Esketamine (Spravato®) for Treatment-Resistant Depression

Spravato® (esketamine) is an FDA-approved nasal spray for adults with treatment-resistant depression — defined as depression that has not responded to at least two adequate antidepressant trials. It is also approved for major depressive disorder with acute suicidal ideation or behavior.

Esketamine works through a fundamentally different mechanism than traditional antidepressants, acting on glutamate receptors rather than serotonin or norepinephrine pathways. For many patients, it produces antidepressant effects significantly faster than conventional medications — sometimes within hours or days.

What to expect:

• Esketamine is self-administered as a nasal spray under clinical supervision in our office

• Each session lasts approximately 2 hours, including a required post-dose monitoring period

• Treatment is typically twice weekly for 4 weeks, then weekly for 4 weeks, then every 1–2 weeks for maintenance

• Due to the monitoring requirement, patients cannot drive on treatment days — arrange transportation in advance

• Esketamine is available only through a certified treatment center enrolled in the Spravato REMS program; our practice is enrolled

Who may be a candidate:
Patients with a diagnosis of treatment-resistant depression or MDD with active suicidal ideation who have not responded to standard antidepressant therapy. A thorough evaluation is required before beginning treatment.

Background: Our lead psychiatrist conducted esketamine research during residency at SIU School of Medicine and has direct clinical experience with this treatment from early in its availability.

To schedule a consultation for esketamine, call our office or request an appointment below.