What Is Treatment-Resistant Depression?

Treatment-resistant depression (TRD) is defined as MDD that has failed to respond adequately to at least two different antidepressants, each at an adequate dose for an adequate duration (typically at least 6 weeks). An estimated 30% of people with MDD have TRD — representing millions of patients who are suffering despite being treated.

How Spravato® Works

Esketamine is an NMDA receptor antagonist. Rather than acting on the serotonin system, it blocks NMDA glutamate receptors and triggers a rapid cascade of neuroplasticity — including synaptogenesis in the prefrontal cortex. In plain terms: it rapidly restores synaptic connections that depression has damaged.

Why Speed Matters: Traditional antidepressants take 4–8 weeks to reach therapeutic effect. Spravato® often produces measurable improvement within 24–48 hours — critically important for patients with severe depression or suicidal ideation who cannot safely wait weeks for relief.

FDA Approvals

  • Treatment-Resistant Depression (TRD): Adults who have not responded adequately to at least two oral antidepressants
  • MDD with Acute Suicidal Ideation (MDD-SI): The only FDA-approved treatment specifically for this indication

What the Treatment Experience Looks Like at UMG

  1. Pre-treatment evaluation — Comprehensive psychiatric assessment to confirm diagnosis and document prior treatment failures
  2. Insurance & prior authorization — Our team manages the entire PA process
  3. Induction phase (Weeks 1–4) — Two sessions per week, 2 hours each; driver required
  4. Maintenance phase — Sessions taper to weekly, then every two weeks
  5. Ongoing psychiatric management — Spravato® works best alongside an oral antidepressant

In the pivotal TRANSFORM trials leading to FDA approval, esketamine produced statistically significant reductions in depression scores, with onset of action within 24 hours in many patients. Approximately 70% of TRD patients experience a meaningful clinical response.