Dr. Ben Yudkoff, Co-Founder and Chief Medical Officer at Lumin Health, hosted a Reddit AMA on the Spravato community on November 21, 2025. The below blog post is a recap of one of the questions presented on that AMA, syndicated to the Lumin Health blog in the event that it answers any questions about ketamine therapy, Spravato treatment, or general concerns you may have about treatment.
https://www.reddit.com/r/Spravato/comments/1p2ar6v/ama_im_dr_ben_yudkoff_psychiatrist_cofounder/
Don’t hesitate to get in touch with us if you’re interested in learning more about ketamine for depression at Lumin Health. Thank you once again to the moderators and community members for facilitating such an engaging discussion.
GhostNamedNat:
hello! my psychiatrist recently said I'm now eligible for spravato. he said my current antidepressants do help, but don't completely eliminate my symptoms. I only provide this info as clarification for what I'm asking, not for medical advice.
Generally, how low of a reaction to previous treatments leads you to prescribe spravato? and what antidepressants should you not take alongside it?
Answer:
Thanks GhostNamedNat. While I have my own personal thoughts, let me start by the standards set by the insurance companies: a person's depression, despite treatment, needs to be moderate or severe, depending on the insurance company. This determination is made using evidence-based depression rating tools like the MADRS, the HAM-D, the BDI, and the PHQ9 (a little bit of alphabet soup - but each of these refers to depression rating scales that are used to qualify the severity of the depression, and are also used to measure the treatment response). Eligibility requires that this foundational hurdle be leapt in order to qualify for treatment.
Outside of that core requirement, I think less about how low of a response to antidepressants leads me to recommend Spravato and more about how low of a response triggers a sense of frustration and wanting something more in my patients. If, in speaking with a patient, he/she/they speaks about wanting more, still experiencing the consequences of depression, feeling frustrated that the next level of treatment seems elusive, I start a conversation about Spravato among other kinds of treatments - both other medications and other interventions - that can be helpful for people who haven't experienced an adequate response (by their own determination) with standard antidepressants, alone.
Here's the good news: there are no antidepressants that are contraindicated with Spravato. Some people get fussy with medications that can have blood pressure impacts, especially medications that belong to the SNRI class (eg, venlafaxine, duloxetine, levomilnacipran, and - though they belong to the SSRI class, we should also consider fluoxetine and sertraline) and the NDRI class (bupropion). But, in practice, so long as the medication is not brand new, most people have acclimated to the medication and the actual impact is small, if any. I don't recommend changing medications before treatment and there's little-to-no evidence that a) these medications increase the rate of side effects; b) that these potential side effects couldn't be managed in the moment with as needed anti-side effect meds.
