There comes a point in treating depression when you have done everything that was asked of you — taken the medications, tolerated the side effects, waited the weeks it takes for an antidepressant to build, and still felt the ceiling of what those medications could offer. That ceiling is not an illusion. For a meaningful percentage of people with major depressive disorder, standard antidepressants simply do not produce adequate relief. If you have arrived at that point, we want you to know there is a treatment developed specifically for your situation — and we offer it here at Vigeo Wellness in Fort Worth.
What SPRAVATO® Is and Why It Exists
SPRAVATO® (esketamine) is a prescription nasal spray that was developed in direct response to the clinical reality of treatment-resistant depression. It is FDA-approved for treatment-resistant depression in adults — meaning those who have not responded adequately to at least two different antidepressants — and also for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior when used in conjunction with an oral antidepressant. This is an important distinction: SPRAVATO® is not an off-label treatment for treatment-resistant depression. Its approval for treatment-resistant depression is based on clinical trial data reviewed by the FDA (Daly et al., 2018; U.S. Food and Drug Administration, 2019; U.S. National Library of Medicine, n.d.).
SPRAVATO® is derived from ketamine and works on the glutamate system — specifically the NMDA receptor — rather than on the serotonin or norepinephrine pathways targeted by conventional antidepressants. This different mechanism is part of why it can be effective in patients who have not responded to standard treatments. The glutamatergic pathway influences neuroplasticity, which is the brain’s capacity to form new connections and reorganize in response to experience. Disrupted neuroplasticity is thought to be a significant contributor to the experience of depression, and SPRAVATO® works through this pathway rather than the monoamine systems targeted by many antidepressants (Krystal et al., 2019; U.S. National Library of Medicine, n.d.).
The Treatment Experience at Vigeo Wellness Fort Worth
SPRAVATO® is administered under clinical supervision — it is not a take-home medication. When you come to our Fort Worth office for a SPRAVATO® session, you will self-administer the nasal spray under the direct observation of our clinical staff. After administration, you remain in our office for at least two hours for monitoring. This is required as part of the FDA’s Risk Evaluation and Mitigation Strategy, or REMS, for SPRAVATO® — a safety protocol reflecting the medication’s potential effects on perception and blood pressure in the hours following administration (SPRAVATO® REMS, n.d.; U.S. National Library of Medicine, n.d.).
During the observation period, you may experience some degree of dissociation, dizziness, or sedation. These effects are temporary and are why you cannot drive yourself to or from a SPRAVATO® appointment — you will need someone to transport you. Most patients find the monitored setting reassuring; you are not going through this alone, and our staff is present throughout. Many people describe the observation period as unexpectedly restful. If you want a more detailed look at the appointment experience, our guide to what SPRAVATO® feels like walks through the session step by step.
One barrier we hear from patients is a reasonable concern about committing to a structured treatment schedule when you are already exhausted and managing depression. We understand that. The standard SPRAVATO® protocol for treatment-resistant depression involves twice-weekly sessions for the first four weeks, then weekly sessions for weeks five through eight, then maintenance dosing after that — either weekly or every two weeks based on your response. It is a commitment, and we want to be honest about that. It is also a commitment that has produced meaningful relief for many patients who had run out of other options. Discuss with your provider whether this schedule is workable given your current life, and let us work with you to make it as accessible as possible.
What to Expect in Terms of Outcomes
SPRAVATO® has demonstrated rapid onset compared to oral antidepressants. Some patients notice improvement in depressive symptoms within the first week or two of treatment. The clinical trials showed that SPRAVATO® was more effective than placebo nasal spray in patients with treatment-resistant depression, including when studied alongside a newly initiated oral antidepressant (Daly et al., 2018; Wajs et al., 2020).
Results still vary by individual, and we will not promise outcomes we cannot guarantee. Not every patient who begins SPRAVATO® achieves remission, and for some, improvement is partial or temporary. What we can tell you is that the evidence supports SPRAVATO® as a clinically meaningful option for people who have exhausted standard antidepressants, and that we will monitor your response carefully and adjust your plan accordingly. To understand how SPRAVATO® benefits patients with treatment-resistant depression, including what the clinical research shows about response rates, our dedicated overview covers the evidence in depth.
It is also important to understand how SPRAVATO® may be prescribed. For treatment-resistant depression, current labeling allows SPRAVATO® to be used either as monotherapy or in conjunction with an oral antidepressant. For depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior, SPRAVATO® is used in conjunction with an oral antidepressant. Your prescribing provider will discuss what that looks like given your history and any prior medication trials (U.S. National Library of Medicine, n.d.).
Who SPRAVATO® Is and Is Not Appropriate For
SPRAVATO® is a prescription medication that requires a provider evaluation before it can be initiated. You will need a diagnosis of treatment-resistant depression and documentation of at least two prior antidepressant trials that did not produce adequate results. During your intake at Vigeo Wellness, we will review your psychiatric history, your current and prior medications, and any medical conditions that may affect your candidacy.
SPRAVATO® is not appropriate for patients with certain cardiovascular conditions, uncontrolled hypertension, a history of aneurysmal vascular disease, or a history of intracerebral hemorrhage. It is also not appropriate during pregnancy or for patients with current psychosis or active alcohol or substance use disorder. These contraindications exist for important safety reasons, and our clinical team will review them carefully with you. The goal is never to gatekeep — it is to make sure that when we proceed, we proceed safely (U.S. National Library of Medicine, n.d.).
A second barrier we encounter is the stigma of seeking a newer treatment. Some patients worry that pursuing SPRAVATO® signals a kind of desperation, or that they will be judged for wanting something beyond standard care. We want to name that directly: seeking treatment that is FDA-approved, clinically studied, and specifically developed for your situation is not desperation. It is informed, self-directed healthcare. We respect that deeply, and we are here to support it.
For patients who are also considering or would like to learn more about ketamine treatment in Fort Worth, our ketamine therapy page and TMS therapy in Fort Worth & Weatherford page provide additional context on the other treatment-resistant depression options we offer at Vigeo Wellness.
SPRAVATO® and Psychiatric Medication Management
At Vigeo Wellness, we offer integrated psychiatric medication management to support your care throughout and beyond a SPRAVATO® treatment course. Your response to SPRAVATO® is something we track closely — not just whether symptoms improve, but how, when, and to what degree. That information informs ongoing decisions about your medication regimen, your dosing schedule, and whether additional therapeutic supports might benefit you.
We believe that care for treatment-resistant depression should be comprehensive. SPRAVATO® is a powerful tool, and it works best when it is part of a broader treatment relationship — one where you are seen, heard, and supported not just for the two hours you are in our office but throughout your entire journey to recovery. If antidepressants have not worked and you are still trying to understand what that means, our related guide on when antidepressants don’t work may also be helpful.
Frequently Asked Questions
Is SPRAVATO® the same as ketamine? SPRAVATO® (esketamine) is chemically related to ketamine but is a distinct compound — specifically the S-enantiomer of ketamine. Both target the NMDA receptor and the glutamate system, but their pharmacological profiles differ. SPRAVATO® is delivered as a nasal spray under clinical supervision and is FDA-approved for treatment-resistant depression; IV ketamine infusion therapy for depression is an off-label use of a different formulation.
How quickly does SPRAVATO® work? Some patients notice improvement in depressive symptoms within the first one to two weeks of treatment. Clinical trials have shown statistically significant symptom reduction compared to placebo, with some benefits appearing early in treatment. Individual responses vary, and a full assessment of response is generally made after the initial four-week induction phase.
Do I have to stay at the clinic after each SPRAVATO® session? Yes. SPRAVATO® requires a minimum two-hour monitoring period at the clinic following each administration, as required by the FDA’s REMS protocol. You must also have a driver available — you cannot drive yourself home after a session. Our staff will be with you throughout the observation period.
Will insurance cover SPRAVATO®? SPRAVATO® is a branded prescription medication with FDA approval for treatment-resistant depression, which means it is covered by many major insurance plans — though prior authorization and documentation of prior treatment failures are typically required. We encourage you to call us at 817-634-5521 to discuss your specific coverage situation.
Can I take SPRAVATO® if I am currently on antidepressants? Many patients do receive SPRAVATO® in conjunction with an oral antidepressant, and for some indications an oral antidepressant is part of the labeled use. For treatment-resistant depression, current labeling allows use with or without an oral antidepressant. Your specific medication regimen should be reviewed with your prescribing provider to ensure there are no contraindications with your current medications.
Key Takeaways
- SPRAVATO® (esketamine) is FDA-approved for treatment-resistant depression in adults who have not responded to at least two antidepressants
- It works on the glutamate system — a fundamentally different mechanism than conventional antidepressants
- Sessions are conducted at our Fort Worth clinic under clinical supervision, with a required two-hour monitoring period after each administration
- Results vary by individual; for treatment-resistant depression, SPRAVATO® may be used with or without an oral antidepressant depending on your provider’s recommendation
- At Vigeo Wellness Fort Worth, SPRAVATO® is part of a comprehensive treatment approach that also includes psychiatric medication management
Conclusion
If antidepressants have not brought you the relief you deserve, that is not the end of your story. SPRAVATO® was developed specifically for this moment — for people who have tried what was offered and still need more. At Vigeo Wellness in Fort Worth, we offer SPRAVATO® in a supervised, supportive environment where you are cared for as a whole person, not just a diagnosis. You can reach us at 817-634-5521 or contact Vigeo Wellness to schedule a consultation. Our Weatherford office is also available at 817-672-9407 if that is closer for you. You are heard. You matter.
References
Canuso, C. M., Singh, J. B., Fedgchin, M., Alphs, L., Lane, R., Lim, P., Pinter, C., Hough, D., Sanacora, G., Manji, H., & Drevets, W. C. (2018). Efficacy and safety of intranasal esketamine for the rapid reduction of symptoms of depression and suicidality in patients at imminent risk for suicide: Results of a double-blind, randomized, placebo-controlled study. American Journal of Psychiatry, 175(7), 620–630. https://doi.org/10.1176/appi.ajp.2018.17060720
Daly, E. J., Singh, J. B., Fedgchin, M., Cooper, K., Lim, P., Shelton, R. C., Thase, M. E., Winokur, A., Van Nueten, L., Manji, H. K., & Drevets, W. C. (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. https://doi.org/10.1001/jamapsychiatry.2017.3739
Krystal, J. H., Abdallah, C. G., Sanacora, G., Charney, D. S., & Duman, R. S. (2019). Ketamine: A paradigm shift for depression research and treatment. Neuron, 101(5), 774–778. https://doi.org/10.1016/j.neuron.2019.02.005
Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Stewart, J. W., Warden, D., Niederehe, G., Thase, M. E., Lavori, P. W., Lebowitz, B. D., McGrath, P. J., Rosenbaum, J. F., Sackeim, H. A., Kupfer, D. J., Luther, J., & Fava, M. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR*D report. American Journal of Psychiatry, 163(11), 1905–1917. https://doi.org/10.1176/ajp.2006.163.11.1905
SPRAVATO® REMS. (n.d.). SPRAVATO® REMS. https://www.spravatorems.com/
U.S. Food and Drug Administration. (2019). FDA approves new nasal spray medication for treatment-resistant depression; available only at a certified doctor’s office or clinic. https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression
U.S. National Library of Medicine. (n.d.). DailyMed: SPRAVATO—esketamine hydrochloride solution. Retrieved June 10, 2026, from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d81a6a79-a74a-44b7-822c-0dfa3036eaed
Wajs, E., Aluisio, L., Holder, R., Daly, E. J., Lane, R., Lim, P., Morrison, R. L., Sanacora, G., Young, A. H., Kasper, S., Sulaiman, A. H., Li, C. T., Paik, J. W., Manji, H. K., Drevets, W. C., & Singh, J. B. (2020). Esketamine nasal spray plus oral antidepressant in patients with treatment-resistant depression: Assessment of long-term safety in a phase 3, open-label study (SUSTAIN-2). Journal of Clinical Psychiatry, 81(3), 19m12891. https://doi.org/10.4088/JCP.19m12891
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. SPRAVATO® (esketamine) is a prescription medication approved for adults with treatment-resistant depression and should only be pursued under the supervision of a licensed provider familiar with your full medical and psychiatric history. SPRAVATO® is also approved, in conjunction with an oral antidepressant, for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior; its effectiveness in preventing suicide or reducing suicidal ideation or behavior has not been demonstrated, and hospitalization may still be required when clinically warranted. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.