Clinical Eligibility Guidance for Treatment-Resistant Depression
Eligibility guidance is provided by licensed psychiatric providers at Open Minds and aligned with FDA-approved Spravato® treatment protocols. Final eligibility is determined after an in-person clinical evaluation.
Clinically reviewed by licensed psychiatric providers at Open Minds.
Spravato® (esketamine) is an FDA-approved treatment designed for people with treatment-resistant depression, but it is not appropriate for everyone.
This page explains who may be a good candidate for Spravato therapy in clear, straightforward terms so you can have an informed conversation with your provider.
What Is Spravato® Therapy?
Spravato® is a prescription nasal spray used in combination with an oral antidepressant. Unlike many traditional antidepressants that primarily target serotonin, Spravato works on the brain’s glutamate system, which plays a key role in mood regulation, motivation, and neural connectivity.
Unlike standard antidepressants—which can take weeks or months to show results—Spravato may begin reducing depressive symptoms within hours or days for some patients.
According to the National Institute of Mental Health, treatment-resistant depression affects nearly one-third of people diagnosed with major depressive disorder, highlighting the need for advanced treatment options like Spravato.
For safety reasons, Spravato must be administered in a certified medical clinic under the supervision of trained and REMS-certified healthcare professionals, such as those at Open Minds.
Spravato® Eligibility Criteria Explained
You may be considered eligible for Spravato therapy if all of the following apply:
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You are 18 years or older
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You have been diagnosed with major depressive disorder (MDD)
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You have tried at least two different antidepressant medications without meaningful improvement
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You are currently experiencing moderate to severe depressive symptoms
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You are able to attend in-clinic treatment sessions and remain for required monitoring
The FDA has approved Spravato specifically for:
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Treatment-resistant depression (TRD)
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Depression with acute suicidal ideation or behavior, when clinically appropriate
How Providers Determine Spravato® Eligibility
Eligibility for Spravato is never based on a checklist alone.
At Open Minds, providers take a whole-person, individualized approach before making any treatment recommendations.
During your evaluation, your psychiatric provider may review:
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Your mental health history
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Previous medications and treatment responses
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Current symptoms and symptom severity
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Medical conditions and current medications
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Safety considerations, including blood pressure and cardiovascular health
This careful evaluation helps ensure Spravato is both safe and clinically appropriate for your specific needs.
Situations Where Spravato® May Not Be Recommended
Spravato can be effective for many people, but it is not the right option for everyone.
You may not be eligible if you:
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Have uncontrolled high blood pressure
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Have a history of certain vascular or neurological conditions
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Are pregnant or breastfeeding
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Have active substance misuse concerns
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Are unable to remain in the clinic for required post-treatment monitoring
Not qualifying for Spravato does not mean you are out of options. It simply means another treatment approach may better support your safety and recovery.
What the Spravato® Evaluation Process Looks Like
If you’re wondering whether you qualify, the process is supportive and straightforward.
You’ll meet with a licensed psychiatric provider for a comprehensive assessment. This is a collaborative conversation—not a test. The goal is to understand your history, what you’ve tried, what hasn’t worked, and what you hope to change.
If Spravato is appropriate, your provider will explain:
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How the treatment works
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Potential risks and benefits
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Required safety monitoring
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What to expect before, during, and after treatment sessions
You can learn more about how Spravato is delivered here: Spravato
What Treatment Typically Involves
If you qualify for Spravato therapy, treatment often includes:
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Twice-weekly sessions during the initial treatment phase
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Gradual spacing of treatments as symptoms improve
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Continued use of an oral antidepressant
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Ongoing provider check-ins to monitor progress and safety
Each session requires remaining in the clinic for at least two hours of observation to ensure safety and manage possible side effects.
What If I’m Not Eligible for Spravato®?
Not being eligible for Spravato does not mean there are no effective treatment options available.
Many patients benefit from:
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Medication management adjustments
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Therapy or trauma-informed care
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Other advanced treatments such as NeuroStar® TMS
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Integrated, personalized care approaches
At Open Minds, treatment plans are individualized. If Spravato isn’t the right fit, your provider will guide you toward other evidence-based options.
Clinical Oversight & Safety
This content is provided for educational purposes and reflects FDA-approved guidance for Spravato® (esketamine) therapy.
Spravato treatment is regulated under the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program, which ensures treatment is delivered safely in certified medical settings with appropriate monitoring.
All evaluations and treatments are conducted in person by licensed psychiatric providers and follow established psychiatric safety guidelines.
Taking the Next Step
If you’re wondering whether you’re eligible for Spravato therapy, the most important step is a professional evaluation.
Eligibility depends on your medical history, current symptoms, and overall health—not just meeting a list of criteria.
To learn more about Open Minds and our approach to care, visit our About page.
If you’re ready to speak with a provider, you can request an appointment here: Book Your Mental Health Consultation
