Spravato, also known as esketamine nasal spray, is an FDA-approved treatment option for certain adults with difficult-to-treat depression. Unlike a standard antidepressant that can be prescribed for use at home, Spravato is administered in a certified healthcare setting with medical supervision. Because of its specific indications and safety requirements, not everyone with depression will automatically qualify.
Spravato may be considered for adults with treatment-resistant depression (TRD), particularly when previous antidepressant treatments have not provided adequate improvement. The Scottsdale TMS & Spravato program describes candidates as adults who have failed two or more antidepressant trials or have not responded sufficiently to traditional medication.
The FDA also approves Spravato for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior, when used with an oral antidepressant. However, Spravato is not established as a treatment that prevents suicide, and urgent or inpatient psychiatric care may still be necessary when clinically appropriate.
Having tried antidepressants without enough improvement does not automatically mean Spravato is right for you. A psychiatric evaluation is needed to determine whether the treatment is appropriate and safe.
Treatment-resistant depression generally refers to depression that has not improved adequately despite appropriate treatment attempts. At Scottsdale TMS & Spravato, the program identifies adults who have tried two or more antidepressants without sufficient success as potential candidates.
This history is important because Spravato is intended for people who need another treatment approach after conventional medication has not provided enough relief.
Your provider may review your previous medications, how long you took them, the doses used, the benefits you experienced, and any side effects. This information helps create a clearer picture of your treatment history before considering esketamine.
Before receiving Spravato, you undergo a comprehensive psychiatric consultation. The provider reviews your symptoms, medical history, previous treatments, and other factors that could affect treatment safety.
The evaluation is an important part of determining eligibility because Spravato has specific safety considerations. Your provider may discuss your current medications, medical conditions, blood pressure, and psychiatric history.
A complete evaluation also gives you an opportunity to ask questions about how treatment works, how often appointments occur, possible side effects, and what happens during the monitoring period.
Being eligible for Spravato also means being able to follow the requirements surrounding administration and monitoring. Spravato cannot simply be prescribed for independent use at home. It must be administered under the direct supervision of a healthcare provider in an appropriate certified setting.
At Scottsdale TMS & Spravato, the treatment process includes supervised self-administration of the nasal spray, monitoring of blood pressure and vital signs, and a post-treatment recovery period.
The FDA requires patients to be monitored for at least two hours after administration, including observation for changes in respiratory status. Blood pressure is assessed before treatment and again after dosing.
Because Spravato can cause temporary sedation, dissociation, and impaired attention or judgment, patients must arrange transportation home and should not drive after treatment.
Yes. A psychiatric diagnosis alone does not guarantee eligibility. Your provider must consider whether the potential benefits outweigh the risks based on your individual health and treatment history.
Certain medical and psychiatric circumstances may require additional evaluation or may make Spravato inappropriate. For example, Spravato should not be administered when an increase in blood pressure or intracranial pressure would pose a serious risk. The medication also carries important warnings related to sedation, dissociation, respiratory depression, and misuse.
Patients should provide an accurate medical history and tell their provider about all medications and substances they use. This allows the treatment team to make a more informed safety assessment.
Qualifying for Spravato is only the beginning of the treatment process. Patients typically follow a structured schedule, with treatment frequency determined according to the approved dosing guidelines and individual response.
Your provider monitors changes in depressive symptoms, side effects, blood pressure, and overall functioning throughout treatment. Continued treatment decisions are based on whether you are receiving meaningful benefit and tolerating the medication appropriately.
Spravato can also be incorporated into a broader depression treatment plan. The Scottsdale TMS & Spravato program describes integrated care that may involve medication management, psychotherapy, or TMS when clinically appropriate.
Determining whether Spravato is appropriate requires more than checking a list of symptoms. Your treatment history, current depression severity, medical history, previous medication response, and ability to participate in supervised sessions all matter.
Our Team at Scottsdale TMS & Spravato provides psychiatric evaluations and supervised treatment designed around individual needs. Dr. Michael Vines and the clinical team can review your history, explain the requirements, and help determine whether esketamine may be an appropriate option for your depression care.
Adults with treatment-resistant depression may qualify for Spravato when traditional antidepressant treatments have not provided adequate relief. The treatment is also FDA-approved for depressive symptoms in adults with major depressive disorder accompanied by acute suicidal ideation or behavior, with specific treatment requirements.
Eligibility is determined through a comprehensive psychiatric evaluation rather than a single symptom or diagnosis. Patients must also receive Spravato under medical supervision and complete the required post-treatment monitoring. Scottsdale TMS & Spravato can help eligible patients understand the evaluation process, safety requirements, and next steps for considering esketamine treatment.
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 29, 2026
