Major depressive disorder affects millions of adults and can interfere with work, relationships, physical health, and quality of life. For some people, symptoms continue despite multiple medication trials and psychotherapy. This is often described as treatment-resistant depression, or TRD (World Health Organization [WHO], 2025).
At our Cherry Hill office, we offer SPRAVATO® therapy for adults with treatment-resistant depression. For patients throughout Camden County and South Jersey who are exploring care beyond conventional antidepressants, understanding how SPRAVATO® works and what treatment involves can help support informed decision-making.
What SPRAVATO® Is and How It Differs From Standard Antidepressants
A Different Mechanism of Action
SPRAVATO® is an intranasal form of esketamine, the S-enantiomer of ketamine. It is self-administered as a nasal spray under direct medical supervision.
Many traditional antidepressants act primarily on serotonin, norepinephrine, or dopamine systems. SPRAVATO® acts as a noncompetitive NMDA receptor antagonist within the brain’s glutamate system. The full mechanism by which it improves depressive symptoms is not fully understood, but this difference has made esketamine an important area of research in depression treatment (U.S. Food and Drug Administration [FDA], 2025).
For patients exploring depression treatment, this mechanism represents a different option from standard oral medication approaches.
SPRAVATO® Is FDA-Approved
SPRAVATO® is FDA-approved for treatment-resistant depression in adults, either as monotherapy or in combination with an oral antidepressant. It is also approved, when used with an oral antidepressant, for depressive symptoms in adults with major depressive disorder and acute suicidal ideation or behavior. The FDA labeling notes that SPRAVATO® has not been shown to prevent suicide or reduce suicidal thoughts or behavior (FDA, 2025).
This is an important distinction from IV ketamine for psychiatric conditions, which is used off-label. At our practice, we discuss the differences between available treatments, along with each patient’s history, goals, and safety considerations.
The Rapid Antidepressant Effect: What Research Has Shown
Speed as a Clinically Meaningful Feature
Clinical trials have found that some adults with treatment-resistant depression experienced symptom improvement within 24 hours of treatment, with further outcomes assessed over a four-week induction period. However, not every patient responds in the same way or on the same timeline (Popova et al., 2019).
SPRAVATO® should not be viewed as a guaranteed or immediate solution. We help patients set realistic expectations around response, side effects, monitoring, and the broader care plan.
Patients who want to learn more about other advanced depression options may find our article on how ketamine clinics are revolutionizing depression treatment helpful.
Relapse Prevention and Maintenance
SPRAVATO® is not designed only for short-term use. In a randomized withdrawal study, adults with treatment-resistant depression who continued esketamine with an oral antidepressant after achieving stable response or remission had a lower risk of relapse than those switched to placebo nasal spray plus an oral antidepressant (Daly et al., 2019).
The FDA dosing schedule for treatment-resistant depression generally includes twice-weekly treatment during the first four weeks, then weekly treatment during weeks five through eight. After that, treatment may continue weekly or every two weeks, depending on response and tolerability (FDA, 2025).
At our Cherry Hill office, we individualize treatment planning based on each patient’s response, medical history, current medications, and long-term goals.
The SPRAVATO® Treatment Process at Our Cherry Hill Office
Administration Under Clinical Supervision
SPRAVATO® is available only through a Risk Evaluation and Mitigation Strategy, or REMS, program. Patients self-administer the nasal spray while under direct supervision in a certified healthcare setting.
After each treatment session, patients must be monitored for at least two hours because SPRAVATO® can cause sedation, dissociation, respiratory depression, increased blood pressure, and other effects that require observation (FDA, 2025).
Patients should arrange transportation home and should not drive or operate machinery until the next day after a restful sleep. We review these logistical requirements before treatment begins so patients understand what to expect from each visit.
Evaluation and Candidacy
Before recommending SPRAVATO®, we complete a comprehensive psychiatric and medical evaluation. This includes reviewing depression symptoms, prior treatment experiences, current medications, blood pressure, medical history, and factors that may affect safety or appropriateness.
Certain medical or psychiatric considerations may require additional assessment. These can include elevated blood pressure, cardiovascular concerns, psychosis-related symptoms, substance use history, pregnancy considerations, and medication interactions. This is not a complete list, and candidacy is always determined individually.
We encourage patients to start with a full conversation about their history and goals. Our guide on how to get ketamine treatment may also help patients prepare for an initial consultation about advanced psychiatric care.
SPRAVATO® and Our Broader Care Model
Integration With Depression Treatment
We do not view SPRAVATO® as a standalone answer for every person with treatment-resistant depression. Depending on the patient, care may also include psychotherapy, medication management, coordination with existing providers, lifestyle support, or other clinically appropriate options.
Our Comprehensive Depression Treatment Program reflects our broader commitment to individualized care. We consider the full picture rather than applying the same treatment path to every patient.
Serving Cherry Hill and South Jersey
For patients throughout Camden County and South Jersey, access to SPRAVATO® offers another option when standard depression treatment has not provided adequate relief.
At our practice, we believe patients deserve thoughtful evaluation, clear information about the evidence and limitations of treatment, and a care plan built around their individual needs. Treatment-resistant depression can be serious and persistent, but prior treatment setbacks do not mean that all options have been exhausted.
Parting Thoughts
For South Jersey residents living with treatment-resistant depression, SPRAVATO® may be worth discussing as part of a comprehensive psychiatric care plan. We provide a thorough evaluation, explain what treatment requires, and help patients determine whether SPRAVATO® is appropriate for their circumstances.
To learn more, schedule a consultation with our Cherry Hill team or call us at (856) 543-6003.
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Ketamine therapy, TMS, SPRAVATO®, and other treatments described should only be pursued under the supervision of a licensed provider familiar with your full medical and psychiatric history. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.
References
Daly, E. J., Trivedi, M. H., Janik, A., et al. (2019). Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: A randomized clinical trial. JAMA Psychiatry, 76(9), 893-903. DOI: 10.1001/jamapsychiatry.2019.1189. https://pubmed.ncbi.nlm.nih.gov/31166571/
Popova, V., Daly, E. J., Trivedi, M., et al. (2019). Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression: A randomized double-blind active-controlled study. American Journal of Psychiatry, 176(6), 428-438. DOI: 10.1176/appi.ajp.2019.19020172. https://pubmed.ncbi.nlm.nih.gov/31109201/
U.S. Food and Drug Administration. (2025). SPRAVATO® (esketamine) nasal spray, CIII: Prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/211243s019lbl.pdf
World Health Organization. (2025, August 29). Depressive disorder (depression). https://www.who.int/news-room/fact-sheets/detail/depression