Who Is a Candidate for Ketamine Treatment?
Understand who may benefit from Spravato® or IV ketamine: TRD definition, suicidal ideation indication, contraindications, substance history, and what screening involves.
Clinically Reviewed: Board-Certified Psychiatrist |Next Review: February 2026
Key Takeaways
- Spravato® is for adults with TRD (inadequate response to ≥2 antidepressants) or MDD with acute suicidal ideation/behavior.
- IV ketamine for depression is off-label but used in similar populations when appropriate.
- Contraindications include aneurysm, AVM, brain bleed, allergy, and certain medical/substance-use factors.
- Spravato® is used with an oral antidepressant; screening ensures safety and appropriateness.
- Spravato® is not approved for children; use in minors is not standard for depression.
Treatment-Resistant Depression (TRD)
TRD usually means major depressive disorder that has not responded adequately to at least two antidepressant trials (different mechanisms or adequate dose and duration). Spravato® is FDA-approved for adults with TRD when used together with an oral antidepressant. IV ketamine for depression is off-label but often offered in similar situations—when TMS or multiple medications have been tried without sufficient improvement.
Acute Suicidal Ideation or Behavior
Spravato® is also approved for depressive symptoms in adults with MDD who have acute suicidal ideation or behavior. It is used as part of a broader treatment plan; crisis resources (e.g., 988 Suicide & Crisis Lifeline) remain essential. Your team will assess safety and level of care needed.
Contraindications and Safety
Spravato® and ketamine are not used in certain conditions, including aneurysm, arteriovenous malformation (AVM), brain bleed, allergy to ketamine/esketamine, and some unstable cardiovascular or other medical conditions. Substance use history is reviewed because of abuse potential and drug interactions. Pregnancy and breastfeeding are discussed; treatment may not be recommended or may require careful decision-making. Not for use in children (Spravato® is not approved in pediatrics).
Medical and Psychiatric Screening
Before starting, you'll have a medical and psychiatric evaluation: current and past depression treatment, medications, substance use, medical history (especially cardiovascular and neurological), and stability for in-clinic treatment. Blood pressure and other vital signs are monitored. This screening helps ensure Spravato® or IV ketamine is safe and appropriate for you.
Frequently Asked Questions
What is treatment-resistant depression (TRD)?
TRD generally means major depressive disorder that hasn't responded adequately to at least two antidepressants (different classes or adequate dose/duration). Spravato® is FDA-approved for adults with TRD when used with an oral antidepressant.
Can ketamine help with suicidal thoughts?
Spravato® is FDA-approved for depressive symptoms in MDD with acute suicidal ideation or behavior. It is used in addition to other care; crisis support (e.g., 988) remains important. IV ketamine is also used in some settings for acute suicidal ideation, though off-label.
Is ketamine approved for children?
Spravato® is not approved for children. Use in minors would be off-label and is not standard in most clinics. IV ketamine in youth is sometimes used in very specific settings (e.g., research, pain) but not routinely for depression in the same way as in adults.
What contraindications might rule me out?
Contraindications can include aneurysm, AVM, brain bleed, allergy to ketamine/esketamine, and certain unstable medical conditions. Substance use history is reviewed because of abuse potential and interactions. Your doctor will screen for these.
Do I need to be on an antidepressant for Spravato®?
Yes. Spravato® is approved for TRD in adults in combination with an oral antidepressant. Your prescriber will ensure you're on an appropriate antidepressant when starting Spravato®.
What does screening involve?
Screening typically includes psychiatric and medical history, current medications, substance use, cardiovascular and neurological concerns, and pregnancy status. Blood pressure and stability for in-clinic treatment are also assessed.