Spravato treatment is delivered in a calm, monitored clinical setting designed to help you feel supported from your first dose forward. If depression hasn’t responded to oral antidepressants, knowing exactly what happens – before, during, and after each session – makes the decision easier.
Spravato (esketamine) is a prescription nasal spray used alongside an oral antidepressant for treatment-resistant depression. Because it must be administered in a certified healthcare setting under supervision, every session takes place at a certified clinic – you self-administer the spray while a clinical team observes and documents your response.
Unlike traditional antidepressants that act primarily on serotonin, esketamine works on the glutamate system – the brain’s most abundant signaling network. By influencing N-methyl-D-aspartate (NMDA) receptors, it can restore synaptic connections and neural communication in brain regions that regulate mood and emotion. Some patients notice changes within hours or days rather than weeks.
Your first visit is a conversation, not a treatment. A licensed provider reviews your diagnosis, medication history, previous therapies, medical conditions, co-occurring conditions, current symptoms, and treatment goals.
You’ll have time to ask questions about dosing, benefits, side effects, scheduling, and cost – and to leave with a clear picture of whether Spravato belongs in your personalized care plan.
Not everyone is a candidate for Spravato. Before approval, your provider’s team:
Confirms you meet the criteria for treatment-resistant depression
Checks if you’re taking an oral antidepressant
Reviews vital signs, baseline blood pressure, current medications, and any contraindications
Completes enrollment in the required REMS safety program
Handles documentation for insurance or financing
Preparation is simple but important:
Plan to be at the clinic for roughly two hours per visit
Wear comfortable clothing
Bring headphones or music if that helps you relax
Arrange your ride in advance – you will not be able to drive yourself home
Continue your oral antidepressant exactly as prescribed unless your provider instructs otherwise
Avoid food for at least two hours and liquids for 30 minutes before dosing to reduce nausea
If you use a nasal corticosteroid or decongestant, take it at least one hour beforehand
Tell your provider about any new medications, illness, or blood pressure changes since your consultation
You’ll be seated in a private, comfortable treatment space. Your provider confirms your blood pressure, hands you the nasal spray device, and guides you through self-administration. The medication itself takes only a few minutes to administer.
Most people describe the experience as floaty, dreamlike, or gently detached. Some feel mild dizziness or a sense of distance from their surroundings. You’re free to rest with your eyes closed, read, listen to music, or simply sit quietly. Clinical staff remain nearby throughout, so you never have to manage the experience alone.
Blood pressure is checked before dosing, about 40 minutes after, and again as needed
A trained team member monitors alertness, comfort, and side effects, documenting everything in your chart
Your treatment plan is reviewed and adjusted as your progress warrants
If you feel uneasy at any point, say so – reassurance and support are part of the protocol, not an interruption to it.
You’ll remain at the clinic for a minimum of two hours after your dose so dissociative and blood pressure effects can resolve safely. Your provider confirms you’re stable and alert, explains what to expect in the hours ahead, then releases you to your designated driver.
Most sensory effects fade within a couple of hours, though some people feel tired, mellow, or slightly foggy for the rest of the day. Plan a low-key evening: rest, hydrate, eat normally, and keep notes on your mood so your provider can track patterns between visits.
You may not drive yourself home after Spravato – no exceptions. Arrange for a trusted adult, family member, friend, or rideshare service to pick you up. Driving and operating machinery are off-limits until the following day, after a full night’s sleep.
Most patients return to work, school, and normal routines the next morning. Because sessions are scheduled during the provider’s clinic hours, many people build treatment around existing commitments without extended time off. Your provider will give personalized guidance based on how you respond.
Treatment follows a structured, tapering schedule rather than a single dose. Frequency is highest at the start, then gradually spaces out as symptoms improve. Your provider adjusts dosing and intervals based on your response, tolerance, and clinical goals at each visit.
Induction Phase: Twice weekly for the first four weeks
Maintenance Phase: Once weekly for weeks five through eight, then weekly or every other week as determined by your provider
Plan on a minimum commitment of about eight weeks to properly evaluate effectiveness. Many patients continue maintenance dosing for several months. Length of treatment is a shared decision, revisited regularly with your provider rather than fixed in advance.
Improvement often shows up in layers: better sleep, more energy, less rumination, and renewed interest in things you’d stopped enjoying.
Some patients notice shifts within the first 24 hours to one week – considerably faster than the four-to-six weeks typical of oral antidepressants. Others need several sessions before change becomes clear. Both timelines are normal, which is why the induction phase and schedule consistency matter.
Spravato is not a one-time cure, and results vary from person to person. It works best as part of a comprehensive plan that includes medication management, therapy, and healthy routines. If your response is limited, your provider can discuss TMS, IV ketamine, or other alternatives.
Because side effects are monitored on-site, they’re usually identified and managed before you leave. Most are short-lived and diminish over the course of treatment as your body adjusts to dosing.
Dissociation (feeling detached from yourself or reality)
Dizziness, vertigo, and feeling drunk
Nausea and vomiting
Sedation and lethargy
Headache and altered taste
Reduced sensitivity
Anxiety
Temporary blood pressure elevation
These typically peak within the first hour and resolve during your observation period.
Fasting beforehand reduces nausea
Sitting still, dimming lights, and slow breathing ease dizziness and dissociation
Anti-nausea medication can be provided when needed
Dosing can be adjusted if effects feel intense
Trained staff are present for your entire session – report any discomfort immediately, and always report symptoms that persist past the day of treatment
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Find the Right Fit: Compare different clinics and practitioners to find one that offers personalized care and a treatment plan built for your specific needs.
Comprehensive Treatment Options: Discover providers who offer a full spectrum of care, including Spravato, TMS, IV ketamine, and therapy, ensuring you find the best approach for you.
Free Candidacy Quizzes: Use our free online tools for TMS, Spravato, and ketamine to arrive at your consultation informed and prepared.
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Financial Clarity: Get information on insurance and financing options, as many providers in our network offer plans to make treatment more accessible.
How long does a Spravato session last? Budget about two to two and a half hours total: a few minutes of dosing plus the required two-hour monitoring window.
Will I be conscious during my session? Yes. You remain awake and able to communicate throughout, even if you feel dreamlike or detached.
Can I keep taking my current antidepressant? Yes – Spravato is approved for use with an oral antidepressant, not instead of one.
Can I drive myself home after Spravato treatment? No. A responsible adult must drive you home after every session. Don’t drive or operate heavy machinery until the day after a full night’s sleep.
How quickly does Spravato work? Some patients feel improvement within hours or days of the first few treatments. Individual responses vary, and a full course is often needed for sustained relief.
Is Spravato covered by insurance? Many private plans may cover Spravato. Contact your carrier to verify benefits – financing options are also available.
Is Spravato the same as ketamine infusion? No. Spravato is FDA-approved esketamine delivered as a nasal spray; IV ketamine is a different formulation and delivery method. Many providers offer both.
What should I do if I experience side effects? Trained healthcare professionals monitor you throughout your session. Communicate any discomfort immediately so it can be addressed on the spot.
What if Spravato doesn’t work for me? Your provider can discuss TMS, accelerated protocols, IV ketamine, or adjusted medication strategies.
Relief may be closer than it feels right now. Spravato appointments are filling quickly – use our directory to find a provider and reach out today to confirm your candidacy and secure a spot.
