If you have tried antidepressant after antidepressant and still feel stuck, you are not alone. Treatment-resistant depression affects roughly 30% of people diagnosed with major depressive disorder, and it can feel like you have run out of options. But there is a newer path forward. Spravato (esketamine) is an FDA-approved nasal spray that works differently than traditional antidepressants. It targets the NMDA receptor in the brain, and many patients notice relief within hours to days. Getting a Spravato prescription is not like picking up a standard medication at your local pharmacy. Because of how it works and how it is administered, there is a specific process involved. Here in Idaho Falls, our team at Autumn Leaves Psychiatry makes that process as smooth and straightforward as possible.
Here is exactly how it works, step by step.
Step 1: Confirm You May Be a Candidate
Spravato is FDA-approved for 2 groups of adults:
- Adults with treatment-resistant depression (TRD), meaning you have tried at least 2 different antidepressant medications without adequate relief.
- Adults with major depressive disorder (MDD) who are experiencing acute suicidal ideation or behavior.
If either of those describes you, Spravato may be worth exploring. You do not need to self-diagnose. That is what the next step is for.
Step 2: Schedule a Psychiatric Evaluation
The first step is booking a consultation with a psychiatric provider. Our team in Idaho Falls performs a thorough evaluation to understand your full mental health history. This includes:
- Your current diagnosis and symptoms
- A review of past medications and treatment outcomes
- Any other mental health conditions being managed
- Your overall health and medication history
This evaluation helps confirm whether Spravato is medically appropriate for you. It also gives us a chance to talk through what treatment actually looks like and answer every question you have.
Contact Autumn Leaves Psychiatry to schedule your evaluation.
Step 3: Get Officially Diagnosed and Prescribed
If the evaluation confirms you meet the criteria, your provider will issue a Spravato prescription. Because Spravato is a controlled substance (Schedule III), it requires a licensed psychiatric provider to prescribe it.
Our board-certified Psychiatric Mental Health Nurse Practitioner, Merjurie Ricklefs, PMHNP-BC, handles prescriptions right here in Idaho Falls. You do not need to travel to Boise or Salt Lake City. Qualified, experienced care is available locally.
This is also a good time to discuss whether medication management or a combination of therapy and medication makes the most sense for your longer-term care plan.
Step 4: Get Enrolled in the Spravato REMS Program
Here is where Spravato differs from a standard prescription. Because of potential side effects like sedation and dissociation, the FDA requires all Spravato patients to enroll in a safety program called the Spravato REMS (Risk Evaluation and Mitigation Strategy). Your prescribing provider handles this enrollment on your behalf.
This program ensures that Spravato is only administered in certified clinical settings. It is a patient safety measure, not a barrier. Our Idaho Falls clinic is a certified Spravato treatment location.
Step 5: Verify Insurance or Discuss Payment
Spravato is covered by many insurance plans, including Medicare. Coverage varies, so our team will work with you to verify your benefits before your first session. We want you to have a clear picture of costs before you begin.
If you have questions about coverage, reach out to our team and we will walk through the details with you.
Step 6: Attend Your First Spravato Treatment Session
Spravato is not taken at home. Every dose is administered right here in our Idaho Falls clinic, under direct observation by a healthcare provider. Here is what a session looks like:
- You self-administer the nasal spray under your provider’s supervision.
- You remain at our clinic for at least 2 hours while we monitor you for side effects.
- You will need someone to drive you home. You cannot drive or operate machinery on the same day as treatment.
Initial treatment typically involves 2 sessions per week for the first 4 weeks. This is called the induction phase. Sessions then taper to once weekly, and eventually once every 1 to 2 weeks for maintenance.
Many patients begin to notice improvements within the first few sessions. Some experience relief as early as 24 hours after their first dose.
Step 7: Build a Complete Treatment Plan
Spravato works best as part of a broader care plan. Our team strongly encourages pairing it with therapy. Cognitive Behavioral Therapy (CBT) is especially effective alongside medication-based treatment for depression.
Medication addresses the neurological side of depression. Therapy helps you build coping tools, challenge thought patterns, and create lasting change. Together, they produce better outcomes than either approach alone.
We build individualized plans because no two patients are the same. Your background, your history, your life, all of it shapes the right path forward.
What to Expect Overall
Getting a Spravato prescription involves more steps than a standard antidepressant. But those steps exist to protect you and to make sure the treatment is used correctly. Our team in Idaho Falls guides you through each one.
To summarize the process:
- Confirm you may qualify (treatment-resistant depression or MDD with acute suicidal ideation)
- Schedule and complete a psychiatric evaluation
- Receive your diagnosis and prescription from a licensed provider
- Enroll in the Spravato REMS program (your provider handles this)
- Verify insurance coverage
- Attend your supervised treatment sessions at our clinic
- Pair Spravato with therapy for a complete care plan
Ready to Take the First Step?
If traditional antidepressants have not worked for you, it does not mean treatment cannot work. It means you may need a different approach. Spravato is a different approach for many people, and our Idaho Falls team is here to help you find out if it is right for you.
Contact Autumn Leaves Psychiatry today to schedule your consultation. We serve patients throughout southeastern Idaho, including Idaho Falls, Ammon, Pocatello, and the surrounding communities.
You deserve care that actually works. Let’s find it together.