For many people living with treatment-resistant depression, trying endless medications without relief can feel exhausting. In recent years, FDA-approved SPRAVATO® (esketamine) has created a new option for patients who haven’t responded to traditional antidepressants.
We spoke with Jill Carter, DNP, FNP-C, PMHNP-BC, about how SPRAVATO® works, what the treatment experience is like, and why she believes it represents a significant shift in mental health care.
Jill Carter has 30 years of experience providing direct patient care. She is an educator and advocate for mental health and interventional psychiatric services.
In 2019, Evolve Health began treating patients with treatment-resistant depression. At that time, we were using IV ketamine because it was what was available, and we saw great outcomes for depression, anxiety, and PTSD. We were able to provide an opportunity for patients to achieve results they hadn’t been able to reach with traditional oral medications for depression and other illnesses.
We later added SPRAVATO®, the FDA-approved nasal spray esketamine. Once it became available on the market, we were able to offer an insurance-covered treatment option with very similar outcomes to IV ketamine. It was truly a new and novel medication.
We started providing a great deal of education in the community, not only with provider peers, but also with insurance companies, patients, and families. We focused on explaining how this medication works differently than anything we’ve had available in decades as a tool to treat depression. I travel to other clinics to provide education, and we also host clinics here at Evolve Health so they can observe our processes and learn how we’ve established such a specialized treatment center.
Over time, as we continued to see these strong results, we also added TMS (transcranial magnetic stimulation). We’re continually looking to add interventional psychiatric services that meet patient needs because not every brain—or every person—responds to treatments in the same way.
SPRAVATO® is esketamine, a nasal spray medication approved by the FDA in 2019 for treatment-resistant depression. It also has an additional indication for major depressive disorder with suicidal ideation.
While the exact mechanism of action is still not fully understood, we believe it increases glutamate levels in the brain which can improve mood. Over time it also supports neuroplasticity and neurogenesis that allows the brain to process and create new pathways, new ways of thinking, new ways of reacting. The accumulation of all those pieces is a reduction in your depressive symptoms that have not responded to other medications.
At Evolve Health, we prioritize comfort and safety. During SPRAVATO® treatment, there is a two-hour monitoring period to ensure vital signs remain stable and patients are safe before leaving the clinic.
We offer comfort items such as warm blankets, beverages (if medically appropriate), snacks, and noise-canceling headphones. We have private rooms, shared rooms, and group spaces, with options depending on patient preference. We tailor the environment to meet individual needs to the best of our ability.
Our medical and psychiatric teams are present in the clinic at all times. We monitor vital signs, including blood pressure, and remain available to address anything that arises. The space is calm, safe, judgement-free, and designed to allow patients to focus on their healing. Our role is to provide medical oversight while also being emotionally supportive and present.
Patients are often nervous before starting SPRAVATO® treatment because the experience is unfamiliar. They may not know exactly what to expect, though they’ve heard it can be effective.
A common concern is dissociation as a side effect. During the initial consultation and education visit, we walk through the entire process: what to expect, how we monitor safety, and strategies to manage potential side effects such as nausea, dissociation, or elevated blood pressure. We discuss grounding techniques, breathing exercises, setting intentions, and collaborate with therapists when appropriate.
We work with our patients to make sure that they have an accurate expectation and understanding of what might happen during their first visit. Our medical and psychiatric teams are always present and can handle anything that comes up during treatment.
Many patients expect symptom reduction, and that’s the goal. But they’re often surprised by improvements in quality of life.
Depression can suppress creativity, social engagement, and enjoyment of everyday moments. Patients are often surprised by their ability to reengage in life by enjoying a TV show, going for a walk, spending time outdoors, or engaging in crafts. I recently had a patient tell me they were going to go start learning to throw pottery, which is something they always wanted to do but didn’t have the energy or motivation to pursue. These functional and personal changes that help them achieve their goals are often unexpected and deeply meaningful.
Evolve Health providers educate patients and demonstrate how the the SPRAVATO® device works before starting treatment.
An early misconception was that esketamine—being related to ketamine—is that it’s about “getting high,” and there is stigma surrounding that association.
Over time, as outcomes have become more established, there’s been growing recognition that this is a medical procedure. SPRAVATO® is an FDA-approved pharmaceutical with specific indications and monitoring requirements.
It’s something that I’m excited to see change across the nation—there’s more and more acceptance that depression is no longer something that should just be tolerated. We actually have solutions and can make a difference with the interventional choices that we have now.
Working at Evolve Health has been one of the most rewarding things I’ve ever done in my career. It’s a privilege to witness someone grow from a place of deep struggle to regaining motivation, experiencing joy, or engaging socially. Sometimes it’s as simple as being able to get your own groceries again. Seeing someone’s quality of life improve and knowing we were a small part of that journey is incredibly rewarding.
This is a really exciting time to work in mental health — the last six years has been pivotal. There are more treatments that are in research and more options available for patients now. We no longer just have our small little toolbox of pills we can offer. We have more treatments like TMS, pharmaceuticals, and other things coming. It should give everybody hope that there’s better options—and more unique options—that may work for them.
Live in Oregon and wondering if SPRAVATO®, TMS, or IV ketamine could help? Reach out to us for a consultation. Our team will connect with you directly to explore your options.