Living with chronic pain and depression at the same time can be challenging. Persistent pain can affect sleep, energy, daily activities, and emotional well-being, while depression can make coping with ongoing discomfort more difficult. This combination may lead patients to explore different treatment options, including newer approaches for difficult-to-treat depression.
Spravato, also known as esketamine, has an FDA-approved role in treating certain forms of depression. However, it is important to understand what Spravato is approved for and what remains outside its established indication.
Spravato is not FDA-approved as a treatment for chronic pain. Its approved uses include treatment-resistant depression in adults and depressive symptoms in adults with major depressive disorder accompanied by acute suicidal ideation or behavior, under specific conditions.
Esketamine is related to ketamine, which has been studied and used in different medical settings, including pain management. However, patients should not assume that evidence involving ketamine for pain automatically applies to Spravato.
If you have chronic pain alongside depression, your provider can evaluate both conditions and determine whether Spravato may be appropriate for the depressive component of your care.
Spravato contains esketamine, which works differently from many traditional antidepressants. It is a noncompetitive NMDA receptor antagonist that affects the brain’s glutamate system.
The different mechanism is one reason Spravato may be considered when conventional antidepressant treatments have not provided adequate improvement. At Scottsdale TMS & Spravato, treatment begins with a psychiatric evaluation that reviews your symptoms, medical history, and previous treatments before determining whether Spravato is appropriate.
Chronic pain and depression can influence one another. Pain may make it harder to sleep, exercise, work, socialize, or participate in activities that support emotional well-being. Depression can also affect motivation and make persistent physical discomfort more difficult to cope with.
Treating depression does not necessarily mean that the underlying pain will disappear. Instead, the goal of Spravato treatment is to address the depressive condition for which it is approved.
A comprehensive treatment plan may include other appropriate approaches for pain, sleep, medication management, or mental health support.
Spravato is self-administered as a nasal spray under direct medical supervision. Patients remain in the clinical setting for approximately two hours while their condition and vital signs are monitored.
Temporary effects can include sedation, dissociation, dizziness, nausea, increased blood pressure, and changes in attention or judgment. Because of these potential effects, patients need a responsible adult to drive them home after treatment and should not drive themselves.
Our Team can monitor your response during each session and provide ongoing psychiatric follow-up as your treatment progresses.
Spravato does not have to be considered in isolation. The Scottsdale program also offers complementary services such as medication management, individual psychotherapy, TMS, and integrated depression care plans.
Combining appropriate services can allow treatment to address different aspects of a person’s mental health. The right approach depends on the diagnosis, previous treatment response, current symptoms, medical history, and individual needs.
Dr. Michael Vines and the clinical team can review these factors during an evaluation and determine whether Spravato fits into an appropriate treatment plan.
Spravato has an established FDA-approved role in treating specific depressive conditions, including treatment-resistant depression in adults. It is not approved specifically for chronic pain, so patients experiencing both depression and persistent pain should have each condition evaluated separately.
Scottsdale TMS & Spravato provides supervised Spravato treatment alongside psychiatric medication management, psychotherapy, TMS, and integrated depression care. A comprehensive evaluation can help determine whether Spravato is an appropriate option for addressing depression when previous treatments have not provided sufficient relief.
Dr. Vines has practiced psychiatry in Arizona for for over 25 years and has experience working with diverse populations that include children, adolescents, adults, geriatrics, SMI patients, and the chemically dependent.
September 15, 2026
