If you or someone you love has tried multiple antidepressants without meaningful relief, you may have heard the term treatment-resistant depression. It’s a clinical way of describing depression that hasn’t responded to at least two adequate medication trials. For some adults in this situation, a medication called Spravato (esketamine) may be part of the conversation. At Pearl Health, Spravato is one of our signature offerings, and we want to walk you through how it works and what an in-office session actually looks like.

How Spravato Works for Treatment-Resistant Depression

Spravato is a nasal spray that contains esketamine, a molecule derived from ketamine. Unlike traditional antidepressants that primarily act on serotonin, norepinephrine, or dopamine, esketamine works on the brain’s glutamate system, particularly the NMDA receptor. Researchers believe this different mechanism may help support the brain’s ability to form new connections in areas involved in mood regulation.

Spravato is FDA-approved for adults with treatment-resistant depression, and it is used together with an oral antidepressant, not as a replacement. It is prescribed and administered only in certified healthcare settings under a special safety program because of how it can affect the body during and shortly after each dose.

Who Might Be a Candidate

Deciding whether Spravato is appropriate is always a clinical conversation, not a checklist. Our psychiatric team looks at your full history, current medications, medical background, and goals for care. Generally, people we talk with about Spravato share a few things in common:

• Adults 18 or older with a diagnosis of major depressive disorder
• Have tried at least two antidepressant medications without adequate relief
• Are able to attend in-office sessions and arrange a ride home afterward
• Are willing to continue working with a prescriber and, when helpful, a therapist
• Do not have certain cardiovascular or other medical conditions that would make treatment unsafe

If Spravato isn’t the right fit, there are still many paths forward. Our team includes psychiatrists, PMHNPs, LCSWs, LMSWs, LPCs, and PhD-level clinicians, so we can build a plan around what actually makes sense for you.

What an In-Office Spravato Session Looks Like at Pearl

Spravato sessions happen in our office because patients need to be monitored for at least two hours after each dose. Here’s a general picture of what to expect at our Ammon, Idaho Falls, Pocatello, or Rexburg locations:

Before you arrive: You’ll be asked not to eat for a couple of hours beforehand and not to drink fluids shortly before your appointment. You’ll also need someone to drive you home, since you cannot drive the rest of the day after treatment.

Check-in and vitals: A member of our team will check your blood pressure and review how you’re feeling. If everything looks good, you’ll be shown to a comfortable, quiet treatment space.

Self-administration: Under staff supervision, you’ll use the nasal spray device yourself, following the exact dose your prescriber ordered. There are usually two or three sprays spaced a few minutes apart.

Monitoring: You’ll rest in the treatment area for at least two hours. Blood pressure is rechecked, and staff are nearby the entire time. Some people feel a floating or dreamlike sensation during this window; others feel drowsy or notice mild dizziness. These effects typically ease before you leave.

Going home: Once your prescriber clears you, your ride takes you home. You’ll be asked not to drive, work, or make important decisions until you’ve had a full night of sleep.

The Rhythm of Treatment

Spravato is not a one-time appointment. In the beginning, sessions are usually scheduled twice a week, then gradually spaced out based on how you’re doing and what your prescriber recommends. Throughout treatment, you’ll stay in close contact with your Pearl provider so the plan can be adjusted thoughtfully over time.

If you’ve been carrying depression that hasn’t lifted despite your best efforts, you don’t have to sort this out alone. Reach out to Pearl Health in Ammon, Idaho Falls, Pocatello, or Rexburg to schedule a consultation, and we’ll help you understand whether Spravato or another approach fits where you are right now.