You have tried the pills. You may have tried therapy, better sleep, more exercise, and a new prescription every few months. Still, the heaviness hasn’t lifted, and you’re tired of hearing “give it more time.” If that sounds like you, Spravato® may be worth a serious conversation. In general, good candidates are adults with major depression who haven’t gotten enough relief from at least two antidepressants, along with adults with depression who are having thoughts of suicide. A provider must confirm it’s safe for your health history. But for many people who feel stuck, it offers something new: a different way of reaching the brain.
Spravato® (esketamine) is an FDA-approved nasal spray. Most antidepressants target brain chemicals like serotonin and norepinephrine. Spravato works on glutamate, a different messenger that helps brain cells communicate and adapt. Because it takes another route, it can help people whose depression hasn’t responded to standard pills.
At MindBodyPinnacle Health, Spravato treatment is offered to eligible adults as part of a whole-person care plan.
Every person is different, but these are the markers providers look for most often:
You’re an adult with major depression. This means low mood, loss of interest, exhaustion, trouble focusing, or changes in sleep and appetite that show up most days.
Two or more antidepressants haven’t helped enough. Doctors call this treatment-resistant depression.
Depression is disrupting daily life. Work, parenting, friendships, even getting out of bed can feel out of reach.
You’re having thoughts of suicide. Spravato is FDA-approved to help reduce depression symptoms in adults with major depression who are having suicidal thoughts or behavior, alongside other care.
You can commit to the schedule. Treatment means regular visits, and you’ll need a ride home afterward.
“Treatment-resistant” doesn’t simply mean a pill didn’t work. A medication may not have had a fair chance if the dose was too low or it was stopped too early. Before recommending Spravato, a careful provider reviews your full history. That’s where medication management can help. Sometimes a smart adjustment is all that’s needed. Other times, it confirms that a new approach is the right next step.
Some patients also find genetic testing useful, since it can offer clues about how your body may process certain medications. It doesn’t decide who gets Spravato, but it can add helpful information.
Spravato isn’t right for everyone, and safety always comes first. Your provider will screen carefully for these situations, which may rule it out:
Certain blood vessel or brain conditions. People with an aneurysm (a weak, bulging spot in a blood vessel), an arteriovenous malformation (an abnormal tangle of blood vessels), or a history of bleeding in the brain should not use Spravato.
An allergy to esketamine or ketamine.
Pregnancy or breastfeeding. Spravato is not recommended in either case. If you’re planning a pregnancy, tell your provider early.
Uncontrolled high blood pressure or heart problems. Spravato can raise blood pressure for a short time after each dose. Sometimes getting blood pressure under control first makes treatment possible.
Other situations call for extra care rather than an automatic no. These include a history of psychosis, bipolar disorder, or substance use. Spravato can cause temporary feelings of detachment, and it has some potential for misuse, which is why it’s given only in a certified medical setting. Being open about your history helps your provider keep you safe.
The best candidates also come in with grounded hopes. Spravato can act faster than many traditional antidepressants, which often take weeks to build up. Still, it isn’t a magic switch, and results vary from person to person. It tends to work best as part of a bigger plan that may include ongoing medication, therapy, healthy sleep habits, and regular check-ins. Being open to that kind of full-picture care is a strong sign you’ll get the most from treatment.
You take Spravato in a certified office, where you use the nasal spray yourself while a health care provider stays nearby. Afterward, you’re monitored for at least two hours. Dizziness, sleepiness, nausea, and a floaty or disconnected feeling are common, and they usually fade the same day. You can’t drive until the next day, after a full night of sleep, so plan a ride home.
Most people start with two sessions a week for the first month, then move to weekly sessions for the next month. After that, sessions are weekly or every other week, depending on how you’re doing.
Not being a candidate doesn’t mean you’re out of options. TMS therapy is a non-invasive treatment that uses magnetic pulses to stimulate mood-related areas of the brain, with no medication and no downtime. Some people who can’t use Spravato may be good candidates for TMS, and your provider can help you weigh both.
The only way to know whether Spravato is right for you is through a proper evaluation. A psychiatric evaluation is the first step. You and your provider will talk through:
Your symptoms and how long you’ve had them
Which medications you’ve tried, at what doses, and how they felt
Your medical history, blood pressure, and any other health conditions
Your goals and daily schedule
Our experienced team will explain the risks and benefits in clear language, and you’ll never be rushed into a decision. Cost is a common worry, too. MindBodyPinnacle Health accepts most major insurance plans and offers CareCredit financing for out-of-pocket services. You can learn more on our financing and insurance page.
Living with depression that won’t budge is exhausting, and you deserve care that takes that seriously. If you think Spravato could be the next step, call (443) 713-8643 or schedule a consultation to find out where you stand. If you’re in crisis or thinking about harming yourself, call or text 988 right away.
About the Author
Dr. Tai Ajani,
DNP, PMHNP-BC
Your Healing Chapter
Starts Today
September 20, 2026
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