If you’ve been living with depression that hasn’t improved despite trying medication, you may have heard about Spravato (esketamine) as a potential next step. But before scheduling an appointment, many people simply want to know whether they’re likely to qualify for Spravato – or whether something in their history might get in the way.
Spravato eligibility isn’t based on a single yes-or-no rule.
Your provider will consider your diagnosis, treatment history, overall health, and individual circumstances together. And while some medical conditions mean Spravato isn’t appropriate, many of the concerns people have – such as high blood pressure, certain medications, or a history of substance use – don’t automatically rule out treatment.
In this guide, we’re focusing specifically on Spravato eligibility, who is a candidate, and what may affect whether treatment is appropriate. However, if you’re looking for information on how Spravato works, what a treatment session is like, or possible side effects, we’ve covered all of that (and more) in our other Spravato resources.
Who is a candidate for Spravato?
The best candidates for Spravato are adults whose depression has not improved enough with standard antidepressant treatment, a condition known as treatment-resistant depression (TRD).
Being a Spravato candidate in Ohio generally means:
- You are 18 years or older.
- You have a confirmed diagnosis of major depressive disorder (MDD).
- Your depression has not improved despite trying at least two antidepressants.
- Your depression severity has been clinically documented.
- You are able to attend treatment in a certified clinic.
Meeting these criteria doesn’t guarantee treatment – that determination is made through a full evaluation – but it does mean you’re likely to be a strong candidate.
How do you qualify for Spravato in Ohio?
The first step toward qualifying for Spravato is a comprehensive psychiatric evaluation – not simply checking off a list of requirements.
At REACH Behavioral Health, the evaluation is designed to understand your unique situation and determine whether Spravato is the safest and most appropriate treatment for you.
During your assessment, our clinical team will typically review:
- Your depression diagnosis and current symptoms.
- Previous antidepressants you’ve tried, including how long you took them.
- Your response to previous treatments.
- Your medical history.
- Current medications and supplements.
- Any history of substance use.
- Blood pressure and other relevant health concerns.
- Insurance requirements and prior authorization, when applicable.
This evaluation isn’t about looking for reasons to say no. It’s about making sure that, if you do begin Spravato treatment, you have the best possible chance of benefiting from it safely.
Who should not take Spravato? Contraindications and disqualifiers
Although many people with treatment-resistant depression may be candidates, Spravato isn’t appropriate for everyone.
There are a small number of situations where Spravato should generally not be used because the risks outweigh the potential benefits.
These include people with:
- Aneurysmal vascular disease, including conditions affecting the aorta, intracranial, or peripheral arterial vessels.
- Arteriovenous malformations (AVMs) – abnormal connections between blood vessels.
- A history of intracerebral hemorrhage (bleeding inside the brain).
- Liver disease.
- A known allergy to esketamine, ketamine, or any ingredient in the Spravato formulation.
Spravato is also approved only for adults aged 18 and over.
Other situations require additional assessment rather than automatically ruling out treatment. These typically include:
- Uncontrolled hypertension or cardiovascular disease.
- Pregnancy, planned pregnancy, or breastfeeding.
- A history of substance misuse.
- Certain neurological conditions.
- A history of severe or active psychotic disorders.
- Medications that may interact with Spravato.
The purpose of your evaluation is to determine whether Spravato can be used safely in your individual circumstances – not simply to decide whether you do or don’t qualify.
Common concerns that don’t automatically disqualify you from Spravato eligibility
The following concerns come up frequently when people are considering Spravato treatment. But none of these are simple yes-or-no answers, so you should never rule yourself out before you’ve had a formal evaluation.
The key is to start the process, be completely open and honest about your history, and let the experts guide you.
Spravato and high blood pressure
High blood pressure is a common concern because Spravato temporarily raises blood pressure after each treatment session. This increase typically peaks within the first hour and gradually returns towards baseline over the following few hours. Because of this, your blood pressure is checked before every treatment session and monitored again afterwards.
Having high blood pressure doesn’t automatically mean you can’t receive Spravato. If your blood pressure is elevated before a treatment session, your provider may delay treatment until it can be given safely or recommend addressing your blood pressure first.
The main concern is whether a temporary increase in blood pressure could pose a significant health risk. For many people whose blood pressure is well controlled – including with medication – Spravato may still be an appropriate treatment option.
Spravato and benzodiazepines
Benzodiazepines are a group of medications commonly prescribed for anxiety, panic attacks, and certain sleep disorders. They include medications such as Xanax® (alprazolam), Ativan® (lorazepam), Klonopin® (clonazepam), and Valium® (diazepam).
Taking a benzodiazepine does not automatically mean you aren’t a candidate for Spravato.
Both Spravato and benzodiazepines cause sedation, and using them together can increase that effect. This is a real clinical consideration – but it’s a manageable one. In practice, providers will review the specific medication, your dosage, and how often you take it. In some cases, they may simply recommend adjusting the timing of certain medications around treatment sessions or taking additional precautions to reduce the risk of excessive sedation.
It’s important not to stop taking a prescribed benzodiazepine without medical advice. The right approach is to disclose everything you’re taking during your evaluation so that a safe treatment plan can be put in place.
Can I take Spravato if I smoke weed?
This is a question many people are hesitant to ask – but it’s an important one.
Occasional cannabis use does not necessarily mean you can’t receive Spravato. However, because both cannabis and Spravato can affect alertness, blood pressure, and how you feel during treatment, it’s important that your provider understands how often you use cannabis and whether it could affect your care.
Your evaluation will also include questions about alcohol use, recreational drugs, and any history of substance misuse, dependence, or addiction.
This isn’t because a previous substance use disorder automatically rules out Spravato. However, Spravato is a Schedule III controlled medication and, like any controlled substance, it needs to be prescribed carefully. A history of substance misuse doesn’t necessarily prevent someone from receiving Spravato, but it may affect how treatment is planned, whether additional monitoring is recommended, or whether another treatment approach would be safer.
The most important thing is to be completely open and honest during your evaluation.
Your provider isn’t asking these questions to judge you, and they aren’t looking for reasons to refuse treatment – they’re gathering the information they need to recommend the safest and most effective option for you.
Insurance, Ohio Medicaid, and practical requirements
Insurance is another common concern for people considering Spravato treatment.
Many commercial insurance plans, Ohio Medicaid plans, and Medicare Part B often provide coverage for Spravato when medical necessity criteria are met. Most plans require prior authorisation, which is a standard part of the approval process for this treatment.
At REACH, our team can explain your coverage options, work with your insurance provider, and help manage the prior authorisation process. During your evaluation, we’ll also discuss any practical requirements, such as attending treatment sessions in a certified clinic and arranging transportation home afterwards.
What if I don’t qualify for Spravato?
Not everyone who is evaluated for Spravato will go on to receive it, but that doesn’t mean you’ve run out of treatment options.
In some situations, you may simply not qualify yet – perhaps needing further documentation of previous treatment, better control of an underlying health condition, or an additional medication trial before insurance approval. These are temporary barriers, not permanent ones.
In other cases, your provider may feel that another treatment is more appropriate based on your symptoms, medical history, or individual needs.
Depending on your situation, this might include:
- Adjusting your current medications.
- Trying a different antidepressant strategy.
- Psychotherapy.
- Other evidence-based treatments for treatment-resistant depression.
- Referral for another level of psychiatric care when appropriate.
Depression treatment isn’t one-size-fits-all, and Spravato is just one of several evidence-based options available.
This is why a proper evaluation is so important.
At REACH, the aim of a psychiatric evaluation is never simply to determine whether you qualify for one specific treatment – it’s to identify the approach most likely to help you move forward safely and effectively.
The best way to find out if you qualify for Spravato in Ohio
If you’re living with treatment-resistant depression in Ohio and wondering whether Spravato could help, the best next step is a comprehensive psychiatric evaluation.
Eligibility isn’t about passing or failing a test. It’s about making sure Spravato is the right treatment for you based on your symptoms, your history, and your overall health.
Many concerns that people assume will disqualify them from Spravato treatment – high blood pressure, benzodiazepine use, occasional cannabis use, or a past history of substance misuse – don’t automatically rule out treatment. They simply mean your provider will take a closer look to make sure treatment can be given safely.
To find out whether you’re eligible for Spravato, schedule an evaluation with REACH Behavioral Health. Our team will review your history, answer your questions, and help you understand the treatment options that best fit your individual needs.