When depression keeps returning after multiple medications, treatment decisions can feel like guesswork. Esketamine (SPRAVATO) offers another path, an in-clinic option designed for adults with treatment-resistant depression (TRD) or for major depressive disorder with acute suicidal ideation or behavior, under close medical supervision. This guide explains who typically qualifies, how safety monitoring works in APA offices in California, and how we integrate it with talk-based care so progress is practical and durable.
Who is Usually Eligible For Esketamine Treatment?
Esketamine Treatment is considered when depression has not improved adequately after two or more antidepressant trials at therapeutic doses and durations. You may be a candidate if:
You’re an adult diagnosed with major depressive disorder and
have tried at least two different antidepressants without enough relief, or
have depression with acute suicidal ideation or behavior and need rapid, closely monitored help.
You can attend in-clinic sessions on a set schedule and arrange transportation home after each dose (no driving the day of treatment).
You and your clinician agree to continue an oral antidepressant alongside esketamine (standard for TRD), and to participate in skills-focused therapy so improvements stick.
Who might not be a fit (or needs extra evaluation)? Uncontrolled hypertension, certain vascular or neurological conditions, pregnancy, untreated substance-use concerns, or any medical issue your prescriber believes would make esketamine unsafe. We screen thoroughly and coordinate with your other clinicians before starting.
The Esketamine Program | Step-by-Step Medical Monitoring
Esketamine is delivered under a REMS (Risk Evaluation and Mitigation Strategy) program. That means every dose happens in APA clinics with vital-sign checks and observation.
Before your first session
Comprehensive evaluation (history, current meds, prior trials, safety review).
Baseline measures (e.g., symptom and function scales) so progress is visible.
Insurance prior authorization (APA team handles the paperwork and outlines expected copays/coinsurance).
Practical prep: arrange a ride home, avoid heavy meals right before dosing, and follow your clinician’s guidance on the morning of treatment.
During each session
Check-in & vitals: We review your day, confirm your ride, and take baseline blood pressure/pulse.
In-clinic nasal dosing: You self-administer esketamine under direct supervision, then rest in a comfortable, medically monitored space.
Observation period: We monitor for expected, time-limited effects—e.g., dissociation, dizziness, mild nausea, or a temporary rise in blood pressure. Staff are with you the whole time.
Discharge criteria: You head home with your arranged ride once vitals and clinical status are stable. No driving, operating machinery, or high-risk activities until the next day.
We re-check symptoms and functioning regularly. If you’re improving, we’ll plan a maintenance cadence; if not, we’ll adjust the plan thoughtfully.
Integrating Esketamine with Therapy: Leveraging Biological Improvement
Esketamine Treatment can reduce the intensity of depressive symptoms; therapy helps you rebuild routines, problem-solve, and prevent relapse. In our San Jose program, we coordinate your dosing days with skills-focused sessions like CBT-style tools, behavioral activation, and sleep strategies so you can:
Turn early energy improvements into consistent action (protect wake time, schedule manageable tasks, reconnect with support).
Challenge “stall” patterns—avoidance, all-or-nothing thinking, or pessimistic predictions that can return as stress rises.
Build a 90-day treatment plan (warning-sign checklist, action steps, follow-up timing).
Many people schedule a therapy session the day after dosing or later the same week, when motivation typically improves.
Esketamine Journey at Advanced Psychiatry Associates Across California
Local access + flexible scheduling: We’ll work out a dosing calendar you can keep and coordinate therapy/med checks around it.
Clear communication: You’ll know what each visit includes, what side effects are expected, and how to prepare.
Team-based care: Your prescriber, therapist, and care coordinator share the same goals: measurable symptom relief and better daily functioning.
Transparent costs: We verify benefits and any prior authorization requirements, then review copays/coinsurance before you start.
Advanced Psychiatry Associates in San Jose will walk you through eligibility, benefits, and the week-by-week plan—then combine dosing with the right therapy support.
You don’t have to keep starting over. With structured monitoring and the right support, you can move from trial-and-error to a clear, coordinated plan.
FAQs
How fast will I notice changes?
Some people feel shifts in mood, energy, or outlook within the first few weeks; for others, it’s more gradual. We track both symptoms and real-life wins (sleep, activity, follow-through) to guide maintenance.
Can I keep my current meds?
Usually yes—continued oral antidepressant is standard in TRD. We’ll review everything you take (including supplements) to avoid interactions.
What about side effects?
Transient dissociation, dizziness, nausea, or a short-term blood-pressure rise are most common. We monitor closely, manage symptoms in-clinic, and give clear guidance for the rest of the day.
What if I’ve tried many treatments already?
Esketamine works via a different mechanism than standard antidepressants. Even after multiple trials, some people experience meaningful improvement—especially when dosing is paired with a structured therapy plan.
