If you’ve tried multiple oral medications for depression and still feel stuck, you’re not alone. Major depressive disorder (MDD) is one of the most common psychiatric disorders, affecting millions of people worldwide. For many, traditional oral antidepressants simply don’t provide adequate relief. When at least two medications have failed, this is considered treatment-resistant depression (TRD)—a serious, complex condition that demands a different approach.
Fortunately, a prescription medicine approved by the FDA for treatment-resistant depression (TRD), SPRAVATO® (esketamine nasal spray), offers renewed hope for adults with MDD accompanied by acute suicidal ideation or behavior. At Active Path Mental Health, we provide this innovative treatment in our certified outpatient healthcare settings, combining it with talk therapy, medication management, and personalized care.
Tried multiple antidepressants without success? Call us or schedule a consultation today to see if SPRAVATO is right for you.
What Is SPRAVATO and Who Is It For?
SPRAVATO for adults is an FDA-approved nasal spray medication derived from esketamine, a form of ketamine that has long been used safely in medical offices and hospitals to relieve pain and treat other serious mental illnesses.
SPRAVATO (esketamine) is an FDA-approved nasal spray for:
- Adults with treatment-resistant depression (TRD) who’ve had an inadequate response to at least two oral antidepressants
- Adults with major depressive disorder (MDD) who are experiencing acute suicidal ideation or behavior
It is not approved as a first-line antidepressant, nor is it approved for other conditions like PTSD or bipolar depression.
This prescription medicine is only available through a restricted program called the REMS program, which ensures it is administered safely in healthcare settings certified for SPRAVATO use.
Why SPRAVATO Is a Game-Changer for TRD
SPRAVATO doesn’t work like typical antidepressants. Instead of targeting serotonin or norepinephrine, it works on the glutamate system in the central nervous system, a powerful pathway that regulates mood, memory, and learning.
In clinical studies, SPRAVATO provided rapid and superior improvement in depressive symptoms compared to placebo, with benefits often seen within 24 to 48 hours. According to clinical trials, SPRAVATO can:
- Repair damaged neural connections
- Promote brain plasticity
- Support restful sleep, emotional regulation, and motivation
- Improve outcomes when other depression treatments have failed
By activating different neural circuits than standard oral antidepressants, SPRAVATO opens the door to faster, more effective healing, especially for adults with treatment-resistant depression TRD.
What Makes SPRAVATO Different From Other Depression Treatments
Many patients spend years cycling through medication adjustments or trying over-the-counter medicines in search of relief. SPRAVATO breaks that cycle by offering:
- A faster onset of action
- A different mechanism of action
- Clinical support during each dose
- Structured care in certified outpatient healthcare settings
Rather than waiting 6+ weeks to know if something works, SPRAVATO can offer a change in days, with support from your healthcare provider at every step.
How SPRAVATO Fits Into a Whole-Person Treatment Plan
At Active Path, SPRAVATO is just one part of a personalized care strategy. We design treatment plans around the whole person—not just the diagnosis.
Your plan may include:
- Talk therapy, such as CBT or ACT
- TMS therapy as a non-medication alternative
- Lifestyle and wellness coaching for long-term healing
This holistic approach ensures you’re supported mentally, physically, and emotionally, with close collaboration between your healthcare providers and, if appropriate, your caregiver or family member.
Can SPRAVATO Help With Other Mental Health Conditions?
Though currently FDA-approved only for TRD and suicidal ideation or behavior, ongoing clinical trials are exploring SPRAVATO’s effectiveness in:
- PTSD
- Bipolar depression
- Substance use disorders
- Severe anxiety
Because these conditions frequently overlap with major depression, your provider may discuss off-label potential or recommend complementary treatments as part of your care.
What to Expect During SPRAVATO Treatment
Your Treatment Schedule
- Induction Phase: 2 sessions/week for 4 weeks
- Maintenance Phase: 1 session/week or every other week
Your In-Clinic Experience
- SPRAVATO is self-administered via nasal spray
- You’ll be monitored in a quiet, private room for 2+ hours
- We’ll track your blood pressure, mental state, and physical responses
- A caregiver or family member must drive you home after treatment
How to Prepare for Your First Session
Getting ready for your first SPRAVATO treatment can feel like a big step, but it doesn’t have to be overwhelming. With a little preparation, you can set yourself up for a smoother and more comfortable experience.
Here’s how to get ready:
- Eat a light meal two hours before your session, unless otherwise advised by your provider.
- Avoid alcohol, cannabis, and other over-the-counter medicines that affect your nervous system 24 hours prior.
- Wear comfortable clothing and bring small comforts, like headphones, a journal, or a cozy sweater.
- Make transportation plans—you will not be allowed to drive after treatment. A caregiver or family member must accompany you or pick you up.
- Set your intention. Many patients benefit from approaching each session with mindfulness. Whether it’s finding relief, clarity, or rest, entering your treatment calmly can support emotional healing.
We encourage you to treat SPRAVATO sessions as time dedicated to you—your care, your recovery, your wellness. Our team will guide you through every step, ensuring you feel seen, heard, and safe.
SPRAVATO Side Effects and Safety
SPRAVATO has a well-established clinical efficacy profile, but side effects may include:
- Dizziness, nausea, dissociation
- Temporary increased blood pressure
- Risk of respiratory depression or respiratory arrest (rare)
- Long-term bladder issues such as ulcerative or interstitial cystitis
SPRAVATO may also pose a small risk of physical and psychological dependence, which is why all treatment takes place under supervision with built-in mitigation strategies.
We also monitor closely for suicidal thoughts and emotional shifts, particularly early in treatment.
Special Considerations for Pregnancy
SPRAVATO is not recommended during pregnancy. However, women exposed during pregnancy are encouraged to enroll in the national pregnancy registry, which supports broader healthcare solutions and improved safety research.
Is SPRAVATO Covered by Insurance?
Yes—most commercial insurers and many Medicare plans cover SPRAVATO for eligible patients. Our team handles healthcare cost containment steps, including:
- Insurance verification
- Prior authorizations
- Cost transparency before you begin
Why Choose Active Path Mental Health?
When it comes to treatment-resistant depression, choosing the right care team matters. At Active Path, we do more than administer SPRAVATO; we walk with you through your healing journey.
Here’s what makes us different:
- Licensed mental health providers trained in administering SPRAVATO with compassion and precision
- Certified across Oregon and Washington designed for privacy, comfort, and safety
- Integrated care options, including talk therapy, TMS, and comprehensive medication management
- A supportive staff that handles everything from insurance navigation to treatment coordination, so you can focus on healing
We also know that healing doesn’t happen in a vacuum. Depression affects not just individuals, but relationships, families, careers, and self-esteem. That’s why we take a whole-person approach, addressing emotional, psychological, social, and physical factors as part of your care plan.
Whether you’re new to mental health treatment or have been searching for years, we’re here to help you move forward—with tools that work, people who listen, and science that supports your recovery.
Schedule your consultation or call 503.832.4861 today. Let today be the day your recovery begins—with healthcare that’s built for you.
