By Madison Avenue TMS & Psychiatry - Published on June 19, 2025

Last updated on June 23, 2025

If you’re living with major depressive disorder (MDD) and have tried multiple antidepressants without feeling better, you’re not alone. According to recent research, about one-third of patients with major depressive disorder did not respond to two or more oral antidepressants. 

Treatment-resistant depression (TRD) is an unfortunate reality for many. You can put in the work — try new medications, deal with the side effects, go to therapy, and follow every step your providers recommend — only to still feel stuck.

But there are promising new treatment options for adults with treatment-resistant depression, including Spravato (esketamine), an FDA-approved breakthrough treatment that’s helping patients find relief, including many here at Madison Avenue TMS & Psychiatry.

What Is Spravato?

Spravato is a prescription nasal spray FDA-approved for adults with treatment-resistant depression and major depressive disorder with suicidal thoughts or behavior. Unlike traditional oral antidepressants, Spravato acts on different receptors in the brain, which affect glutamate, a neurotransmitter associated with mood and cognition.

Unlike standard antidepressants that may take 4–6 weeks to show effects, some patients report improvement within 24 hours of their first dose.

Who Is a Candidate for Spravato?

Spravato is not for everyone and is not a first-line treatment. You may be a candidate if:

• You’ve tried two or more oral antidepressants without success
• You’re experiencing persistent depressive symptoms
• You’ve been diagnosed with treatment-resistant depression
• You’re struggling with suicidal thoughts as part of major depressive disorder

Providers consider a variety of factors before recommending Spravato, including:

• Medication history and treatment response
• Overall mental and physical health
• Lifestyle factors, support systems, and treatment goals

Before being prescribed Spravato, patients should complete a thorough psychiatric evaluation to determine the best course of care.

Benefits and Side Effects of Spravato 

Patients struggling with treatment-resistant depression who take Spravato may experience a significant reduction of depressive symptoms. Many patients report:

• Noticeable mood improvements within the first few weeks
• Relief from depressive symptoms that didn’t respond to other treatments
• Greater clarity, energy, and motivation

As with any treatment, there are potential side effects, including:

• Sleepiness, dizziness, anxiety, or nausea
• Temporary dissociation (feeling “out of body”)
• Mild sedation or increased blood pressure

Be aware that patients under age 24 have an increased risk of suicidal thoughts and actions when taking any antidepressant, and people with blood vessel disease, a history of aneurysms, or who are allergic to esketamine should not take Spravato 

What to Expect from the Spravato Treatment Process 

1. Pre-Treatment Consultation

“Your psychiatric team will review your medical history, discuss your symptoms, and determine whether Spravato treatment for depression is right for you,” said Dr. David Woo, head clinical psychiatrist and founder of Madison Avenue TMS & Psychiatry in New York City. “They should handle insurance verification and walk you through the treatment process.”

2. In-clinic Treatment Sessions

• Patients self-administer the Spravato nasal spray under the direct observation of licensed clinicians in a comfortable, private suite. Patients can choose to listen to music, read, or simply relax during the duration of the session
• Patients will be monitored for at least two hours after administration to ensure their safety and comfort 
• Patients cannot drive themselves after they take their dose and must arrange transportation; they may use public transit, rideshares, or walk.

3. Spravato Treatment Schedule

The initial phase of Spravato treatment lasts about two months, with the maintenance phase beginning at week 9. 

• Weeks 1–4: 2 sessions per week
• Weeks 5–8: 1 session per week
• Week 9 and beyond: Maintenance varies; some patients taper to every other week

Common Questions About Spravato 

Below are some common questions about Spravato, but more information can be found on Spravato’s official website. 

Is Spravato covered by insurance?
Yes, most commercial insurers and Medicare Advantage plans cover Spravato. Our office will help you navigate the insurance process and verify coverage.

Is Spravato approved for children or teens?
No. Spravato is approved for adults 18+ only. Our staff can help you explore other options for younger patients.

Where can I get Spravato in NYC?
Madison Avenue TMS & Psychiatry is a Risk Evaluation and Mitigation Strategy (REMS) certified provider offering Spravato in Midtown Manhattan.

Why Patients Choose Madison Avenue TMS & Psychiatry for Spravato Treatment

Unlike wellness chains or trendy pop-ups, Madison Avenue TMS & Psychiatry is a psychiatry-led clinic providing science-backed, dual-modality care in NYC for over a decade. As a REMS-certified provider, we offer Spravato treatment in a safe, supportive environment at our location in Midtown Manhattan. Founded by board-certified psychiatrist Dr. David Woo, we specialize in evidence-based, personalized mental health care for treatment-resistant depression. 

• Board-certified psychiatrist with over a decade of expertise with treatment-resistant depression
• Access to both Spravato and TMS therapy, customized to your needs
• Evidence-based care in a discreet, quiet, central NYC location
• Transparent insurance and billing support, including patient assistance programs
• Collaborative treatment plans that prioritize your long-term healing
• Specialization in combining TMS + ketamine-based treatments for improved outcomes
• Clear communication from the first call to the final session

By listening to each patient’s unique struggles and concerns, Dr. Woo and his care team craft tailored treatment plans that deliver life-changing outcomes.

If You’re Struggling With Treatment-Resistant Depression, Don’t Give Up Hope

We know how exhausting it can be searching for a solution to help your depressive symptoms. But know that relief is possible, and Spravato may be the treatment that changes everything for you.

If you’re ready to explore new options for treatment-resistant depression, we’re here to help. To learn more or schedule a consultation with our team at Madison Avenue TMS & Psychiatry, call us at (212) 731-2033 or visit madisonavetms.com.

Madison Avenue TMS & Psychiatry