There is a particular kind of exhaustion that comes from trying to treat depression and not getting better. You have filled the prescriptions. You have waited through the adjustment periods — the weeks of side effects that the pharmacy paperwork warned you about — and then waited longer still for the therapeutic effect that was supposed to follow. You have gone back and reported that it wasn’t working, started something else, and done it all again. For a significant number of people with major depressive disorder, that cycle goes on for years. If that is where you are, we want to be direct with you about something: the fact that antidepressants haven’t worked for you is not evidence that nothing will. It may be evidence that you need a different kind of treatment altogether. SPRAVATO® (esketamine) was designed for exactly this population, and we offer it here, at Vigeo Wellness in Weatherford, for patients who are ready to try a new path.
What Is SPRAVATO® and How Is It Different
SPRAVATO® is an FDA-approved nasal spray formulation of esketamine — a molecule derived from ketamine — that is specifically indicated for treatment-resistant depression (TRD) in adults. Treatment-resistant depression is defined clinically as major depressive disorder that has not responded to at least two adequate antidepressant trials. If that describes your experience, SPRAVATO® was developed with you in mind (Daly et al., 2018; Popova et al., 2019; U.S. Food and Drug Administration, 2019; U.S. National Library of Medicine, n.d.).
What makes SPRAVATO® fundamentally different from conventional antidepressants is its mechanism. Standard antidepressants — SSRIs, SNRIs, tricyclics — primarily target monoamine neurotransmitters like serotonin and norepinephrine. They are effective for many patients, but they are slow, often requiring four to eight weeks to produce a meaningful clinical effect, and they do not work for everyone. SPRAVATO® targets the glutamatergic system through NMDA receptor modulation, a mechanism that produces antidepressant effects through an entirely different pathway. This is why patients who have failed multiple serotonin-targeting medications can still respond to SPRAVATO® — it is not simply another version of what you have already tried (Krystal et al., 2019; Rush et al., 2006).
The clinical trials that led to SPRAVATO®’s FDA approval demonstrated significant antidepressant effects compared to placebo in patients with TRD, including meaningful reductions in depressive symptoms and, in some trials, faster onset of effect than traditional antidepressants. This is meaningful for patients who have been waiting — for years, in some cases — for something that actually works. If you are still trying to understand what it means when antidepressants don’t work, that experience is exactly why newer options like SPRAVATO® exist.
How SPRAVATO® Treatment Works at Vigeo Wellness
SPRAVATO® is not a medication you take at home on your own. Because of its potential for dissociative effects and sedation, it must be administered in a certified healthcare setting under direct medical supervision — and patients are monitored for a mandatory observation period following each session. This is a requirement of the FDA’s REMS program (Risk Evaluation and Mitigation Strategy) for SPRAVATO®, and it applies to all providers who offer it (SPRAVATO® REMS, n.d.; U.S. National Library of Medicine, n.d.).
At our Weatherford office, SPRAVATO® treatment follows a structured protocol. The initial phase of treatment typically involves twice-weekly sessions for the first four weeks. This induction phase is followed by a maintenance period with reduced frequency — weekly or biweekly sessions — depending on your response and your provider’s clinical judgment. For treatment-resistant depression, SPRAVATO® may be prescribed either alone or in conjunction with an oral antidepressant; for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior, it is used in conjunction with an oral antidepressant. We work closely with each patient to coordinate care, which may involve collaboration with your current psychiatric or primary care provider (U.S. National Library of Medicine, n.d.).
The SPRAVATO® session itself involves self-administering the nasal spray under clinical supervision, then remaining in our office for the required observation window. The dissociative effects, when they occur, are transient and resolve before you leave. You will need someone to drive you home from each session — you cannot drive yourself on the day of treatment. We go through all of these logistics in detail during your initial consultation so there are no surprises.
Who SPRAVATO® Is Appropriate For
SPRAVATO® is FDA-approved specifically for adults with treatment-resistant depression — defined as major depressive disorder that has not responded adequately to at least two antidepressants of adequate dose and duration. It is also approved, in conjunction with an oral antidepressant, for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior. These are serious, well-defined clinical categories, and we evaluate each patient carefully against them (Canuso et al., 2018; U.S. National Library of Medicine, n.d.).
SPRAVATO® is not appropriate for everyone with depression. Certain medical conditions — including aneurysmal vascular disease, arteriovenous malformation, or a history of intracerebral hemorrhage — may preclude its use. Blood pressure and other medical considerations also require careful review. A history of psychosis requires careful evaluation. We conduct a thorough intake evaluation for every patient, not to create barriers, but because this is how responsible, individualized care works. We will tell you clearly whether SPRAVATO® is appropriate for you, and if it is not, we will discuss what other options might be worth exploring.
Results vary by individual — we will not overstate what SPRAVATO® can do, and we will not minimize the reality that some patients do not achieve the response they hoped for. What we can offer is honesty, careful monitoring, and a treatment team that stays engaged with your progress across every stage of the protocol. To learn more about the benefits of SPRAVATO® for treatment-resistant depression, our dedicated resource page explores the evidence in greater depth.
Addressing the Hesitation
One of the most common reasons patients delay exploring SPRAVATO® is uncertainty about what treatment will feel like. The dissociative properties of esketamine are well-documented, and for patients who have never experienced dissociation, the prospect can be anxiety-provoking. We take that seriously. We do not brush past it. When you come in for your consultation at our Weatherford office, we spend real time explaining what patients typically describe during sessions — the altered perception of space, time, and body awareness — and we answer every question you bring. The experience is temporary, it is supervised, and the vast majority of patients find that the anticipation is more difficult than the session itself. For more detail, our guide to what SPRAVATO® feels like walks through the treatment experience step by step.
The other barrier we often hear is the time commitment. SPRAVATO® requires in-office sessions — twice weekly initially — which is a real logistical challenge for people who are working, caring for family, or managing the fatigue and executive function difficulties that depression itself creates. We understand this and we do what we can to accommodate scheduling within our Weatherford location. We know that driving into Fort Worth for twice-weekly appointments would be prohibitive for many Parker County residents, and that is a reason this service exists here. Our depression treatment in Weatherford is designed to bring advanced care close to home.
Frequently Asked Questions
Is SPRAVATO® the same as ketamine?
SPRAVATO® (esketamine) is derived from ketamine — esketamine is one of the two molecular forms (enantiomers) that make up ketamine. They share a mechanism of action through NMDA receptor modulation, but they are different products. SPRAVATO® is a nasal spray that is FDA-approved for treatment-resistant depression. IV ketamine infusions are a separate therapy, also available at Vigeo Wellness, that are used off-label for depression and other conditions. We can discuss both options and how they compare during your consultation.
How quickly does SPRAVATO® work?
Some patients begin to notice improvement within the first one to two weeks of the induction phase, which is considerably faster than traditional antidepressants. However, response timelines vary by individual, and the full benefit of SPRAVATO® typically develops over the full induction course. We do not promise a specific timeline, but we do monitor closely and communicate openly about what we are observing in your response.
Does insurance cover SPRAVATO®?
SPRAVATO® is FDA-approved, and many commercial insurance plans and Medicare cover it, at least partially, for patients who meet the criteria of treatment-resistant depression. Coverage varies significantly by insurer, plan, and state, so we strongly recommend verifying your benefits prior to treatment. Our team can help you understand what documentation insurers typically require and walk you through the prior authorization process.
Can I continue my current antidepressant while taking SPRAVATO®?
Many patients receive SPRAVATO® alongside an oral antidepressant, and for some indications an oral antidepressant is part of the labeled use. For treatment-resistant depression, current labeling allows SPRAVATO® to be used alone or in conjunction with an oral antidepressant. We will review your current medications carefully during intake to ensure compatibility and to make any recommendations that seem clinically appropriate.
What happens if SPRAVATO® stops working or I want to discontinue?
SPRAVATO® treatment can be tapered or discontinued under your provider’s supervision. Some patients continue on a long-term maintenance schedule; others reach a point of sustained remission and reduce or stop treatment in collaboration with their prescriber. We do not lock patients into a protocol — our goal is ongoing clinical improvement, and we adjust the plan based on how you are actually doing.
Key Takeaways
- SPRAVATO® (esketamine) is FDA-approved for treatment-resistant depression in adults who have not responded to at least two adequate antidepressant trials — it was developed specifically for patients who have already tried other options.
- SPRAVATO® targets the glutamatergic system through NMDA receptor modulation — a fundamentally different mechanism from conventional antidepressants — which is why it may work when serotonin-targeting medications have not.
- Treatment requires in-office supervised sessions, twice weekly during induction, and Vigeo Wellness in Weatherford makes this accessible to Parker County residents without requiring a trip to Fort Worth.
- Results vary by individual; we will be honest about expected timelines and what the evidence shows about who responds best.
- For treatment-resistant depression, SPRAVATO® may be used alone or with an oral antidepressant depending on your provider’s recommendation, and insurance coverage is available for many qualifying patients.
If you have been through medication after medication without the relief you were hoping for, please do not interpret that as the end of the road. SPRAVATO® was built for this exact situation. Call our Weatherford office at 817-672-9407 or contact Vigeo Wellness to schedule a consultation. We will review your history, answer your questions without pressure, and help you determine honestly whether SPRAVATO® is the right next step. You have been trying. You deserve a team that keeps trying with 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
Popova, V., Daly, E. J., Trivedi, M., Cooper, K., Lane, R., Lim, P., Mazzucco, C., Hough, D., Thase, M. E., Shelton, R. C., Molero, P., Vieta, E., Bajbouj, M., Manji, H., Drevets, W. C., & Singh, J. B. (2019). Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression: A randomized double-blind active-controlled study. American Journal of Psychiatry, 176(6), 428–438. https://doi.org/10.1176/appi.ajp.2019.19020172
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://web.archive.org/web/20190306/https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified
U.S. National Library of Medicine. (n.d.). DailyMed: SPRAVATO—esketamine hydrochloride solution. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d81a6a79-a74a-44b7-822c-0dfa3036eaed
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.