Who Actually Qualifies for Spravato?

Spravato isn’t a first-line treatment for depression, and it’s not meant for everyone. It’s designed for people who’ve already tried standard options and are still struggling. That’s part of what makes it effective — and also why eligibility matters.

If you’re wondering whether you qualify for Spravato, here’s what that typically means in real-world clinical terms.

Spravato (esketamine) is FDA-approved for adults with treatment-resistant depression (TRD). In practical terms, this usually means:

• You’ve been diagnosed with major depressive disorder
• You’ve tried at least two different antidepressant medications
• Those medications were taken at appropriate doses and durations
• Your symptoms didn’t improve enough — or didn’t improve at all

This isn’t about willpower or “trying harder.” Many people with treatment-resistant depression have done everything they were supposed to do and still feel stuck.

Spravato works differently from traditional antidepressants, which is why it can help when other medications haven’t.

Spravato is also approved for adults with major depressive disorder who are experiencing acute suicidal ideation or behavior, when used alongside an oral antidepressant.

In these cases, the focus is on rapid symptom relief under close medical supervision. Not every clinic offers Spravato for this indication, and careful screening is essential.

This is one of the most common points of confusion.

To qualify for Spravato, previous antidepressants generally need to have been:

• Prescribed by a medical provider
• Taken consistently
• Used for long enough to reasonably assess effectiveness

Stopping a medication early due to side effects doesn’t automatically disqualify you. In many cases, that still counts as a documented treatment attempt.

Part of the evaluation process is reviewing your medication history in detail and determining whether Spravato is medically appropriate.

Before starting Spravato, patients are screened for medical factors that could affect safety or eligibility. This may include:

• Blood pressure history
• Heart conditions
• Certain neurological issues
• Substance use considerations
• Current medications

Spravato must be administered in a certified clinical setting, with monitoring before, during, and after each session. This is part of the FDA’s REMS (Risk Evaluation and Mitigation Strategy) program, which is designed to prioritize patient safety.

Meeting the basic criteria doesn’t automatically mean Spravato is the right next step — and that’s intentional.

A proper evaluation looks at:

• Your symptoms and how they affect daily life
• What you’ve already tried
• How you’ve responded to past treatments
• Whether Spravato fits into a broader care plan

For many patients, Spravato is most effective when it’s part of ongoing psychiatric care, not a standalone intervention.

Just as important as who qualifies is understanding when Spravato may not be appropriate. This doesn’t mean someone has no options — it usually means a different approach may be safer or more effective.

Spravato may not be recommended if:

You haven’t tried standard antidepressants yet
Spravato is not a first-line treatment. Most patients need to have tried at least two antidepressants before it’s considered.

You have certain uncontrolled medical conditions
This can include poorly controlled high blood pressure, certain heart conditions, or other issues that could increase risk during treatment.

You have a history of conditions where dissociation could be unsafe
In some neurological or psychiatric situations, the dissociative effects of Spravato may not be appropriate.

Active substance misuse is a concern
Each case is evaluated individually, but active, unmanaged substance use can affect eligibility and safety.

You’re unable to remain in the clinic for monitoring
Spravato requires on-site observation after each dose. Patients who cannot commit to this may need to explore other options.

Not qualifying for Spravato doesn’t mean treatment has failed — it simply means the care plan needs to be tailored differently. For some patients, IV ketamine, medication adjustments, psychotherapy, or other interventions may be better suited.

Many people who ultimately qualify for Spravato aren’t sure at first. They may wonder whether they’ve “failed enough treatments” or whether their depression is “severe enough.”

Those questions are exactly why an individualized evaluation matters.

If you’re exploring Spravato as an option, the next step isn’t self-diagnosis — it’s a conversation with a qualified provider who can review your history and talk through whether Spravato makes sense for you.

You can learn more about Spravato treatment at Therapeutic Infusions and how we approach evaluation, safety, and ongoing care on our Spravato treatment page.