If you’re wondering whether you qualify for Spravato at a certified clinic in Manhattan, here’s the short answer. Spravato (esketamine) is a prescription nasal spray for adults whose depression hasn’t improved after trying two or more antidepressants. There’s also a separate pathway for people living with depression who are having thoughts of suicide. A clinician confirms Spravato eligibility after reviewing your history, so nothing here replaces that conversation with a provider in New York. This guide is meant to help you walk into that conversation feeling informed instead of overwhelmed.
Esketamine is the active ingredient in Spravato. It comes from [ketamine](https://nushama.com/ketamine-for-depression) and works through a different pathway in the brain than standard antidepressants, which is part of why it can help when other medicines haven’t.
Let’s walk through what the eligibility criteria actually mean, without the medical jargon.
## What “treatment-resistant depression” actually means
Treatment-resistant depression (TRD) means your depression hasn’t responded well to at least two different antidepressants, even when each was taken at an adequate dose for an adequate length of time. That last part matters more than most people realize, so it’s worth slowing down.
An “adequate trial” usually means two things happened:
* **Adequate dose.** You took the medicine at a therapeutic strength, not just a starter dose that was never raised.
* **Adequate duration.** You stayed on it long enough to see whether it worked, often around six to eight weeks, rather than stopping after a week or two.
So a medication you started and quickly stopped because of side effects may not count as a full trial. Neither does a prescription you filled but rarely took. This isn’t about judging anyone. Life gets in the way. Side effects are real. Stopping a medicine that made you feel worse is a completely reasonable choice. It simply means a clinician may want to understand what happened before counting that medication toward the two-trial mark.
If you’ve genuinely given two or more antidepressants a fair chance and still feel stuck, you’re not alone, and you’re not short on [options in Manhattan](https://nushama.com/blog/spravato-provider-manhattan-depression). Among people who receive treatment for major depression, [roughly one-third meet the criteria for treatment resistance](https://www.jnj.com/media-center/press-releases/johnson-johnson-elevates-leadership-in-depression-with-new-data-at-2026-american-college-of-neuropsychopharmacology-annual-meeting), defined as an inadequate response to two or more oral antidepressants at adequate dosing and duration. Treatment resistance is more common than most people think, and it says nothing about your effort or your character.
### One recent change worth knowing
Spravato was [first approved by the FDA in 2019 for treatment-resistant depression](https://www.jnj.com/media-center/press-releases/janssen-announces-u-s-fda-approval-of-spravatotm-esketamine-ciii-nasal-spray-for-adults-with-treatment-resistant-depression-trd-who-have-cycled-through-multiple-treatments-without-relief), taken alongside an oral antidepressant. In January 2025, the [FDA approved Spravato as a monotherapy](https://www.prnewswire.com/news-releases/spravato-esketamine-approved-in-the-us-as-the-first-and-only-monotherapy-for-adults-with-treatment-resistant-depression-302355833.html), meaning it can be used on its own for treatment-resistant depression without a daily oral antidepressant. That change widened the door for people who couldn’t tolerate the older medicines, and certified clinics in Manhattan now offer both pathways. We cover this in more depth in our guide to [Spravato vs. IV ketamine in Manhattan](https://nushama.com/blog/spravato-vs-iv-ketamine-manhattan).
## The second pathway: depression with suicidal thoughts
There’s a second reason someone may qualify for Spravato, and it’s separate from the two-antidepressant rule. In 2020, the [FDA approved Spravato for adults with major depressive disorder who are experiencing acute suicidal ideation or behavior](https://www.prnewswire.com/news-releases/janssen-announces-us-fda-approval-of-spravato-esketamine-ciii-nasal-spray-to-treat-depressive-symptoms-in-adults-with-major-depressive-disorder-with-acute-suicidal-ideation-or-behavior-301104437.html), meaning active thoughts of suicide or recent suicidal actions.
This pathway exists because standard antidepressants can take weeks to start working, and that wait can feel unbearable when someone is in crisis. Under this indication, a person doesn’t need to have already tried two antidepressants to be considered. If you’re in New York City and experiencing this, providers in Manhattan can evaluate you for this pathway directly.
If you’re having thoughts of suicide right now, please don’t wait for a consultation. Call or text 988 to reach the Suicide and Crisis Lifeline, available around the clock. Spravato is given under medical supervision as part of a broader care plan, and it’s not a substitute for emergency help in a moment of crisis.
## Who isn’t a good candidate for Spravato
Certain medical histories make Spravato a poor fit, mostly because the medicine can briefly raise blood pressure. According to the prescribing information, it [should not be used by people with certain blood-vessel conditions](https://www.jnjlabels.com/package-insert/product-monograph/prescribing-information/SPRAVATO-pi.pdf), including aneurysmal vascular disease (a weakened, bulging artery wall) or a history of intracerebral hemorrhage (bleeding in the brain). An allergy to esketamine or ketamine also rules it out.
Other situations call for a closer look rather than an automatic no. A care team will want to talk through things like:
* Heart or blood-pressure conditions that aren’t well controlled
* A history of certain kinds of psychosis
* Pregnancy or breastfeeding
* A current relationship with substance use that needs support
None of these should discourage you from asking. They’re the reason a careful medical review exists in the first place. The goal is simple: make sure the medicine is safe for your body, not just helpful for your mood. At a Manhattan clinic like Nushama, the care team makes that call with you, not at you.
## How Spravato eligibility gets confirmed in Manhattan
Confirming eligibility starts with a conversation and a review of your treatment history. You won’t be expected to have perfect records. At Nushama’s Midtown Manhattan location on Madison Avenue, the care team helps you piece together which medications you’ve tried, at what doses, and for how long.
Here’s what that process usually involves:
1. **A medical and psychiatric intake.** You’ll talk through your depression history, past medications, physical health, and current symptoms.
2. **A records review.** Where possible, the team looks at prior prescriptions to confirm which trials were adequate.
3. **A safety screen.** This covers blood pressure, relevant medical conditions, and anything on the caution list above.
4. **A plan built around you.** If Spravato is a fit, the team explains the schedule and what each visit looks like.
Because Spravato affects the brain quickly, it’s given in a certified medical setting with monitoring afterward. In Manhattan, Nushama’s clinic on the 21st floor of 515 Madison Avenue is one such REMS-certified location. This is part of a national safety program called [REMS (Risk Evaluation and Mitigation Strategy)](https://www.spravatohcp.com/files/lu_dig_rems_leave_behind.pdf), which requires that Spravato be administered where a clinician can watch you for a period after each dose. You don’t take it at home. Our [guide to REMS certification and insurance](https://nushama.com/blog/rems-certified-spravato-manhattan) walks through what that means for coverage.
Two things we deliberately keep separate so we can do them justice: the physical experience of a dose, and the common side effects. If you’re curious what a visit actually feels like, our [what to expect during a Spravato session](https://nushama.com/blog/spravato-treatment-for-depression) walkthrough covers it start to finish. For a full look at how esketamine works and what it treats, see our [Spravato treatment overview](https://nushama.com/spravato/).
## A self-assessment checklist
This checklist won’t diagnose you or confirm eligibility. Think of it as a way to organize your thoughts before you talk to a care team. You may be a candidate for Spravato if several of these sound familiar:
* You’ve been diagnosed with major depressive disorder.
* You’ve tried two or more antidepressants in your current depressive episode.
* Each of those medicines was taken at a full dose for several weeks.
* Your depression still interferes with daily life.
* You’re 18 or older.
* You don’t have a blood-vessel condition on the caution list, such as aneurysmal vascular disease or a history of brain bleed.
A separate path may apply if you have major depressive disorder and are experiencing active suicidal thoughts, even if you haven’t yet tried two antidepressants.
If you checked several boxes, the next step is a conversation with a Manhattan-based clinician, not a commitment.
## FAQs
### Does one failed antidepressant count toward Spravato eligibility?
Usually not on its own. Treatment-resistant depression is defined as an inadequate response to two or more antidepressants, each taken at a full dose for a sufficient length of time. One medication that didn’t help is a start, but a care team typically looks for at least two adequate trials before considering Spravato.
### Do I need a referral to be considered for Spravato in Manhattan?
Not necessarily. Many people in New York City reach out to a [Spravato provider](https://nushama.com/blog/spravato-provider-manhattan-depression) directly and start with a consultation. If you already work with a therapist, psychiatrist, or primary care doctor in the city, their records can help confirm your treatment history, but a formal referral isn’t always required to begin the conversation.
### How is Spravato eligibility confirmed?
Eligibility is confirmed through a medical and psychiatric intake, a review of your past antidepressant trials, and a safety screen for conditions like uncontrolled blood pressure or certain blood-vessel conditions. If the criteria fit and the medicine is safe for you, the care team builds a treatment plan together with you.
### What if my depression comes with suicidal thoughts?
There’s a specific FDA-approved pathway for adults who have major depressive disorder along with acute suicidal thoughts or behavior, and it doesn’t require two prior failed antidepressants. If you’re in crisis right now, call or text 988 to reach the Suicide and Crisis Lifeline before anything else.
### Is Spravato taken at home?
No. Spravato is given in a certified medical setting, and a clinician monitors you for a period after each dose. This is required under a national safety program and is one of the ways the treatment stays closely supervised. Nushama’s [Spravato insurance and REMS guide](https://nushama.com/blog/rems-certified-spravato-manhattan) explains the process in detail.
## Where to go from here in Manhattan
Qualifying for Spravato comes down to two questions your care team helps you answer: has your depression persisted through two or more honest antidepressant trials, or are you living with depression alongside suicidal thoughts? If either sounds like you, and your medical history is clear of the few conditions that make esketamine unsafe, you may be a candidate.
At Nushama’s Midtown Manhattan clinic, eligibility reviews are led by an experienced medical team, with licensed therapists and integration support alongside the medicine, in a calm setting on Madison Avenue built around members rather than a clinic waiting room. We offer both [IV ketamine](https://nushama.com/blog/why-nushamas-ketamine-infusion-success-rate-leads-manhattan-trd-treatment) and Spravato under one roof in the heart of New York City, so the conversation can focus on what fits you rather than what happens to be available.
When you’re ready, our Manhattan care team is here to talk it through and confirm whether Spravato is right for you. [Book a consultation at Nushama’s Manhattan clinic](https://nushama.com/) at your own pace, with no pressure to decide anything today.
