When two antidepressants have not been enough.

No. While Spravato (esketamine) is derived from ketamine, it is a specific FDA-approved medication, carefully regulated and administered under medical supervision through the Spravato REMS program — in a controlled healthcare setting with monitoring before, during, and after each session.

Some people describe feeling loopy, floaty, or disconnected during treatment — a normal, expected effect. Others feel deeply relaxed, sleepy, or notice mild changes in how they perceive time or their surroundings. These effects are temporary, which is why you stay with us for at least two hours afterward. Most patients gradually return to their usual state before leaving.

Most antidepressants increase the availability of serotonin, norepinephrine, or dopamine, and often take four to eight weeks to reach full effect. Spravato targets the brain’s glutamate system by acting on NMDA receptors, which can help restore communication between brain cells and promote new neural connections. Because of this, some patients notice improvement sooner — though everyone’s response differs. It is used along with an oral antidepressant, not as a replacement.

No. You must arrange transportation after every treatment session. Driving, operating machinery, and making important decisions are not allowed until the following day, after a restful night’s sleep.

Many commercial plans and Medicare cover Spravato for eligible patients, and prior authorization is often required. Our team works with your insurance company to determine coverage and discuss out-of-pocket costs before treatment begins. Many patients may also qualify for copay savings or patient support programs through Johnson & Johnson, and we will help you enroll.

It is different for everyone and depends on how you respond and your long-term goals. After the induction phase, treatments are typically spaced to every one to two weeks. Some patients eventually extend the interval or discontinue; others benefit from ongoing maintenance to prevent relapse. The goal is always the lowest effective frequency that maintains lasting improvement.

Not everyone responds, and that is okay. If we are not seeing the improvement we expect, we reassess your symptoms, response, and overall plan. You are not out of options — your provider will discuss medication adjustments, psychotherapy, lifestyle interventions, lab evaluation, genetic testing when appropriate, or other advanced treatments. Our goal is not to offer one treatment; it is to find the plan that works for you.

Both are evidence-based options for depression that has not responded to medication, but they work differently. Spravato is a nasal spray given in a certified office, targets the glutamate system, and requires two hours of monitoring and a ride home. TMS uses magnetic pulses, needs no sedation or recovery, and is typically five days a week for six to eight weeks. We offer Spravato but not TMS — if TMS is the better fit, we are glad to refer you to a trusted partner in Northwest Arkansas.