How Psychiatrists Decide If Spravato Is the Right Fit for You

Choosing a treatment plan for treatment-resistant depression (TRD) is never a one-size-fits-all decision. For individuals who have tried multiple antidepressants without success, Spravato (esketamine nasal spray) has emerged as a breakthrough option. However, not every patient automatically qualifies. Psychiatrists follow a careful, evidence-based process to determine whether Spravato in NYC or anywhere else is the right fit.

In this guide, we'll break down how psychiatrists make this critical decision, what factors they consider, what assessments are involved, and what you can expect if you're exploring Spravato as a treatment option.

What Is Spravato?

Before diving into the decision-making process, let's recap what Spravato is:

• Esketamine Nasal Spray: A derivative of ketamine, designed for use alongside an oral antidepressant.

• FDA-Approved: Specifically for adults with treatment-resistant depression and major depressive disorder (MDD) with acute suicidal ideation.

• Administration: Only available at certified treatment centers, like those offering Spravato in NYC, under medical supervision.

Spravato works differently than traditional antidepressants by targeting the glutamate system, promoting neuroplasticity, and delivering rapid improvements in mood.

Step-by-Step: How Psychiatrists Assess Spravato Candidacy

1. Thorough Psychiatric Evaluation

First and foremost, psychiatrists conduct an in-depth psychiatric assessment that includes:

• Personal and Family Mental Health History

• Medication History

• Substance Use History

• Psychosocial Factors (relationships, work, living situation)

This detailed background helps determine whether you meet the baseline criteria for Spravato in NYC or your local clinic.

2. Confirmation of Treatment-Resistant Depression

Spravato is only indicated for treatment-resistant depression, meaning patients must have:

• Tried at least two different antidepressants

• Taken them at therapeutic doses

• Given each medication an adequate trial period (typically 6-8 weeks)

Psychiatrists will review medical records, pharmacy history, or consult previous providers to confirm this.

3. Ruling Out Contraindications

Certain medical or psychiatric conditions may disqualify a patient from receiving Spravato:

• Active substance abuse or addiction

• Uncontrolled hypertension

• History of aneurysms or cardiovascular events

• Psychotic disorders (e.g., schizophrenia)

4. Current Symptom Assessment

Psychiatrists use structured tools such as:

• PHQ-9 (Patient Health Questionnaire)

• MADRS (Montgomery-Åsberg Depression Rating Scale)

• Suicide Risk Assessment Tools

Severity of depression and presence of suicidal ideation are crucial factors in decision-making.

Important Factors That Influence Psychiatrist Decisions

Medical History

• Cardiovascular health

• Allergies to anesthetics

• History of adverse medication reactions

Psychological Stability

• Current coping mechanisms

• Readiness to participate in therapy

• Ability to adhere to treatment guidelines

Support System

• Family or friends available for transportation (since patients cannot drive after sessions)

• Emotional support during treatment

Clinics offering Spravato in NYC typically require that patients identify a "treatment buddy" for safety and support.

The Role of Insurance in Spravato Eligibility

Because Spravato is an expensive treatment, psychiatrists also consider insurance requirements, which often include:

• Documented history of treatment resistance

• Pre-authorization forms

• Regular outcome tracking to justify ongoing treatment

Many providers offering Spravato in NYC have dedicated staff to assist patients with insurance approvals and appeals.

Informed Consent: What Patients Must Know

Before starting Spravato, patients must undergo a thorough informed consent process covering:

• Expected benefits and limitations

• Potential side effects (dissociation, dizziness, blood pressure spikes)

• Treatment logistics (clinic visits, observation periods)

• Responsibilities regarding post-treatment care

In clinics specializing in Spravato treatment in NYC, this consent process is often reinforced with written materials, videos, and Q&A sessions.

Real Patient Example: How Sarah Was Approved for Spravato

Sarah, a 32-year-old teacher from Manhattan, had tried four different antidepressants over six years without lasting relief. After a comprehensive evaluation at a certified clinic offering Spravato in NYC, her psychiatrist determined she was a suitable candidate.

Key factors that supported Sarah’s approval:

• Documented treatment resistance

• Strong support network

• No contraindications

• Commitment to concurrent therapy

After six weeks of Spravato combined with Cognitive Behavioral Therapy (CBT), Sarah experienced a 50% reduction in her depression symptoms and resumed part-time teaching.

What Happens After You're Approved?

Once deemed eligible, the typical process includes:

1. Baseline Assessments: Mental health scales, vital signs

2. Treatment Scheduling: Two sessions per week during induction phase

3. Observation Period: Two hours of monitoring after each nasal spray session

4. Ongoing Evaluations: Regular mood assessments, side effect tracking

In cities like New York, Spravato in NYC providers often create individualized schedules to accommodate work and personal life.

How Psychiatrists Monitor Progress

Psychiatrists don’t just approve Spravato and walk away. They track:

• Symptom improvements after each session

• Side effect occurrence and severity

• Blood pressure readings

• Functional improvements (work, relationships, self-care)

Treatment continuation depends on demonstrated benefit during the first 8-12 weeks.

Red Flags That May Pause or End Treatment

Spravato might not be continued if:

• No significant symptom improvement is observed

• Severe side effects develop

• Patient fails to comply with post-treatment restrictions

• Substance use or psychiatric instability emerges

Clinics offering Spravato maintain strict safety protocols to intervene early if issues arise.

Final Thoughts

Psychiatrists use a thorough, patient-centered, evidence-based approach when determining Spravato eligibility. It's not about offering the latest "quick fix"—it's about ensuring the right treatment for the right person at the right time.

If you're struggling with treatment-resistant depression and curious about Spravato in NYC, the first step is scheduling a comprehensive psychiatric evaluation with a REMS-certified provider. They will guide you through the process and determine if Spravato can open the door to lasting healing.