Treatment-Resistant Depression: Spravato, Ketamine & TMS

What advanced treatments, like Spravato or TMS, are available through telehealth for treatment-resistant depression?

For treatment-resistant depression, options include Spravato and TMS in person at Calm Clinic in Las Vegas, and at-home ketamine via telehealth in some states. Spravato and TMS require clinic visits. Ketamine and follow-up care often happen on video. What you can use depends on your state and a visit with a licensed provider.

Advanced Options for Treatment-Resistant Depression

Standard antidepressants haven't worked. You're exhausted. You're not out of options.

Treatment-resistant depression often needs care beyond first-line meds: FDA-approved Spravato, off-label ketamine, and TMS. Each option requires a clinical evaluation. None guarantees a specific outcome.

Your next step is a visit with a licensed clinician. The first evaluation lasts 30 to 40 minutes. Your provider reviews what you've tried, what hasn't worked, and what might fit now.

Treatment Options and State-Specific Requirements

Spravato (esketamine)
Spravato is an FDA-approved nasal spray for treatment-resistant depression. You take it in person at our Las Vegas office. Not near Las Vegas? Call 702-848-2256 to ask about options.

At-Home Ketamine Therapy
Ketamine is prescribed off-label and is not FDA-approved for any psychiatric condition. At-home ketamine via telehealth is available only in the states listed on our ketamine page. We can't prescribe it in the states where we can't prescribe controlled substances, and it isn't offered in Texas. In the other states we serve, call 702-848-2256 before booking a ketamine visit. Appointments are on secure video. Your provider decides if you're a fit based on your history.

TMS
We offer TMS in person at Calm Clinic in Las Vegas (TMS at Calm Clinic). TMS uses magnetic pulses to target brain areas tied to mood. Not near Las Vegas? Ask your provider about TMS closer to home. Your psychiatrist stays in charge of your overall care.

Telehealth and In-Person Rules
We offer telehealth in 47 U.S. states and the District of Columbia. Most visits are on secure video.

Georgia requires an in-person visit within 12 months. Visits before then can be by secure video. Call (702) 848-2256 to schedule. In Alabama, Arkansas, Hawaii, Louisiana, Maine, Massachusetts, Minnesota, Missouri, Oklahoma, Pennsylvania and West Virginia, we don't prescribe controlled substances, including ketamine. We can still evaluate you and provide therapy and non-controlled medication management when clinically appropriate.

Insurance Coverage, Costs, and Benefit Verification

Coverage depends on your state and plan: we're in network with Aetna, Cigna and UnitedHealthcare in many states, and you can check your plan by state. Insurance visits need at least 72 hours advance notice so we can verify your benefits before your first session. You'll know what your plan covers and any out-of-pocket costs upfront.

Self-pay visits are $150 for new and follow-up appointments. We also provide superbills for out-of-network reimbursement when your plan allows it.

Coverage for Spravato and TMS often requires records of prior medication trials. Your provider helps gather that history and submits it to your insurer when appropriate.

The booking tool shows real open times.

Ongoing Care with the Same Provider

Treatment-resistant depression doesn't resolve in one visit. You need a provider who knows your history and adjusts your plan as things change.

You'll see the same clinician at each visit unless you ask to switch. That continuity helps your provider spot patterns over weeks and months: sleep changes, mood shifts, side effects, and life stressors. They can tell a setback from a treatment that isn't working. They can also coordinate care when you're using more than one therapy.

Follow-up visits are shorter but still focus on your whole picture. If a treatment isn't helping, your provider works with you to adjust the plan.

Important to Know

Controlled substances are not guaranteed and may require an in-person visit where required by law. Federal telehealth rules for controlled substances are temporary through Dec 31, 2026 and may change (federal rule).

This content is educational and not a substitute for professional medical advice, diagnosis, or treatment.

For mental health emergencies, call 988 or go to the nearest emergency room. For non-emergency questions, contact us at 702-848-2256.

Frequently Asked Questions

How do I know if I'm eligible for ketamine or Spravato?

Your provider reviews your history at your first visit. Most people need records of failed trials of at least two antidepressants before advanced options.

Can I use my insurance for these treatments?

Coverage depends on your state and plan: we're in network with Aetna, Cigna and UnitedHealthcare in many states, and you can check your plan by state. Book insurance visits at least 72 hours ahead so we can check your benefits before your first session.

What if I live in Georgia or another state with different rules?

Georgia requires an in-person visit within 12 months. Visits before then can be by secure video. Call (702) 848-2256 to schedule. In Alabama, Arkansas, Hawaii, Louisiana, Maine, Massachusetts, Minnesota, Missouri, Oklahoma, Pennsylvania and West Virginia, we don't prescribe controlled substances, including ketamine, but we can still evaluate you and manage non-controlled medication when clinically appropriate.

Is TMS available through your clinic?

Yes. We offer TMS in person at Calm Clinic in Las Vegas (TMS at Calm Clinic). Your provider keeps managing your medications during a TMS course.

What happens if a treatment isn't working?

Your provider adjusts the plan with you. Seeing the same clinician each visit helps them track what is and isn't working.