For many individuals living with depression, treatment begins with therapy, antidepressant medication, or a combination of both. These approaches can be very effective, but some people continue to experience significant symptoms despite appropriate care. Depression may improve only partially, symptoms may return after periods of stability, or medications may stop working as effectively over time. When this happens, clinicians often begin to consider whether a different treatment approach may be needed.
Advances in psychiatric medicine have introduced treatments designed specifically for depression that has been difficult to manage with conventional medications. Esketamine is one such therapy. By working through different brain pathways than traditional antidepressants, esketamine may offer another option for individuals whose depression has not improved adequately with standard treatment strategies.
Esketamine is a medication used for certain forms of depression that have not improved adequately with standard antidepressant treatment. It is derived from ketamine and works through a different neurochemical pathway than most conventional antidepressant medications. Esketamine is administered as a nasal spray under medical supervision as part of a structured treatment program.
Unlike traditional antidepressants that primarily target serotonin, norepinephrine, or dopamine, esketamine acts on the brain’s glutamate system, which plays a central role in neural communication and brain plasticity. Glutamate influences how brain cells signal to one another and helps regulate pathways involved in mood, learning, and emotional processing. By affecting glutamate receptors, esketamine may support the brain’s ability to form and strengthen neural connections that are often disrupted in depression. This different mechanism is one reason esketamine may help individuals whose depression has not responded well to conventional antidepressants.
Spravato is the brand name for a prescription medication that contains esketamine as its active ingredient. The medication is administered as a nasal spray in a certified treatment setting under medical supervision. Because of its effects on perception, blood pressure, and awareness during treatment, esketamine therapy must be carefully monitored by trained clinical staff. At Willow & Stone, this treatment is incorporated into a structured care plan that includes evaluation, monitoring, and follow-up to ensure both safety and effectiveness.
Most antidepressant medications work by gradually increasing levels of neurotransmitters such as serotonin, norepinephrine, or dopamine. These medications can be effective for many individuals, but they often require several weeks before noticeable improvement occurs. For some people, these treatments provide only partial relief or may not produce the desired response.
Esketamine works through a different biological pathway involving the brain’s glutamate system, which plays a key role in neural signaling and brain connectivity. By influencing glutamate receptors, esketamine affects how brain cells communicate and adapt, rather than focusing primarily on serotonin pathways. Because of this distinct mechanism, esketamine may offer an additional treatment option for individuals whose depression has not improved with conventional antidepressant medications.
Esketamine may be considered for individuals whose depression has not improved with conventional treatment approaches. A clinical evaluation helps determine whether this therapy may be appropriate based on symptoms, treatment history, and overall mental health needs.
Esketamine is commonly used for individuals diagnosed with treatment-resistant depression, which generally refers to depression that has not improved after trying multiple antidepressant medications at appropriate doses and durations. People in this situation may continue to experience symptoms such as persistent sadness, fatigue, difficulty concentrating, or loss of motivation despite ongoing treatment. Because esketamine works through a different brain pathway involving the glutamate system, it may provide an additional treatment option when traditional antidepressants have not produced meaningful improvement. Determining whether this therapy is appropriate requires a careful review of prior treatments and current symptoms.
Some individuals experience only partial improvement with antidepressant treatment and continue to struggle with ongoing depressive symptoms. Mood may improve somewhat, yet fatigue, emotional numbness, or difficulty concentrating may still affect daily functioning. In these situations, depression may not meet the strict definition of treatment-resistant depression but can still be difficult to manage with medication alone. Esketamine may sometimes be considered when symptoms remain despite ongoing antidepressant therapy. A thorough psychiatric evaluation helps determine whether this treatment may be appropriate within a broader care plan.
Esketamine treatment is delivered through a structured clinical program designed to ensure both safety and effectiveness. Because the medication can temporarily affect perception, awareness, and blood pressure, it must be administered in a certified medical setting under supervision. Each step of the process is carefully monitored by trained clinical staff.
Esketamine is administered as a nasal spray during a scheduled appointment at the clinic. Patients self-administer the medication under the guidance of medical staff who ensure the correct dosage and provide instructions throughout the process. The treatment takes place in a quiet clinical environment where patients can remain comfortable during the appointment. Because the medication can cause temporary changes in perception or alertness, patients remain in the clinic during the observation period after administration.
After receiving the medication, patients remain in the clinic while the medication takes effect. Clinical staff monitor patients throughout this period and check vital signs such as blood pressure. Some individuals may experience temporary sensations such as dizziness, dissociation, or drowsiness during treatment. Monitoring helps ensure that these effects resolve safely before patients leave the clinic.
Esketamine treatment is typically delivered in a series of sessions during an initial phase, followed by a maintenance phase depending on individual response. The schedule allows clinicians to observe how symptoms change over time and adjust treatment as needed. Follow-up visits also help ensure that the therapy remains integrated into a broader depression care plan.
Esketamine is typically used as part of a broader treatment strategy rather than as a standalone therapy. While the medication may help improve depressive symptoms, long-term mental health stability often involves addressing the biological, psychological, and lifestyle factors that influence mood. Integrating esketamine into a comprehensive care plan allows treatment to support both symptom relief and overall mental health.
At Willow & Stone, esketamine treatment is considered within the context of each patient’s full clinical picture. Medication strategies, lifestyle factors, therapy, and other aspects of mental health care are evaluated together to develop a personalized plan. This integrative approach helps ensure that treatment supports lasting improvement rather than focusing on a single intervention alone.
Willow & Stone provides integrative psychiatric care for individuals exploring esketamine treatment throughout the Dallas–Fort Worth area, with an office located in Arlington. Patients across the broader DFW region, including Dallas, Fort Worth, Mansfield, and surrounding communities, can access in-person care for treatments that require on-site supervision. We also offer secure telehealth appointments across Texas for psychiatric evaluation, treatment planning, and follow-up care when appropriate.
Many patients come to Willow & Stone after feeling that previous treatment experiences focused mainly on medication changes without fully exploring the factors influencing their depression. Our approach is designed to provide thoughtful, individualized psychiatric care that looks at the broader context of mental health.
Care begins with a detailed psychiatric evaluation that reviews symptoms, treatment history, and overall health. This process helps clinicians understand how depression has developed over time and how previous treatments have affected symptoms. Taking time to explore these details often provides important insight into why depression has been difficult to treat.
Treatment planning considers the biological, psychological, and lifestyle factors that influence mood and emotional health. This integrative approach helps ensure that care addresses more than symptoms alone. Medication strategies, mental health support, and overall health considerations are evaluated together when developing a treatment plan.
Depression affects each person differently, and treatment strategies often need to reflect those differences. Care plans are developed collaboratively with attention to symptoms, treatment history, and personal goals. This allows treatment to evolve as progress becomes clearer and needs change over time.
Persistent depression can feel discouraging, particularly when previous treatments have not produced lasting improvement. However, ongoing symptoms often signal that additional factors affecting mental health need to be explored. With careful evaluation and a comprehensive approach to care, new treatment pathways may become available that support more stable and lasting recovery.
Spravato is an FDA-approved esketamine nasal spray for treatment-resistant depression and for depressive symptoms with acute suicidal ideation, delivered under REMS-certified supervision.
No. Spravato’s REMS program requires in-person administration and monitoring. Telehealth is used for evaluation, planning, and follow-up around the dosing.
Adults with treatment-resistant depression — typically those who haven’t responded adequately to other antidepressants. Dr. Forbes evaluates whether it’s appropriate for you.
Willow & Stone provides integrative, cash-pay telehealth psychiatry to patients across Texas and New Mexico — from major metros to rural communities with few local providers.
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