Choosing the right path to healing isn’t always straightforward—especially when it comes to managing treatment-resistant depression (TRD). For individuals who haven’t found success with traditional antidepressants, Spravato (esketamine nasal spray) has become a groundbreaking option. But how do psychiatrists determine whether you’re a candidate for Spravato?
If you’re considering Spravato in NYC, understanding the evaluation process can help you feel confident and prepared. In this article, we’ll unpack how psychiatrists assess suitability for Spravato treatment, the criteria they use, and the steps involved to ensure you get the safest and most effective care.
What Is Spravato?
Before diving into the decision-making process, let’s briefly revisit what Spravato is:
- Esketamine Nasal Spray: A fast-acting medication derived from ketamine, approved for adults with TRD and major depressive disorder (MDD) with suicidal ideation.
- FDA-Approved: Since 2019, offering new hope to those who haven’t responded to other treatments.
- Administered at Certified Centers: Like many facilities offering Spravato in NYC, treatment must occur under medical supervision.
Spravato works differently from traditional antidepressants by targeting the glutamate system to enhance brain plasticity and mood regulation.
The Psychiatrist’s Step-by-Step Evaluation Process for Spravato in NYC
1. Comprehensive Mental Health Assessment
Psychiatrists begin with a full psychiatric evaluation, which includes:
- Mental Health History: Diagnoses, treatments, hospitalizations.
- Medication History: Which antidepressants have been tried, for how long, and at what dosages.
- Current Symptoms: Depression severity, suicidal thoughts, functional impairments.
- Family History: Genetics can play a role in mental health treatment response.
Clinics providing Spravato in NYC often use standardized diagnostic tools like the DSM-5 criteria to guide this process.
2. Confirming Treatment-Resistant Depression
Spravato is reserved for treatment-resistant cases. Psychiatrists must confirm that:
- You have tried at least two different antidepressants at therapeutic doses.
- You adhered to treatments for at least 6-8 weeks each time without sufficient improvement.
Patients receiving Spravato in NYC are required to provide medical records or pharmacy histories to document previous treatment failures.
3. Medical and Physical Health Screening
Spravato is powerful—but not for everyone. Certain conditions can make it unsafe, so psychiatrists screen for:
- Cardiovascular issues (e.g., hypertension, aneurysms)
- Substance abuse (past or present)
- Psychotic disorders (e.g., schizophrenia, schizoaffective disorder)
- Pregnancy and breastfeeding status
Before beginning Spravato in NYC, a physical exam and lab work (blood pressure, liver function tests, etc.) are often required.
4. Substance Use Assessment
Because Spravato has dissociative properties and some abuse potential, psychiatrists carefully assess your substance use history:
- Alcohol misuse
- Illicit drug use
- Prescription medication misuse
For patients seeking Spravato in NYC, an open, honest discussion about substance use ensures safe and effective treatment planning.
5. Psychological Stability and Therapy Readiness
Psychiatrists also gauge:
- Coping skills
- Motivation for therapy
- Ability to participate in a structured treatment program
Many centers offering Spravato in NYC integrate talk therapy into treatment because Spravato works best when combined with psychological support.
Additional Considerations Before Approving Spravato
Insurance Requirements
Many insurers covering Spravato in NYC require:
- Documentation of antidepressant failures
- Prior authorization paperwork
- Ongoing progress reports
Psychiatrists and clinic staff often help patients navigate these processes to minimize delays.
Support System Assessment
Because you cannot drive after a Spravato session (due to possible sedation and dissociation), psychiatrists will ask about:
- A designated driver for each treatment day
- Emotional support at home
- Access to emergency help if needed
Clinics administering Spravato in NYC sometimes require a “treatment buddy” commitment for safety.
How Psychiatrists Determine “Right Fit” Status
Here’s how decisions typically break down:
✅ Good Candidate:
- Diagnosed with TRD or MDD with suicidal ideation
- Failed multiple antidepressants
- No disqualifying medical conditions
- Engaged in therapy or willing to start
- Reliable support system
❌ Not Yet Ready:
- Active substance use disorder
- Uncontrolled physical health issues
- Untreated psychosis
- Refusal or inability to comply with post-treatment monitoring
In short: eligibility for Spravato in NYC depends on readiness, safety, and clear medical need.
What Happens After Approval?
Once you’re approved, here’s what you can expect:
- Induction Phase: Twice-weekly Spravato treatments for 4 weeks
- Maintenance Phase: Weekly or biweekly sessions based on progress
- Observation Period: Mandatory 2-hour monitoring after each session
- Ongoing Psychiatric Check-Ins: Regular mood evaluations and side-effect monitoring
Clinics offering Spravato in NYC create custom schedules to fit your needs while following REMS (Risk Evaluation and Mitigation Strategy) program protocols.
Monitoring Treatment Success
Psychiatrists track:
- Symptom reduction via PHQ-9 or MADRS scores
- Side effects (e.g., dizziness, nausea, dissociation)
- Improvements in daily life functioning (e.g., work, relationships, hobbies)
If no improvements are seen within 8–12 weeks, psychiatrists may adjust treatment plans or explore alternative options.
Real-World Example: Emma’s Journey with Spravato
After two months of integrated Spravato sessions and weekly therapy:
- Her PHQ-9 scores dropped by 60%\n- She returned to work full-time\n- She reported better sleep, higher energy, and restored hope
Emma’s story mirrors that of many who find renewed life through carefully selected Spravato treatment.
Common Myths About Spravato Candidacy
Myth 1: “Spravato is for anyone who feels sad.”
Truth: Only those with treatment-resistant depression or acute suicidal ideation qualify.
Myth 2: “If I had side effects with ketamine, I can’t take Spravato.”
Truth: Esketamine (Spravato) is different from IV ketamine; many patients tolerate it better.
Myth 3: “I don’t need therapy if I use Spravato.”
Truth: Combining therapy with Spravato leads to stronger, longer-lasting outcomes.
Final Thoughts
The decision to start Spravato isn’t taken lightly. Psychiatrists use a thorough, patient-centered approach that evaluates your mental health history, physical health, support system, and readiness for deep healing.
If you’re exploring Spravato in NYC, trust that your psychiatric team is working to ensure this transformative treatment is safe, appropriate, and maximized for your success.
