Who Is (and Isn’t) a Good Candidate for Spravato Treatment?
Ketamine therapy, particularly in the form of Spravato (esketamine nasal spray), is emerging as a breakthrough psychiatric treatment for people suffering from treatment-resistant depression, major depressive disorder with suicidal thoughts, anxiety, PTSD and CPTSD. But ketamine isn’t right for everyone. Understanding who may (or may not) benefit from this therapy is essential to ensuring safe, effective, and personalized psychiatric care.
Who Is a Good Candidate for Ketamine Therapy?
Spravato is particularly helpful for adults with one or more of the following characteristics:
Have treatment-resistant depression (TRD), typically defined as inadequate response to at least two antidepressant trials.
Are experiencing major depressive disorder (MDD) with suicidal thoughts—Spravato is FDA-approved for this group and may provide rapid symptom relief.
Live with severe anxiety that has not improved with first-line medications.
Suffering from PTSD or complex PTSD (CPTSD).
Are medically stable, without contraindications to dissociative anesthetics like ketamine.
Are currently engaged in psychotherapy or follow-up psychiatric care, which may enhance and sustain the benefits of ketamine. (Other modalities such as TMS may be used in conjunction with ketamine for comprehensive symptom management.)
Spravato works differently from traditional antidepressants, and its mechanism of action (through NMDA receptor modulation and promotion of neuroplasticity) can help interrupt deep patterns of depressive thought. Learn more about how Spravato works.
Who Is NOT a Good Candidate for Ketamine Therapy?
While Spravato offers a new path forward for many, certain conditions may rule out or delay treatment:
Current or past psychotic disorders, including schizophrenia, due to risk of worsening symptoms.
Uncontrolled high blood pressure or significant heart disease, which can be affected by ketamine’s cardiovascular effects.
Recent or active substance misuse involving ketamine or PCP, which raises concerns about safety and dependency.
Pregnancy or breastfeeding, as there’s insufficient research on ketamine’s safety in these populations.
Inability to comply with in-office treatment protocols, such as lacking a ride home or post-treatment supervision.
Unstable medical conditions or cognitive impairments that prevent safe participation in monitored care.
For those who may not qualify for Spravato, alternative treatments such as TMS for severe depression may offer a non-invasive, well-tolerated path to recovery.
Finding the Right Fit Through Evaluation
A structured psychiatric evaluation is the best way to assess candidacy for Spravato treatment. At PathWave Psychiatry, we take a collaborative, safety-focused approach—often working in partnership with patients' therapists and medical providers.
If you're wondering about insurance coverage, our guide to ketamine therapy and insurance explains how many plans—including Medicare and commercial carriers—may help cover the cost.
Spravato Treatment in the East Bay
PathWave Psychiatry is located in the Elmwood neighborhood of Berkeley, California (near the border of Rockridge in Oakland) and offers Spravato and TMS treatment for depression and anxiety throughout the East Bay area. We serve patients from Berkeley, Oakland, Emeryville, Piedmont, Albany, El Cerrito, Moraga, Orinda, LaFayette and neighboring communities.
We accept Medicare, Tricare/TriWest, UC Berkeley’s SHIP, and most major commercial insurance plans, including Aetna, Anthem Blue Cross, Blue Shield of California, Cigna, Magellan, Noridian, Optum, UMR, and UnitedHealthcare.
If you’re considering ketamine therapy or wondering whether Spravato may be right for you, contact us to schedule a consultation.
