Who Is a Good Candidate for Ketamine Therapy?

August 27, 2026
Depression Treatment, Spravato

For some people, depression does not improve enough with the first treatment, the second treatment, or even several carefully planned attempts. When symptoms continue despite medication and other support, it may be time to discuss additional options with a qualified mental health provider.

Many people who ask about ketamine therapy for depression have already tried to do the right things. They have talked with a provider, started medication, waited for it to work, adjusted doses, or tried more than one antidepressant. Some have also tried therapy, lifestyle changes, or other forms of support.

At Freedom Behavioral Health Solutions, when we talk about ketamine therapy for depression, we are referring to SPRAVATO®, the brand name for esketamine nasal spray. SPRAVATO® is a prescription treatment option for certain adults with treatment-resistant depression. It is given in a supervised clinical setting and is not the same as recreational ketamine or street drug use.

Not everyone is a candidate for SPRAVATO® / esketamine treatment. The best way to know whether it may be appropriate is to meet with a qualified mental health provider who can review your symptoms, treatment history, medical background, medications, and safety considerations.

Still, there are some common signs that may suggest it is worth having the conversation.

You May Be a Candidate If Depression Has Not Improved After Multiple Medications

SPRAVATO® / esketamine is generally considered for adults with treatment-resistant depression. This often means a person has tried at least two antidepressant medications without enough improvement.

That does not always mean the medications did nothing at all. Some people have a partial response, but still struggle with symptoms that interfere with daily life. Others feel better for a short time, then symptoms return. Some stop medications because side effects make them hard to tolerate.

A provider will usually want to know:

Which medications you have tried

How long you took each medication

What doses were used

Whether you took them consistently

What side effects you experienced

Whether anything helped, even a little

This history matters because it helps the provider understand whether your depression may truly be treatment-resistant and whether SPRAVATO® might be a reasonable next step.

If you are not sure what you have taken in the past, that is okay. Bring what you know. Pharmacy records, medication bottles, patient portal history, or notes from past providers may also help.

You May Be a Candidate If Depression Is Still Affecting Daily Life

A good candidate for ketamine therapy is not defined only by a medication list. Providers also want to understand how depression is affecting your life right now.

Depression can show up in many ways. Some people feel deeply sad or hopeless. Others feel emotionally numb, irritable, exhausted, or disconnected from the people around them. Depression may affect sleep, appetite, motivation, focus, work, school, relationships, or the ability to take care of basic responsibilities.

You may be ready to ask about SPRAVATO® if depression is still interfering with your life even after treatment. That might sound like:

“I can function, but I do not feel like myself.”

“I have tried medication, but I still feel stuck.”

“My depression keeps coming back.”

“I do not enjoy things the way I used to.”

“I am tired of waiting for something to work.”

These are important concerns to bring to a provider. You do not need to prove that things are “bad enough” before asking for help. If your current treatment plan is not giving you enough relief, it is reasonable to ask what other options may be available.

You Should Be Medically Appropriate for Treatment

Because SPRAVATO® is a medical treatment, candidacy is not based only on depression symptoms. Safety matters. Before recommending treatment, a provider will review your medical history. This may include blood pressure, heart health, vascular conditions, neurological history, current medications, substance use history, pregnancy status, and other health factors.

SPRAVATO® can temporarily increase blood pressure and can cause side effects such as sedation, dissociation, dizziness, nausea, anxiety, or feeling disconnected from your surroundings. For many patients, these effects are temporary and monitored in the clinic. But for some people, certain medical risks may make treatment unsafe or require more review.

This is why the evaluation process is so important. A provider is not only asking, “Could this help your depression?” They are also asking, “Is this appropriate and safe for you?”

You Should Be Able to Attend Monitored Appointments

SPRAVATO® is not a medication you pick up at the pharmacy and take home. It is administered in a certified medical setting, and patients are monitored after each treatment.

That means a good candidate also needs to be able to follow the appointment requirements. You should be able to come to the clinic for scheduled visits, remain for monitoring, and arrange transportation home. Patients should not drive themselves after treatment.

This practical piece is sometimes overlooked. Even if SPRAVATO® may be clinically appropriate, the schedule and transportation needs have to work in real life.

Before starting treatment, it can help to think through:

Who can drive you home?

Can your work schedule allow for appointments?

Do you have support if you feel tired afterward?

Can you consistently attend visits during the early treatment phase?

Do you understand that treatment requires monitoring?

At Freedom Behavioral Health Solutions, our team helps patients understand these requirements before starting so they can plan ahead.

Who May Not Be a Good Candidate for SPRAVATO® / Esketamine?

Some people may not be good candidates for SPRAVATO®, or they may need additional medical review before treatment can be considered.

SPRAVATO® may not be appropriate for people with certain blood vessel conditions, a history of bleeding in the brain, or situations where an increase in blood pressure or intracranial pressure could pose serious risk. People with uncontrolled high blood pressure or significant medical concerns may need those issues addressed first.

A provider will also want to carefully review current substance use, history of substance misuse, certain psychiatric symptoms, pregnancy or plans for pregnancy, and medications that may increase sedation or other risks.

This does not mean every concern automatically rules someone out. It means the decision should be made carefully with a qualified provider.

There are also situations where SPRAVATO® may not be the first priority. If someone is in immediate danger, unable to stay safe, experiencing severe crisis symptoms, or at risk of harming themselves, urgent or emergency care may be needed first.

If you are having thoughts of harming yourself or feel like you may not be safe, call or text 988 to reach the Suicide & Crisis Lifeline, call 911, or go to the nearest emergency room.

How We Can Help

If you are trying to determine whether you are a good candidate for ketamine therapy, Freedom Behavioral Health Solutions can help you take the next step. Our team provides mental health care for patients struggling with depression, including treatment-resistant depression. Depending on your needs and location, care may include psychiatric evaluation, medication management, therapy services, SPRAVATO® / esketamine treatment, Deep TMS, or other outpatient treatment options.

When you contact your local Freedom Behavioral Health Solutions, you do not need to already know whether SPRAVATO® is right for you. That is what the evaluation process is for. Our team can help review your history, explain what information may be needed, and guide you toward the most appropriate next step.

Depression can feel discouraging when treatment has not worked the way you hoped. But needing another option does not mean you have failed. It means your care may need a different approach.

If you have tried depression medication and still feel stuck, reach out to Freedom Behavioral Health Solutions to learn more about SPRAVATO® / esketamine treatment and other options for treatment-resistant depression.