One of the quiet concerns many patients have before starting Spravato is this:

What happens if it doesn’t work for me?

That question is understandable. Most people considering Spravato have already tried multiple antidepressants without meaningful relief. The idea of another treatment not working can feel discouraging.

The reality is this: if Spravato doesn’t provide the results you hoped for, it doesn’t mean you’re out of options.

Before deciding a treatment hasn’t worked, providers look at:

• Symptom changes over time
• Functional improvement (sleep, motivation, daily activity)
• Side effect tolerance
• Dose adjustments and schedule adherence

Some patients respond quickly. Others improve more gradually. In some cases, modifying the schedule or optimizing accompanying medications makes a difference.

It’s rarely a single-session decision.

If early sessions don’t produce clear improvement, providers may:

• Review medication timing
• Reassess antidepressant support
• Evaluate dose adjustments within approved parameters
• Consider whether external stressors are affecting outcomes

Treatment-resistant depression often requires layered, coordinated care rather than a single intervention.

In some cases, even after appropriate duration and adjustments, symptoms may not meaningfully improve.

When that happens, the next step isn’t resignation — it’s reassessment.

Providers may consider:

• IV ketamine therapy, which allows for greater dosing flexibility
• Medication strategy changes or augmentation
• Re-evaluation of diagnosis
• Integration with structured psychotherapy
• Referral for additional specialty evaluation if needed

The goal is to refine the approach, not abandon treatment.

For some patients, IV ketamine may be explored if:

• Spravato did not produce adequate improvement
• Insurance restrictions limit dose flexibility
• A more individualized infusion protocol is clinically appropriate

Because IV administration allows weight-based dosing and session-by-session adjustment, it can offer a different therapeutic pathway.

This isn’t a “backup plan.” It’s simply another option in the broader ketamine-based treatment spectrum.

If neither Spravato nor IV ketamine provides sufficient benefit, providers may explore:

• Advanced medication combinations
• Neuromodulation therapies
• More intensive psychotherapy integration
• Coordinated psychiatric re-evaluation

Depression treatment is not linear. What doesn’t work today doesn’t predict what may work next.

It’s important to avoid two extremes:

• Assuming Spravato will fix everything immediately
• Assuming that lack of immediate change means failure

Clear communication, structured follow-up, and honest reassessment are part of responsible care.

Progress sometimes appears as:

• Reduced suicidal thinking
• Improved resilience to stress
• Better sleep
• Increased emotional range

These changes may precede larger shifts in mood.

The term treatment-resistant depression describes how symptoms respond to interventions — not who you are.

If Spravato doesn’t produce the results you hoped for, that outcome reflects biological complexity, not personal failure.

The focus remains on finding what works.

Spravato is one tool in a larger treatment framework. For many patients, it provides meaningful improvement. For others, it helps clarify the next step.

Either way, the path forward is guided by:

• Careful evaluation
• Medical oversight
• Ongoing reassessment
• A willingness to adapt

If you’re considering Spravato but are worried about what happens if it doesn’t work, a structured evaluation can help clarify both expectations and contingency planning.

You can learn more about Spravato treatment and available alternatives at Therapeutic Infusions on our Spravato treatment page.