When depression has not improved after multiple medication trials, it can be hard to imagine a different path forward. Many people in Twin Falls and across southern Idaho have spent years adjusting medications, managing side effects, attending therapy, and trying to hold onto hope while symptoms continue.
At H3O Wellness, we believe treatment-resistant depression deserves a careful, individualized conversation. SPRAVATO® is one option that may be appropriate for some adults whose depression has not responded adequately to standard treatment. It is not right for everyone, and it does not replace comprehensive psychiatric care, but it can provide another evidence-informed option to discuss after a thorough evaluation.
What Treatment-Resistant Depression Means
Treatment-resistant depression, often called TRD, is generally used to describe major depressive disorder that has not responded adequately to at least two appropriate antidepressant trials.
That definition can be useful, but it is only part of the picture. A thorough evaluation should also consider whether prior medications were taken at a therapeutic dose for an adequate length of time, whether side effects limited treatment, whether psychotherapy was part of care, and whether other health or mental health conditions may be affecting symptoms.
TRD does not mean depression is untreatable. It means the usual first steps have not provided enough relief and a more complete review of your treatment options may be warranted.
Our psychiatric services can help patients review their treatment history, current symptoms, medications, medical considerations, and goals before deciding what to explore next.
What SPRAVATO® Is
SPRAVATO® is esketamine, a prescription nasal spray administered in a certified healthcare setting under direct medical supervision. It works differently from many traditional antidepressants, which primarily act on serotonin, norepinephrine, or dopamine systems.
SPRAVATO® affects glutamate signaling, including the NMDA receptor pathway. Researchers continue to study how this mechanism contributes to antidepressant effects and which patients may benefit most.
SPRAVATO® is FDA-approved for adults with treatment-resistant depression, either as monotherapy or in conjunction with an oral antidepressant. It is also approved, in conjunction with an oral antidepressant, for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior.
Its use in people experiencing acute suicidal thoughts or behavior requires especially careful clinical judgment. SPRAVATO® has not been shown to prevent suicide or reduce suicidal thoughts or behavior, and it does not replace hospitalization or emergency care when either is clinically necessary.
At H3O Wellness, we offer SPRAVATO® treatment as part of a broader approach to depression care. Eligibility is determined through an individual evaluation, not a checklist alone.
How SPRAVATO® Differs From IV Ketamine
SPRAVATO® and IV ketamine are related but distinct treatment options.
SPRAVATO® is esketamine nasal spray with specific FDA-approved uses and REMS safety requirements. IV ketamine is administered by infusion and may be discussed as an off-label option for depression in selected situations.
The treatments differ in formulation, administration, regulatory status, monitoring requirements, treatment schedules, and insurance considerations. Neither is automatically a better choice for every person with treatment-resistant depression.
For patients who want to understand the broader range of options, our comparison of advanced depression treatments in Idaho offers a helpful overview. Our article on IV ketamine for treatment-resistant depression also explains how that separate treatment pathway may be discussed.
What to Expect During a SPRAVATO® Appointment
SPRAVATO® cannot be taken at home. Each dose is self-administered under the direct supervision of a healthcare provider in a certified setting.
Before treatment, your care team reviews relevant health information and checks factors such as blood pressure. After administration, you remain in the clinic for monitoring for at least two hours.
Some people experience sedation, dizziness, dissociation, nausea, temporary blood-pressure changes, or changes in perception during treatment. The monitoring period is an important safety requirement, not simply an administrative step.
You should arrange safe transportation after treatment and should not drive, operate machinery, or engage in potentially hazardous activities until the next day after a restful sleep.
Treatment schedules vary by diagnosis, response, and clinical circumstances. For treatment-resistant depression, the initial phase often includes twice-weekly treatment for four weeks, followed by less frequent sessions if ongoing treatment is appropriate.
How SPRAVATO® May Fit Into a Depression Care Plan
SPRAVATO® is not intended to be a stand-alone answer to every aspect of depression. Even when it is used as monotherapy for treatment-resistant depression, patients may still benefit from psychotherapy, psychiatric follow-up, support for sleep or substance-use concerns, medication review, and care for co-occurring anxiety or other conditions.
For some people, TMS may be a better fit. TMS therapy is an FDA-cleared, noninvasive treatment that uses magnetic stimulation rather than medication during each session.
For others, continued medication management, therapy, or a different treatment plan may be more appropriate. Our role is to help patients understand the benefits, limitations, time commitments, safety considerations, and practical realities of each option.
No treatment can guarantee results. Some patients notice symptom changes early in treatment, while others need more time or do not respond as hoped. Regular follow-up helps us assess whether the plan remains appropriate.
Insurance and Practical Considerations
Insurance coverage for SPRAVATO® varies by plan and often requires prior authorization. Coverage may depend on diagnosis, treatment history, documentation, network status, and other plan-specific requirements.
Our team can help patients understand the process, but insurance approval cannot be guaranteed. Review our insurance information and speak with your insurer about your individual benefits before beginning treatment.
The time commitment also matters. SPRAVATO® appointments include both medication administration and required observation time, so planning for transportation, work, family responsibilities, and recovery time is important.
Frequently Asked Questions
Is SPRAVATO® the same as IV ketamine?
No. SPRAVATO® is esketamine nasal spray with FDA-approved uses for adults with treatment-resistant depression and, with an oral antidepressant, depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior. IV ketamine is a different treatment approach used off-label for depression.
How long does a SPRAVATO® appointment take?
Appointments include administration and at least two hours of required monitoring afterward. Your total visit time may vary depending on your clinical needs and scheduling.
Can I take SPRAVATO® while on an antidepressant?
Possibly. SPRAVATO® may be used as monotherapy for treatment-resistant depression or in conjunction with an oral antidepressant, depending on the clinical situation. Do not stop or change your medications without guidance from your prescribing provider.
Can SPRAVATO® replace emergency mental health care?
No. SPRAVATO® does not replace emergency evaluation, crisis support, or hospitalization when clinically necessary. If you are in immediate danger or cannot stay safe, call or text 988, call 911, or go to the nearest emergency department.
Does insurance cover SPRAVATO®?
Some plans may cover SPRAVATO® for qualifying patients, often with prior authorization. Coverage varies, so patients should verify benefits with their insurer and discuss practical questions with our team.
How do I know whether SPRAVATO® is right for me?
A psychiatric evaluation is the first step. We review your depression history, previous treatment experience, current medications, medical history, safety considerations, and preferences before discussing whether SPRAVATO® may be appropriate.
Key Takeaways
- Treatment-resistant depression usually refers to depression that has not responded adequately to at least two appropriate antidepressant trials.
- SPRAVATO® is esketamine nasal spray administered under direct clinical supervision in a certified healthcare setting.
- SPRAVATO® is FDA-approved for adults with treatment-resistant depression as monotherapy or with an oral antidepressant.
- It is also approved with an oral antidepressant for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior.
- Every treatment session includes required monitoring for at least two hours, and patients should plan for safe transportation home.
- Treatment decisions should follow a thorough evaluation, and no outcome can be guaranteed.
A More Informed Next Step
Depression that has not improved with medication can be deeply discouraging, but it does not mean that you have exhausted every reasonable option.
At H3O Wellness, we help patients in Twin Falls and surrounding southern Idaho communities explore treatment-resistant depression care with clarity and respect. Whether SPRAVATO®, TMS, medication management, therapy coordination, or another approach may fit your needs, the first step is a careful conversation.
To schedule an evaluation or ask questions about treatment options, contact our team.
About H3O Wellness
H3O Wellness is an interventional psychiatry and mental wellness practice serving Twin Falls, Burley, and surrounding southern Idaho communities. We offer individualized psychiatric care and advanced treatment options in a respectful, patient-centered setting.
Medical Disclaimer
The content of this blog is provided for educational purposes only and does not constitute medical advice. Individual results vary, and no treatment outcome can be guaranteed. The information presented here is not a substitute for professional medical evaluation, diagnosis, or treatment.
SPRAVATO® may not be appropriate for every patient and is subject to REMS program requirements. Always discuss your symptoms, medical history, and treatment options with a licensed healthcare provider before making healthcare decisions.
Works Cited
Daly, E. J., Singh, J. B., Fedgchin, M., et al. (2018). Efficacy and safety of intranasal esketamine adjunctive to oral antidepressant therapy in treatment-resistant depression: A randomized clinical trial. JAMA Psychiatry, 75(2), 139–148.
Gaynes, B. N., Lux, L., Gartlehner, G., et al. (2020). Defining treatment-resistant depression. Depression and Anxiety, 37(2), 134–145.
Lam, R. W., Kennedy, S. H., Adams, C., et al. (2024). Canadian Network for Mood and Anxiety Treatments 2023 update on clinical guidelines for management of major depressive disorder in adults. The Canadian Journal of Psychiatry, 69(9), 641–687.
National Institute of Mental Health. (n.d.). Brain stimulation therapies.
U.S. Food and Drug Administration. (2025). SPRAVATO® (esketamine) nasal spray prescribing information.