Depression can be complex and challenging to treat, especially for people living with major depressive disorder (MDD) or treatment-resistant depression (TRD). Traditional oral antidepressants are not always effective for everyone, which has led to new and innovative approaches in mental health care.
One option that continues to show positive results is the combination of Spravato® and medication management, a dual treatment method that supports faster relief and long-term progress for clients with persistent symptoms. At LightHeart Mental Health, our experienced providers offer FDA-approved Spravato® treatment alongside structured medication management for adults with treatment-resistant depression. This approach allows our psychiatric team to monitor progress, maintain safety, and support improved outcomes for individuals who have not responded to standard antidepressant therapy.
Together, Spravato® and medication management offer a comprehensive approach that addresses both immediate symptom relief and long-term stability, representing continued progress in modern mental health care.
Introduction to Spravato® and medication management
Spravato® (esketamine) is an FDA-approved antidepressant nasal spray used for adults with treatment-resistant depression who have not responded to at least two previous antidepressant medications.
Spravato® works differently from traditional oral antidepressants, targeting the brain’s glutamate system to help reduce depressive symptoms within hours or days. Treatments take place in a clinical setting under the supervision of trained providers to support client comfort and safety.
Medication management is a structured process that involves evaluating, prescribing, and monitoring medications so they are effective and well-tolerated. It requires collaboration between clients and psychiatric providers to make dosage adjustments, track side effects, and coordinate care.
When used together, Spravato® and medication management complement each other, creating a balanced approach that promotes rapid symptom relief and ongoing mood stability.
Understanding treatment-resistant depression and major depressive disorder
Major depressive disorder (MDD) is a common mood condition affecting millions of adults each year. Symptoms may include:
- Persistent sadness
- Loss of interest
- Changes in sleep or appetite
- Low energy
- Difficulty concentrating
For many, oral antidepressants can help alleviate these symptoms. However, for some, the effects are limited or temporary.
Treatment-resistant depression (TRD) refers to depression that does not improve after trying at least two antidepressant medications. Individuals with TRD often experience ongoing depressive symptoms that interfere with work, relationships, and daily life.
This challenge highlights the need for alternative treatment options. For those who have not found relief through traditional methods, Spravato® combined with medication management provides an evidence-based path forward that supports both short-term relief and long-term emotional stability.
How Spravato® works: Mechanism and benefits
Spravato® contains esketamine, a form of ketamine that targets the brain’s NMDA receptors, part of the glutamate system involved in mood regulation and communication between brain cells. By stimulating these receptors, Spravato® helps the brain build new connections that support emotional balance and cognitive function.
Key benefits of Spravato® can include:
- Rapid relief from depressive symptoms in people with difficult-to-treat depression
- Improved emotional balance and motivation
- Support for better daily functioning and engagement
Spravato® is administered as a nasal spray in a certified clinical setting under professional supervision. Clients remain under observation for about two hours after each session to monitor for temporary side effects such as dizziness, increased blood pressure, or fatigue.
Although uncommon, serious reactions like respiratory depression can occur, which is why Spravato® treatments must be delivered by qualified professionals who follow strict monitoring protocols. This structured care provides a safe and supportive environment throughout each session.
What is medication management in mental health care?
Medication management plays an essential role in comprehensive mental health treatment. It allows each client’s medications to be prescribed and monitored in a way that maximizes benefits and minimizes risks.
This process includes:
- Reviewing the client’s medical history and current medications
- Monitoring response and side effects
- Adjusting dosages to optimize results
- Coordinating with therapists and other care providers to maintain continuity of care
When paired with Spravato® treatment, medication management provides the structure needed to evaluate how different medications interact and to make timely adjustments. This collaborative approach enables providers at LightHeart Mental Health to design treatment plans that fit each client’s unique needs, preferences, and progress.
Benefits of combining Spravato® with medication management
Combining Spravato® and medication management creates a comprehensive framework for addressing treatment-resistant depression. These interventions can improve both the speed and durability of treatment outcomes while supporting long-term stability.
This integrated approach can:
- Support faster relief from depressive symptoms through the rapid-acting effects of Spravato®
- Encourage long-term progress through careful medication monitoring and follow-up
- Improve adherence to treatment plans
- Strengthen collaboration between clients and mental health professionals
At LightHeart Mental Health, this approach reflects our commitment to providing integrated, person-centered care. By connecting therapy, psychiatry, and innovative interventions like Spravato®, we offer a cohesive treatment experience for people managing complex forms of depression.
Treatment protocols and session guidelines
Each Spravato® treatment session follows a structured process focused on safety and comfort.
A typical treatment session includes:
- A pre-treatment assessment, including blood pressure and health screening
- Guided self-administration of the Spravato® nasal spray under supervision
- Observation for about two hours while providers monitor for potential side effects
- A post-treatment evaluation and scheduling of follow-up sessions
Medication management remains an essential part of care throughout this process. Providers review how Spravato® interacts with other medications and make necessary adjustments to maintain balance and effectiveness. This model of care is available in outpatient settings with ongoing provider supervision.
Safety measures and risk evaluation
Because Spravato® affects brain chemistry, safety and ongoing assessment are essential parts of treatment. Before beginning therapy, clients complete a screening to identify any contraindications, such as severe liver impairment or a history of substance use.
During each session, healthcare providers monitor vital signs, including blood pressure and oxygen levels, to detect early signs of possible complications. Adverse effects such as respiratory depression or dissociation are rare but manageable when identified quickly.
LightHeart Mental Health follows careful risk evaluation and mitigation strategies that include:
- Maintaining a calm, supportive treatment environment
- Keeping clients in the clinic until potential side effects subside
- Providing education about post-session care and safety precautions
Our providers are trained in psychiatric and medical monitoring, prioritizing safety and well-being for every client.
Case studies and clinical evidence on this treatment approach
Multiple clinical studies support the use of Spravato® in clients with treatment-resistant depression. Research published in JAMA Psychiatry shows that a dual strategy may help lower the risk of relapse and improve daily functioning in clients with treatment-resistant depression. In one clinical trial, continuing Spravato® alongside an oral antidepressant reduced the risk of relapse by 51% compared to using an antidepressant with a placebo.1
In another study published in the International Journal of Neuropsychopharmacology, researchers reported that many participants who achieved remission during earlier trials remained in remission throughout the maintenance phase,2 suggesting that continued treatment with Spravato® can help sustain recovery and prevent relapse in adults with TRD.
Clinical experience at LightHeart Mental Health reflects these results. Many clients report significant progress, enhanced emotional stability, and increased engagement in daily life. These outcomes demonstrate the potential benefits of integrating Spravato® into a comprehensive medication management plan for long-term success.
FAQs on combining Spravato® and medication management
What medications cannot be taken with Spravato®?
Certain sedatives, opioids, and alcohol should not be used while receiving Spravato®. Providers will review potential interactions before starting treatment.
Does Spravato® have to be used with an antidepressant?
Yes. Spravato® must be used with an oral antidepressant as part of a comprehensive treatment plan for adults with treatment-resistant depression.
What should Spravato® be taken in conjunction with?
Spravato® is typically combined with oral antidepressants and structured medication management under professional supervision.
What is the Spravato® controversy?
Most discussions surrounding Spravato® focus on accessibility and cost rather than its safety or effectiveness. When administered by trained professionals, Spravato® is considered a safe and evidence-based option for depression treatment.
LightHeart Mental Health is dedicated to supporting your mental health. If you are feeling suicidal or experiencing a mental health crisis, please reach out for immediate support by contacting your local emergency services, visiting your local emergency room, or calling/texting the National Crisis Hotline at 988.
Sources:
- JAMA Psychiatry. “Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients with Treatment-Resistant Depression.” Accessed November 19, 2025.
- International Journal of Neuropsychopharmacology. “Safety and Efficacy with Esketamine in Treatment-Resistant Depression: Long-Term Extension Study.” Accessed November 19, 2025.
Embracing a dual treatment approach for better outcomes
Combining Spravato® with ongoing medication management provides a personalized, evidence-based strategy for clients with major depressive disorder and treatment-resistant depression. This dual approach supports faster symptom relief, improved adherence, and greater long-term stability.
Our providers at LightHeart Mental Health prioritize safety, collaboration, and individualized care. Through consistent monitoring and compassionate guidance, we help clients make meaningful progress in their mental health journey. LightHeart Mental Health is here to support your well-being. Call us at 425.800.5688 to schedule an appointment today.
For new clients, please click here to schedule an appointment. For existing clients, please click here and find your office location to contact your office directly.
LightHeart Mental Health is dedicated to supporting your mental health. If you are feeling suicidal or experiencing a mental health crisis, please reach out for immediate support by contacting your local emergency services, visiting your local emergency room, or calling/texting the National Crisis Hotline at 988.
Sources:
- JAMA Psychiatry. “Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients with Treatment-Resistant Depression.” Accessed November 19, 2025.
- International Journal of Neuropsychopharmacology. “Safety and Efficacy with Esketamine in Treatment-Resistant Depression: Long-Term Extension Study.” Accessed November 19, 2025.