Is Spravato Worth It? An Honest Cost-Benefit Look for Treatment-Resistant Depression
Whether Spravato is worth it depends on what you're comparing it to. The medication is a real investment in time and money — twice a week for four weeks, then ongoing maintenance. But the cost of doing nothing — staying in treatment-resistant depression — is often invisible until you stop and total it up. Here's an honest cost-benefit look for patients deciding whether to start.
Actual response and remission rates
In clinical trials of treatment-resistant depression, roughly 60 to 70 percent of patients on Spravato (plus an oral antidepressant) showed clinically meaningful response. Roughly half reached remission. These are stronger numbers than what's typical for a third or fourth antidepressant trial. In our clinic, the patterns hold — most patients improve, some substantially.
The cost of doing nothing
Untreated or under-treated depression has costs that don't show up on a bill. Lost productivity at work, often estimated at $5,000 to $15,000 per year for people with moderate depression. Strained relationships. Reduced parenting capacity. Ongoing medications and provider visits that aren't fully working. Quality-of-life loss that's hard to monetize but real.
Cost compared to other treatments
Spravato with commercial insurance is often comparable in monthly cost to a regular psychiatric medication plus provider visits, especially after your deductible is met. TMS (transcranial magnetic stimulation) is also insurance-covered for treatment-resistant depression and runs roughly $200 to $400 per session for about 30 sessions; total covered cost is in the same ballpark. IV ketamine infusions are typically self-pay at $400 to $800 per session, six to eight sessions in induction. ECT (electroconvulsive therapy) is covered but more invasive and time-intensive.
Quality-of-life data patients rarely see
Beyond depression scores, the clinical trials measured things like work and social functioning. Patients who responded to Spravato showed meaningful improvements in both. Anecdotally, the same patterns show up in clinic — people return to work, restart relationships, take on projects they'd been avoiding.
When Spravato may not be worth it
If you haven't tried two antidepressants at adequate dose, insurance may deny coverage and the math changes. If you have certain medical contraindications, the safety profile shifts. If your depression is primarily driven by an untreated medical condition, substance use, or unprocessed trauma, Spravato alone is unlikely to be the full answer. These are the conversations we have during a consult.
How to decide for your specific situation
Run the numbers honestly. Look at what your depression has cost you in money and quality of life over the last two years. Compare that to the time and cost of induction plus six months of maintenance. For most patients who qualify, the comparison is straightforward.
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