Esketamine (Spravato) Treatment

A Medically Supervised Option for Treatment-Resistant Depression

Mental health symptoms can sometimes reach a point where you need more support than therapy alone can provide. Psychiatric medication can be one helpful tool, especially when symptoms start affecting your daily life, relationships, work or overall sense of wellbeing.

At Davis Behavioral Health, psychiatric medication is never a one-size-fits-all decision. Our approach is careful, collaborative and built around your unique needs. We take time to understand what you’re experiencing, answer your questions and work with you to figure out whether medication might help—at your pace and with your comfort in mind.

What You Can Expect

Your journey starts with an evaluation by our licensed psychiatric professionals.
They’ll carefully review your treatment history, current symptoms and overall health to determine whether esketamine is a good fit.
If you move forward with treatment, you’ll come to our clinic for supervised sessions where we’ll monitor you during and after each dose.
For those already working with other DBH services, we coordinate across your care team to make sure everyone is on the same page.

What Is Esketamine (Spravato)?

Esketamine is a nasal spray medication used in combination with an oral antidepressant for adults with depression that hasn’t responded meaningfully to other treatments. Unlike traditional antidepressants, which often work on serotonin or norepinephrine pathways, esketamine acts on different brain pathways involved in mood regulation.

Because of how it works and is administered, esketamine treatment must take place in a healthcare setting under direct medical supervision.

Who May Be a Candidate?

Esketamine treatment may be considered if you:

Are diagnosed with major depressive disorder
Have tried multiple antidepressant medications without sufficient improvement
Continue to experience significant symptoms that interfere with daily life

Esketamine isn’t the right option for everyone. A thorough evaluation is necessary to determine whether this treatment is appropriate based on your medical history, current symptoms and overall treatment goals.

Our Approach to Esketamine Treatment

At Davis Behavioral Health, we prioritize thorough assessments, safety and collaboration when offering esketamine treatment.

Our approach includes:

A comprehensive psychiatric evaluation before starting treatment
Clear education about what to expect before, during and after sessions
Monitoring for side effects and treatment response
Ongoing communication and follow-up

Coordination with therapy and medication management services when appropriate

Esketamine isn’t intended to replace therapy or other supports, but rather to work alongside them as part of an individualized treatment plan.

Learn More

Esketamine treatment is one of several psychiatric care options available at DBH. Understanding how these services differ can help you make informed decisions about your care.

Medication Management focus on on evaluating and managing traditional psychiatric medications over time. This service is appropriate for people who may benefit from antidepressants, mood stabilizers or other standard psychiatric medications.

Mental Health Outpatient Services provide therapy, counseling and skills-based support. These services work well alongside esketamine treatment to address underlying patterns and build coping strategies.

TMS Therapy offers a non-medication treatment option for depression when medications haven’t been effective. TMS uses magnetic pulses to stimulate specific brain areas and may be considered as an alternative or complement to medication-based approaches.

Our clinical team helps you understand how these options differ and which approach—or combination—may be most appropriate for your needs.

Safety and Supervision

Esketamine treatment is administered in a controlled clinical environment. You’ll be monitored during each visit and remain on-site for a period of observation following treatment to ensure your safety.

Because of these requirements, esketamine is only provided through certified treatment programs and under strict medical protocols. This level of supervision helps manage potential side effects and ensures the treatment is administered safely.

Taking the First Step

Considering esketamine treatment doesn’t mean committing to it. The first step is simply an evaluation and conversation with our psychiatric care team to explore whether this option makes sense for your situation.

If you’re experiencing ongoing depression and would like to learn whether esketamine treatment may be an option, Davis Behavioral Health is here to help guide you through the decision-making process.

To schedule an evaluation or learn more about your options.

Contact us

What is esketamine and how does it work?

Esketamine is a nasal spray medication used to treat treatment-resistant depression in adults. It works differently than traditional antidepressants by targeting NMDA receptors in the brain, which are involved in mood regulation and neural connections.

Traditional antidepressants typically affect serotonin or norepinephrine pathways, while esketamine acts on glutamate pathways. This different mechanism may help people who haven’t responded to other medications.

Esketamine is always used in combination with an oral antidepressant and must be administered in a clinical setting under medical supervision.

What is the success rate of esketamine?

Clinical studies show that esketamine can be effective for many people with treatment-resistant depression, though individual results vary. Research indicates that a significant percentage of people experience improvement in depressive symptoms within the first few weeks of treatment.

However, success depends on many factors, including the severity of depression, previous treatments tried and individual response to the medication. Not everyone responds to esketamine, which is why thorough evaluation and ongoing monitoring are important.

Your provider can discuss realistic expectations based on your specific situation and treatment history.

How do you feel after esketamine?

Immediately after esketamine administration, you may experience temporary side effects such as dissociation (feeling disconnected from your thoughts or surroundings), dizziness, nausea, increased blood pressure or sedation.

These effects typically occur within the first two hours and usually resolve before you leave the clinic. This is why you’ll be monitored for at least two hours after each dose.

Some people also report feeling tired or foggy for the rest of the day. Over time, as treatment continues, many people notice gradual improvements in mood and depression symptoms.

symptoms. What are the disadvantages of esketamine?

Esketamine requires a significant time commitment, as each treatment session involves traveling to the clinic, receiving the medication and staying for a two-hour observation period. You cannot drive yourself home after treatment. Potential side effects include:

Nausea
Sedation
Dissociation
Increased blood pressure

There’s also a risk of misuse or dependence, which is why the medication is only available through certified programs with strict protocols.

Esketamine may not be appropriate if you have certain medical conditions, and it doesn’t work for everyone. Insurance coverage varies, and cost can be a consideration for some people.

How fast does esketamine work?

Some people notice improvements in depression symptoms within hours to days after their first dose, though this varies widely. The typical treatment schedule involves twice-weekly sessions for the first month, followed by weekly sessions and then less frequent maintenance dosing.

Many people see the most significant improvement after several weeks of consistent treatment. However, esketamine doesn’t work immediately for everyone, and some people may not respond at all.

Your provider will monitor your progress closely during the initial weeks to determine whether the treatment is helping and whether adjustments to the schedule are needed.

What are the alternatives to esketamine?

Several alternatives exist for treatment-resistant depression:

TMS (Transcranial Magnetic Stimulation) therapy uses magnetic pulses to stimulate specific brain areas and doesn’t involve medication.
Electroconvulsive therapy (ECT) may be considered for severe cases.
Switching to a different class of antidepressant medications or combining multiple medications may also help.
Intensive outpatient therapy programs provide structured support and skills training.
Lifestyle modifications, including exercise, sleep improvement and dietary changes, can support other treatments.

Some people benefit from trying different therapy approaches, such as cognitive behavioral therapy or dialectical behavior therapy. Your provider can help you explore which alternatives make sense for your situation.