Who shouldn't take Spravato, and why we check.
Very few people are ruled out of Spravato. The label lists three things that rule it out completely: certain blood-vessel conditions, a past bleed in the brain, and an allergy to esketamine or ketamine. A few other conditions need a closer look, which is exactly what your evaluation is for. Most people who ask turn out to be fine.
What are the contraindications for Spravato?
The contraindications for Spravato are the conditions in which it should not be used at all (Spravato Prescribing Information):
- Aneurysmal vascular disease in the brain, chest, abdomen, arms or legs, or an arteriovenous malformation. Spravato raises blood pressure for a few hours, which these conditions can't safely tolerate.
- A history of bleeding in the brain (intracerebral hemorrhage).
- An allergy to esketamine, ketamine or any ingredient in the spray.
Three conditions rule it out. Everything else is a conversation.
If none of the three apply to you, the question becomes how to treat you safely, not whether you can be treated. Check if you qualify.
What conditions need a closer look before Spravato?
Some conditions don't rule Spravato out but mean we plan more carefully, and we go through each one at your evaluation.
| Condition | Why it matters | What we do |
|---|---|---|
| High blood pressure | Spravato raises blood pressure for a few hours after each dose. | Check it before every treatment; it needs to be under control first. |
| A recent heart attack or stroke | The label advises caution after a recent cardiovascular event. | Weigh timing and safety with you and your other doctors. |
| Pregnancy or planning one | The label warns Spravato may cause harm to a developing baby. | Talk through other options and pregnancy planning. |
| Breastfeeding | Esketamine passes into breast milk, and breastfeeding isn't recommended during treatment. | Plan the timing with you, or look at other options. |
| A history of psychosis | Requires careful judgment. | Review your history in detail before deciding. |
| Substance use history | Esketamine can be misused, which is why it's only given in our office. | Assess it openly. It doesn't automatically rule you out. |
| Liver disease | Moderate liver disease means esketamine clears more slowly. Severe liver disease wasn't studied, and Spravato isn't recommended there. | Review your liver health first, and monitor you longer after each dose if needed. |
| A past hypertensive emergency affecting the brain | Even small rises in blood pressure matter more after hypertensive encephalopathy. | Check blood pressure and symptoms more often during each session. |
| Stimulants or MAOI antidepressants | Both can add to Spravato's rise in blood pressure. | Watch blood pressure more closely. Spravato and other medications. |
| Bladder symptoms | Urinary symptoms were more common with Spravato than placebo in trials, and bladder inflammation has been seen with long-term ketamine misuse. | Ask about your bladder at the start and along the way. Tell us about any new symptoms. |
From the SPRAVATO® (esketamine) Prescribing Information, Janssen Pharmaceuticals. Spravato is approved for adults.
If antidepressants haven't worked for you, you're exactly who Spravato is for.
Spravato is approved for adults whose depression hasn't responded to at least two antidepressants. It works on the brain's glutamate signalling, a different system from the antidepressants you've already tried. That history isn't a strike against you. It's what qualifies you.
What doesn't rule you out of Spravato?
Plenty of things people worry about don't rule them out. These come up at almost every evaluation, and none of them is a barrier on its own:
- How many antidepressants you've tried. Two is the minimum, and there's no maximum. A long list is the qualification, not a warning sign.
- Your age. Spravato is approved for adults with no upper age limit, and the label found no overall difference in safety for people 65 and older. Medicare and Spravato.
- Bipolar depression. If it's treatment-resistant, Spravato is given alongside a mood stabilizer. Spravato and bipolar depression.
- Anxiety, ADHD, autism or chronic pain. Spravato doesn't treat these, but treatment-resistant depression alongside one of them still qualifies. Depression with anxiety and ADHD, autism or chronic pain.
- Blood pressure that's under control. We check it before every dose.
- Your other medications. Most continue as usual; a few need closer watching.
- A past substance use problem. We talk about it openly. Every dose is given and watched in our office, which is part of why it's possible.
How do we check whether Spravato is safe for you?
We check whether Spravato is safe for you at a thorough evaluation, usually by video within one business day of your first call. We go through your health history, your medications, your blood pressure and the antidepressants you've tried. That same thoroughness is why our insurance requests are approved 95% of the time on the first try.
We'll say so plainly.
If Spravato isn't the right fit, we'll tell you at your evaluation and talk through what might help instead.
Check if you qualify in two minutes.
Answer a few questions and we'll tell you whether Spravato is likely to be an option, then confirm it at your evaluation.
Name, date of birth and insurer. We check your plan and call you back. No commitment.
Check my coverageRegister once, and our team starts your insurance check and reaches out to schedule your evaluation.
Request an evaluationWhat people ask about who can take Spravato.
Who should not take Spravato?
People with aneurysmal blood-vessel disease or an arteriovenous malformation, a history of bleeding in the brain, or an allergy to esketamine or ketamine should not take Spravato.
Can you take Spravato with high blood pressure?
Often, yes, if your blood pressure is under control. We check it before every treatment because Spravato raises it for a few hours.
Can you take Spravato if you have bipolar disorder?
Yes, if you have treatment-resistant depression, given alongside a mood stabilizer. Spravato and bipolar depression.
Can older adults take Spravato?
Yes. Spravato is approved for adults with no upper age limit, and many of our patients are on Medicare. Medicare and Spravato.
Can you take Spravato while breastfeeding?
Breastfeeding isn't recommended during Spravato treatment, because esketamine passes into breast milk. We'll talk through timing and other options with you.
Can you take Spravato if you have liver disease?
With mild or moderate liver disease, often yes, sometimes with a longer stay after each dose. Spravato isn't recommended with severe liver disease.
Is there a minimum age for Spravato?
Spravato is approved for adults, 18 and older.