Depression does not always improve with the first medication or treatment approach. For some adults, symptoms continue despite trying multiple antidepressants. This is often described as treatment-resistant depression and can make finding an effective option particularly challenging. Spravato, a prescription esketamine nasal spray, provides another approach for eligible patients when traditional antidepressant treatment has not provided enough relief.
Spravato is the brand name for esketamine nasal spray. It is an FDA-approved treatment for adults with treatment-resistant depression and is used as part of a structured treatment plan. It is also approved, with an oral antidepressant, for depressive symptoms in adults with major depressive disorder accompanied by acute suicidal ideation or behavior.
Unlike conventional antidepressants, esketamine primarily affects the brain’s glutamate system. This different mechanism makes Spravato an option for patients whose depression has not responded adequately to previous antidepressant treatments.
Spravato is not a medication that patients simply take independently at home. It is administered in a certified healthcare setting with professional supervision and monitoring.
Esketamine works by blocking NMDA receptors, which influences glutamate signaling in the brain. Glutamate is an important neurotransmitter involved in communication between nerve cells.
Through its effects on this system, esketamine may promote changes in neural communication and connections associated with mood regulation. This mechanism differs from many traditional antidepressants that primarily target serotonin, norepinephrine, or dopamine.
One potential advantage of Spravato is that some patients may notice improvements sooner than they would with conventional antidepressants. However, response varies, and treatment should be evaluated over multiple sessions rather than based on one appointment.
Spravato is generally considered for adults with treatment-resistant depression. The Scottsdale TMS & Spravato program identifies potential candidates as adults who have not responded adequately to traditional antidepressant treatment, including those who have failed two or more antidepressant trials.
A history of unsuccessful medication treatment alone does not guarantee that Spravato is appropriate. A healthcare provider must consider your symptoms, medical history, previous medications, current treatments, and potential safety concerns.
An evaluation also gives you an opportunity to discuss what you hope to achieve through treatment and whether esketamine fits within your overall depression care.
Spravato is administered as a nasal spray under the supervision of a healthcare professional. After receiving the medication, patients remain at the treatment center for observation rather than immediately returning home.
The clinical team monitors your response, including vital signs and potential temporary effects such as dizziness, sleepiness, nausea, increased blood pressure, or dissociation.
The FDA requires patients to remain under observation for at least two hours after administration and to be assessed before leaving the healthcare setting.
This supervised approach allows the treatment team to monitor your condition while the immediate effects of esketamine gradually wear off.
The goal of Spravato treatment is to reduce the burden of depressive symptoms and improve overall functioning. As symptoms improve, some patients may notice changes in areas such as:
Not every patient experiences the same results. Depression can involve multiple symptoms, and improvement may occur gradually. Your provider can evaluate changes in your symptoms and determine whether treatment is providing meaningful benefit.
Spravato can also be incorporated into a broader treatment strategy rather than being viewed as a standalone solution.
Treatment-resistant depression often requires a personalized approach. Depending on your needs, Spravato may be combined with an oral antidepressant, psychotherapy, medication management, or other psychiatric services.
Spravato treatment also follows a structured schedule. Treatment is typically more frequent during the initial phase and may become less frequent during maintenance, depending on the patient’s response and tolerability.
At Scottsdale TMS & Spravato, the treatment process is designed around evaluation, supervised administration, monitoring, and ongoing assessment. This allows the clinical team to track how you are responding instead of relying on a one-size-fits-all approach.
Spravato may offer another option when conventional antidepressants have not provided adequate improvement, but it is important to understand the treatment requirements before starting. Patients should be prepared for supervised appointments, a post-treatment observation period, and transportation arrangements because esketamine can temporarily affect alertness and coordination.
It is also important to discuss your medical history, current medications, and previous treatment experiences with your provider. These details help determine whether Spravato is appropriate and how it may fit into your overall care.
Dr. Michael Vines and Our Team can explain the potential benefits, risks, treatment process, and monitoring requirements so you can make an informed decision about your depression treatment.
Spravato offers a different approach to treating depression by using esketamine to influence the brain’s glutamate system. It may be appropriate for certain adults with treatment-resistant depression who have not received enough benefit from conventional antidepressants. Because treatment can produce temporary effects such as dissociation, dizziness, sedation, and increased blood pressure, Spravato is administered under professional supervision with a required monitoring period.
The goal is not simply to administer medication but to evaluate whether treatment is helping improve depressive symptoms and daily functioning. Scottsdale TMS & Spravato provides supervised esketamine treatment as part of an individualized approach to depression care.
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.
August 9, 2026
