What Actually Happens During a Spravato Session
If You Are Considering Spravato, You Probably Have Questions
If your psychiatrist has recommended Spravato (esketamine) for treatment-resistant depression, you are likely wondering what the experience is actually like. It is one thing to read about a medication online and another entirely to know what will happen from the moment you walk into the clinic to the moment you head home. That gap between information and experience is where anxiety tends to build, and it is completely normal.
Spravato is not your typical antidepressant. You do not pick it up at a pharmacy and take it at home. It is a nasal spray that must be self-administered under medical supervision at a REMS-certified treatment center, and there is a mandatory observation period afterward. These requirements exist for good reason, and understanding them ahead of time can make your first session far less intimidating. At Serenada Mental Health, we walk every patient through the process before their first appointment so there are no surprises. This guide covers everything you need to know.
Before You Arrive: Preparation Matters
Your Spravato journey actually starts well before you step into the clinic. A few important steps need to happen first, and following them closely helps ensure your session goes smoothly. The preparation phase sets the foundation for a safe and effective experience.
The Eligibility Conversation
Before anything else, you will have a thorough consultation with a psychiatric provider. Spravato is FDA-approved for adults with treatment-resistant depression (TRD), meaning you have tried at least two antidepressants at adequate doses without sufficient improvement. It is also approved for adults with major depressive disorder and acute suicidal ideation or behavior. As of January 2025, Spravato became the first and only FDA-approved standalone monotherapy for TRD, meaning you no longer need to take an oral antidepressant alongside it. Your provider will review your full psychiatric history, current medications, and medical conditions to confirm Spravato is appropriate for you. If you are looking for a qualified provider in Central Texas, our team at Serenada specializes in this evaluation.
What to Do (and Avoid) Before Your Session
The night before your session, avoid eating for at least two hours prior to your appointment, as nausea is one of the most common side effects and an empty stomach significantly reduces that risk. Do not drink liquids for 30 minutes before your visit. Skip any nasal corticosteroid sprays on the day of treatment, since they can interfere with absorption. Perhaps most importantly, arrange transportation home. You will not be allowed to drive yourself after a Spravato session because the medication can cause sedation and dissociation. This is not a suggestion; it is a hard requirement under the SPRAVATO REMS Program. A friend, family member, or rideshare service all work fine, but you need a plan in place before you arrive. You should also plan to avoid alcohol for at least 24 hours before your session, as it can amplify the sedative effects of esketamine.
Arrival and Check-In: The First 15 Minutes
When you arrive at a REMS-certified Spravato treatment center, the staff will guide you through a brief check-in process. This is not a rushed handshake and a clipboard. Your provider will take a baseline blood pressure reading, check how you are feeling that day, and confirm you have followed the pre-treatment guidelines. They will also review any medications you are currently taking and ask about changes since your last visit.
You will be shown to a comfortable treatment area, typically a private or semi-private room with a recliner or comfortable chair. Many clinics set up these spaces to be calming: dim lighting, blankets, and the option to listen to music. Think of it less like a typical doctor visit and more like a dedicated space where you can settle in for the next couple of hours. At Serenada, we have designed our treatment rooms with patient comfort specifically in mind, because the environment matters when you are going through this kind of therapy.
Self-Administering the Nasal Spray: What the Data Says
Here is a detail that surprises many patients: you administer the Spravato nasal spray yourself, but you do it under the direct supervision of a healthcare provider. The medication comes in a single-use device that delivers 28 mg per spray. Your prescribed dose determines how many devices you will use. A 56 mg dose requires two devices, and an 84 mg dose requires three. According to the FDA prescribing information, the recommended starting dose is 56 mg or 84 mg twice weekly during the first four weeks, known as the induction phase.
Your provider will hand you the device and give step-by-step instructions. You spray it into one nostril, wait about five minutes, then spray into the other nostril if using additional devices. You will be asked to sniff gently, not forcefully, to avoid the medication dripping down your throat. If it does drip, do not swallow it; simply let your provider know and they will provide a tissue. After each spray, you rest quietly. The entire self-administration process takes roughly 15 to 20 minutes. It is natural to feel a bit nervous the first time, but your care team will be right there with you, talking you through every step.
Induction Phase (Weeks 1-4): 56 mg or 84 mg, twice weekly
Optimization Phase (Weeks 5-8): 56 mg or 84 mg, once weekly
Maintenance Phase (Week 9+): 56 mg or 84 mg, once weekly or every 2 weeks
Starting Dose: Typically 56 mg on Day 1; may increase to 84 mg based on response
The Observation Period: What Happens During Those Two Hours
After you finish administering the nasal spray, the clock starts on a mandatory two-hour observation period. This is the centerpiece of the REMS program and the part patients tend to ask about most. You will remain in the clinic under the direct supervision of healthcare staff the entire time.
What You Might Feel
The most commonly reported experience is dissociation, which occurred in 41% of patients in clinical trials. People describe it in different ways: feeling floaty, disconnected from their surroundings, as if they are in a dream, or mildly detached from their body. It sounds unsettling in writing, but most patients find it tolerable and some even find it calming. Dissociation typically peaks within 30 to 40 minutes and fades well before the observation period ends. You might also experience dizziness (reported in 29% of patients), nausea (28%), or sedation (23%), according to research published in PMC/NIH. Some patients notice mild visual distortions or feel a sense of heightened introspection. These effects are temporary and generally resolve within an hour or two.
How Staff Monitor You
During the observation window, your care team will check in on you regularly. They will monitor your blood pressure, typically at around 40 minutes post-dose and again before you are cleared to leave, because Spravato can cause a temporary increase in blood pressure that may last about four hours. They will assess your level of alertness, check for any signs of respiratory changes, and ask how you are feeling emotionally and physically. If at any point you feel uncomfortable, anxious, or confused, you can signal the staff and they will respond immediately. You are never left to manage the experience alone.
What to Bring and How to Pass the Time
Many patients bring headphones and listen to calming music or a guided meditation. Some bring an eye mask and simply rest. A journal can be helpful too, since the dissociative state sometimes brings up thoughts or feelings that patients want to capture while they are fresh. What you should not bring is work, a laptop, or anything that demands focus and concentration. This is a time to let the medication do its work while you relax as much as possible. Some patients also find it helpful to set an intention before the session begins, something simple like "I am open to feeling better" or "I am giving myself permission to rest." It sounds small, but it can create a sense of purpose and calm that carries through the entire experience.
After the Session: Heading Home and What Comes Next
Before you are discharged, your provider will confirm that your blood pressure has returned to a safe range, that you are alert and oriented, and that any dissociation or sedation has resolved. This is a clinical decision, not a formality. Once you are cleared, your designated driver can take you home.
Plan to take it easy for the rest of the day. Most patients feel back to their baseline within a few hours, but some report lingering drowsiness or a mild foggy feeling. Avoid driving, operating machinery, or making major decisions until the next day. You can eat and drink normally once the nausea risk has passed. It is also a good idea to avoid alcohol for the remainder of the day, as combining it with esketamine can worsen sedation. Your provider will give you specific aftercare instructions, and they will schedule your next session before you leave. To learn more about how our clinic handles follow-up care, visit our Spravato Treatment page.
How Quickly Does Spravato Start Working?
This is one of the most common questions patients ask, and the answer is one of Spravato's biggest advantages over traditional antidepressants. While oral antidepressants typically take four to six weeks to show meaningful effects, many patients begin noticing initial mood changes within 24 to 72 hours after their first Spravato session. Some patients report subtle improvements even on the first day. That said, the full benefit usually becomes clearer over the induction phase as the medication builds in your system.
Clinical data supports this timeline. In the Phase 3 monotherapy trial published in JAMA Psychiatry, 22.5% of patients on Spravato achieved remission at four weeks compared to 7.6% on placebo, which is nearly a threefold difference. By day 74, 65% of patients achieved at least a 50% reduction in their depression scores. If you want to dive deeper into the clinical evidence, our blog on advanced treatment options for depression covers the data in detail.
Side Effects and Safety: The Full Picture
Every medication has side effects, and Spravato is no different. The key is understanding which ones are common, which are rare, and what safeguards are in place to protect you. Being informed does not mean being afraid; it means being prepared. Here is an honest overview based on clinical trial data and the FDA label.
The most common side effects are dissociation (41%), dizziness (29%), nausea (28%), sedation (23%), decreased feeling or sensitivity (18%), vertigo (16%), and increased blood pressure. Most of these are temporary, peaking during the observation period and resolving before you leave the clinic. Spravato carries a Boxed Warning for two reasons: abuse potential (it is a Schedule III controlled substance, related to ketamine) and the risk of increased blood pressure and suicidal thinking in young adults under 25, which is a class-wide warning for all antidepressants.
It is worth noting what Spravato does not typically cause. Unlike many oral antidepressants, it has a very low incidence of sexual dysfunction and weight gain, which are two of the most common reasons people stop taking traditional medications. Clinical trials showed low discontinuation rates due to side effects, suggesting that most patients find the side effect profile manageable. For a deeper look at potential side effects, the Mayo Clinic's esketamine guide is an excellent resource.
Insurance Coverage and Access at Serenada
Good news on the insurance front: coverage for Spravato has improved significantly since its initial approval. Most major commercial plans, Medicare, many Medicaid programs, and the VA now cover Spravato for its FDA-approved indications. Janssen, the manufacturer, also offers patient assistance programs for those who qualify. If insurance questions are holding you back from starting treatment, we encourage you to reach out through our contact page, and our team can help verify your benefits before your first appointment.
At Serenada Mental Health, we offer Spravato therapy at our Georgetown, Texas location, serving patients from Waco, Austin, and throughout Central Texas. Our clinic is REMS-certified, our treatment rooms are designed for comfort, and our psychiatric team has deep experience with esketamine therapy. We also offer complementary treatments including sublingual ketamine and comprehensive medication management, which you can explore on our services page.
The Bottom Line
A Spravato session is not like any doctor appointment you have had before. It takes longer, it involves a supervised observation period, and it can produce unusual sensations like dissociation. But those safeguards exist for your protection, and the experience is something most patients adapt to quickly. What makes it worthwhile is the potential for real relief, often within days rather than the weeks or months that oral antidepressants require. If you have been cycling through medications without improvement, Spravato offers a genuinely different mechanism of action and a different kind of hope.
If you are ready to explore whether Spravato is right for you, or if you simply want to talk through your options with an experienced psychiatric provider, we are here to help. Schedule a consultation with Serenada Mental Health today. No one should have to navigate treatment-resistant depression alone.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Spravato must be administered under medical supervision at a REMS-certified facility. Individual experiences may vary. If you are experiencing a mental health crisis, call or text 988 to reach the Suicide & Crisis Lifeline.