov/42613710/
3. Clemens K, et al. Impact of social determinants of health on esketamine nasal spray initiation among patients with treatment-resistant depression in the United States. J Manag Care Spec Pharm. 2025. https://pubmed.ncbi.nlm.nih.gov/39704732/
4. Jha MK, et al. Mental Health-Related Disability Days and Costs Among Patients with Treatment-Resistant Depression Initiated on Esketamine Nasal Spray and Conventional Therapies in the USA. Drugs Real World Outcomes. 2025. https://pubmed.ncbi.nlm.nih.gov/39828878/
5. Wang Y, et al. Esketamine Use and Attempted Suicide or Intentional Self-Harm Among Individuals with Treatment-Resistant Depression: A Retrospective Cohort Study. Drug Saf. 2026. https://pubmed.ncbi.nlm.nih.gov/42684573/
6. 988 Suicide and Crisis Lifeline. https://988lifeline.org/
Disclaimer
This article is for educational purposes only and is not a substitute for individualized evaluation, diagnosis, or treatment from a qualified healthcare professional.