If you have been treating depression for a while without the relief you hoped for, you may have heard a confusing list of treatment names: SSRIs, SNRIs, ketamine, esketamine, Spravato, and TMS.
These treatments are sometimes discussed as though they are different versions of the same thing. They are not. They work differently, require different time commitments, and may be appropriate at different points in your treatment.
At Vitality Wellness Clinic, we provide psychiatric care for adults throughout Texas via telehealth and offer Spravato treatment in person at our Pearland, Texas clinic. If another treatment such as TMS may be a better fit, we can also provide a referral.
Understanding the differences can help you have a more informed conversation with your psychiatric provider.
What Does Treatment-Resistant Depression Mean?
Treatment-resistant depression does not mean that your depression cannot be treated. It describes your treatment history.
In general, treatment-resistant depression means that depression has not responded adequately to two or more antidepressant treatments taken at an appropriate dose and for an adequate amount of time.
Simply having taken two antidepressants does not necessarily mean you have treatment-resistant depression. Your psychiatric provider will review which medications you tried, the doses, how long you took them, why they were stopped, and how much improvement you experienced.
If you have completed two or more adequate antidepressant trials and are still experiencing significant depression, it may be time to discuss additional treatment options.
Antidepressants: Still an Important First Step
Traditional antidepressants include SSRIs, SNRIs, and several other medication classes. They remain an important treatment option because they are well studied, widely available, and effective for many people.
Antidepressants generally work gradually. Some symptoms may improve earlier, but it can take several weeks at an appropriate dose to determine how well a medication is working.
Side effects vary depending on the medication and may include nausea, changes in sleep or appetite, weight changes, sexual side effects, or emotional blunting.
Needing to change medications does not mean you have failed treatment. Sometimes a medication was stopped because of side effects, was not taken long enough, or never reached an adequate dose.
Good medication management involves carefully reviewing those details before deciding what should come next.
What Is Spravato?
Spravato, also known as esketamine, is an FDA-approved prescription nasal spray used for certain adults with major depressive disorder.
For adults with treatment-resistant depression, Spravato may be used with or without an oral antidepressant.
Spravato works differently from traditional antidepressants. Esketamine acts on the brain’s glutamate system rather than primarily targeting serotonin, norepinephrine, or dopamine.
This different mechanism is one reason Spravato may be considered when traditional antidepressant treatments have not provided enough relief.
Spravato Is Not the Same as IV Ketamine
Spravato and ketamine are related, but they are not interchangeable treatments.
Spravato contains esketamine and is an FDA-approved nasal spray for specific depression indications. IV ketamine for depression is an off-label treatment generally provided through specialized ketamine or infusion clinics.
At Vitality Wellness Clinic, we provide Spravato treatment in person at our Pearland, Texas clinic.
We do not provide IV ketamine infusions.
What Happens During a Spravato Treatment?
Spravato is not a medication that you pick up at the pharmacy and take home.
The nasal spray is self-administered under the supervision of a healthcare professional at a certified treatment center.
Before treatment, your blood pressure is checked and our clinical team reviews how you are feeling. You then administer the medication while being supervised by the treatment team.
After receiving Spravato, you remain at the clinic for monitoring for at least two hours. Your healthcare provider determines when you are clinically ready to leave.
Because Spravato can cause sedation, dissociation, changes in blood pressure, respiratory depression, and other effects, monitoring is an important part of every treatment visit.
What Might Spravato Feel Like?
Everyone’s experience can be different.
Some patients experience a temporary feeling of being disconnected from themselves, their thoughts, feelings, surroundings, or sense of time. This is known as dissociation.
Other possible side effects include dizziness, sleepiness, nausea, changes in perception, increased blood pressure, headache, anxiety, decreased energy, vomiting, or a sensation of spinning.
Our clinical team monitors you throughout the treatment visit and determines when you are ready to leave.
How Often Will I Need Spravato?
Treatment is generally more frequent when you first begin.
For treatment-resistant depression, Spravato is typically given twice a week during the first four weeks.
During weeks five through eight, treatment is typically once a week.
After that, treatment frequency is individualized based on your response and clinical needs. Some patients continue weekly treatment while others may transition to every other week.
Your treatment schedule is determined with your healthcare provider based on how you are responding.
How Quickly Can Spravato Work?
One of the differences between Spravato and conventional antidepressants is the potential for a more rapid improvement in depressive symptoms for some patients.
That does not mean everyone will feel better after the first treatment, and Spravato is not an instant cure.
Response varies from person to person. Throughout treatment, we continue to evaluate your depression symptoms, functioning, side effects, and overall progress to determine whether treatment is helping.
Preparing for Your Spravato Appointment
There are a few important things to plan for on treatment days.
Because some patients experience nausea or vomiting, you may be instructed not to eat for at least two hours before treatment and not to drink liquids for at least 30 minutes beforehand.
If you use a nasal corticosteroid or nasal decongestant, talk with your healthcare provider about when to use it before your Spravato treatment.
Most importantly, arrange transportation home before arriving for your appointment.
Can I Drive After Spravato?
No.
You will need someone to drive you home after each treatment.
Even if you feel normal when you leave the clinic, you should not drive, operate machinery, or perform activities requiring complete mental alertness until the next day after a restful sleep.
Transportation is therefore an important consideration when deciding whether Spravato fits your lifestyle and treatment needs.
Who May Be a Candidate for Spravato?
Spravato may be an option for adults who continue to experience significant depression despite adequate antidepressant treatment.
If you have tried two or more antidepressant treatments at an appropriate dose and for an adequate length of time without enough improvement, it may be worth discussing whether you have treatment-resistant depression and whether Spravato could be an option.
Having tried two medications does not automatically mean that Spravato is appropriate for you or that your insurance will approve treatment.
At Vitality Wellness Clinic, we complete an evaluation before treatment. We review your depression symptoms, previous medication trials, current medications, medical and psychiatric history, blood pressure, substance use history, and other safety considerations.
Is Spravato Appropriate for Everyone?
No.
There are medical and psychiatric circumstances in which Spravato may not be appropriate.
For example, Spravato should not be used in people with certain aneurysmal vascular diseases, arteriovenous malformations, a history of bleeding in the brain, or an allergy to esketamine, ketamine, or other ingredients in the medication.
It is important to tell your provider about your complete medical history, including high blood pressure, cardiovascular or neurological conditions, liver problems, history of psychosis, pregnancy or plans for pregnancy, and any history of difficulty with alcohol, prescription medications, or other substances.
Your provider should also know about all prescription medications, over-the-counter medications, vitamins, herbs, and supplements you take.
A comprehensive evaluation helps us determine whether Spravato can be used safely and appropriately as part of your treatment plan.
Why Does Spravato Have to Be Given in a Certified Treatment Center?
Spravato is available through a safety program called the Spravato Risk Evaluation and Mitigation Strategy, or REMS.
Because of the potential for serious side effects including sedation, dissociation, respiratory depression, abuse, and misuse, Spravato must be administered in a certified healthcare setting where patients can be appropriately monitored.
This is why Spravato cannot simply be prescribed for you to use independently at home.
Vitality Wellness Clinic provides Spravato treatment in person at our Pearland, Texas location for appropriate patients.
What About TMS?
Transcranial magnetic stimulation, or TMS, is another treatment option for depression.
TMS uses magnetic pulses to stimulate areas of the brain involved in mood regulation. Unlike Spravato, TMS does not involve taking a medication.
Traditional TMS treatment generally requires multiple treatment sessions each week for several weeks. Patients remain awake during treatment and can typically drive themselves afterward.
The treatment schedule can be challenging for people with inflexible work or family responsibilities. Headache and scalp discomfort are among the more commonly reported side effects.
TMS may be worth considering for people who have not responded adequately to antidepressants, have difficulty tolerating medication side effects, or prefer a non-medication approach.
Vitality Wellness Clinic does not currently perform TMS in our office.
However, we can evaluate your treatment history, discuss whether TMS may be an appropriate option, and provide a referral to a TMS treatment provider when indicated.
Our goal is to help you find the treatment that best fits your needs, even when that treatment is provided outside of our practice.
Will Insurance Cover Spravato?
Insurance coverage varies.
Many insurance plans require prior authorization and documentation of your diagnosis and previous antidepressant treatments before approving Spravato.
It is also important to understand that coverage for the Spravato medication and coverage for the clinical treatment and monitoring services may be handled differently by your insurance plan. It is worth asking whether the medication itself falls under your medical benefit or your pharmacy benefit, and whether the treatment visits are covered.
Your deductible, copay, coinsurance, and other out-of-pocket costs depend on your individual benefits.
Manufacturer savings or patient support programs may also be available to some eligible patients.
Our team can help you understand the authorization process and determine what information may be required by your insurance plan before treatment begins.
Which Depression Treatment Is Right for You?
There is no single treatment that is best for everyone.
Your psychiatric provider may consider which medications you have already tried, whether those trials were adequate, the severity of your depression, your medical history, previous treatment response, medication side effects, transportation, ability to attend treatment appointments, insurance coverage, and your personal treatment preferences.
These treatments are also not necessarily mutually exclusive.
Medication management, psychotherapy, Spravato, TMS, and lifestyle interventions can all play different roles in an individualized depression treatment plan.
At Vitality Wellness Clinic, we believe psychiatric care should also look beyond symptoms alone. Sleep, nutrition, movement, physical health, hormonal changes, relationships, trauma, alcohol and substance use, and life stressors can all influence mental health.
The goal is not simply to find the newest treatment. The goal is to identify the treatment or combination of treatments that makes sense for you.
Considering Spravato Treatment in Pearland, Texas?
If you have tried two or more antidepressant treatments and are still struggling with depression, it may be time to explore additional options.
Vitality Wellness Clinic provides adult psychiatric evaluations, medication management, and whole-person psychiatric care throughout Texas via telehealth.
For appropriate patients, Spravato treatment is provided in person at our Pearland, Texas clinic.
The first step is an evaluation. We will review what you have tried, how you responded, your current symptoms, and your medical and psychiatric history. From there, we can discuss whether Spravato may be appropriate or whether another treatment approach, including a referral for TMS, makes more sense.
You do not need to determine which treatment is right for you before scheduling an evaluation. We can help you understand your options and develop an individualized treatment plan.
Additional Spravato Patient Resources
For additional information about Spravato, including treatment expectations, safety information, frequently asked questions, insurance coverage, and patient support programs, visit the official Spravato patient website.
Information on external websites is provided for educational purposes. Insurance coverage and eligibility for patient assistance or savings programs vary and are not guaranteed.
Spravato is not a replacement for emergency psychiatric care or hospitalization when hospitalization is clinically necessary.
This article is for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment.