Before You Walk In
If you have been prescribed Spravato (esketamine nasal spray) for treatment-resistant depression, you are probably wondering what the actual experience is like. Reading clinical descriptions is one thing — understanding what it really feels like, from the moment you arrive to the moment you leave, is another.
Spravato is the only FDA-approved form of ketamine for psychiatric use, and unlike other ketamine treatments, it follows a specific, standardized protocol. Every Spravato session takes place at a certified healthcare facility under medical supervision. You cannot take it home. Here is a detailed look at what a typical session involves.
Arriving at the Facility
You will arrive at a certified REMS (Risk Evaluation and Mitigation Strategy) healthcare facility — this could be a psychiatrist's office, a hospital outpatient clinic, or a specialized mental health center. Plan to be there for at least two and a half hours, as the FDA requires a two-hour monitoring period after administration. Spravato works by modulating NMDA receptors in the brain.
Most providers recommend arriving a few minutes early, especially for your first visit. You will check in, confirm your identity, and sign any necessary consent forms. If this is your first session, you may have a brief conversation with the provider about what to expect.
Before the session, your provider will check your blood pressure. Spravato can temporarily raise blood pressure, and your readings will be checked multiple times during the visit. If your blood pressure is too high before the session, your provider may delay treatment.
The Preparation
Most providers recommend not eating for at least two hours before your session and not drinking liquids for at least 30 minutes before. This reduces the risk of nausea, which is one of the more common side effects. If you use a nasal decongestant or nasal corticosteroid spray, avoid using it for at least an hour before your Spravato session, as these can affect absorption.
You will be guided to a comfortable treatment area. Many facilities have private or semi-private rooms with recliners, blankets, and dim lighting. Some offer eye masks and headphones with calming music. You may want to bring your own headphones, a playlist, or a comfort item.
The staff will explain the self-administration process. Unlike an IV infusion, where a nurse administers the medication, you will spray the Spravato yourself — but under direct supervision.
Administering the Spray
The Spravato device looks like a small nasal spray applicator. Each device delivers two sprays — one in each nostril. Depending on your prescribed dose, you will use either two or three devices per session (for a total of 56 mg or 84 mg).
Here is the step-by-step process:
- The staff member will hand you the first device and walk you through the technique.
- You tilt your head back slightly, insert the tip into one nostril, and press the plunger while breathing in gently through your nose.
- You repeat with the other nostril.
- After the first device, you wait five minutes before using the next one.
- If you are using three devices, you will repeat the process a third time.
The entire administration takes about 10 to 15 minutes. The taste — because some of the spray drips down the back of your throat — is bitter and medicinal. Some patients find this mildly unpleasant, but it fades quickly. Try to avoid blowing your nose or sniffing forcefully for at least 15 minutes after the last spray to maximize absorption.
What the Experience Feels Like
The effects of Spravato typically begin within 15 to 20 minutes after the last spray. The experience varies from person to person and can even vary between sessions, but here is what many patients report:
The Onset
You may first notice a feeling of heaviness in your body or a subtle shift in your awareness. Colors might seem slightly different, sounds might feel more distant or muffled, and you may start to feel a gentle detachment from your surroundings. Some people describe it as the world becoming "softer" or "slightly unreal."
The Peak
About 20 to 40 minutes after administration, the effects tend to reach their peak. This is when dissociation is most pronounced. You may feel:
- A floating sensation — as though your body is lighter than it should be, or you are gently drifting.
- Altered perception of time — minutes may feel stretched or compressed. You might lose track of how long you have been sitting there.
- Visual changes — things may look slightly distorted, colors may seem brighter, or you might notice patterns or lights with your eyes closed.
- Emotional shifts — some patients feel a wave of calm or peace. Others notice emotions bubbling up — sadness, nostalgia, or relief. Some feel a sense of clarity about something that has been troubling them.
- Dreamlike thinking — your thoughts may flow in unusual directions, connecting ideas in ways they normally would not. Some patients describe a "stream of consciousness" quality to their thinking.
The Important Reassurance
Throughout this experience, you remain conscious. You can speak if you need to, you can open your eyes, and you know where you are. This is not general anesthesia — it is a mild to moderate altered state. If you feel anxious, reminding yourself that the effects are temporary and will pass within the next hour or so can be very grounding.
Some sessions feel more intense than others. Your first session may feel particularly unfamiliar simply because you do not know what to expect. Most patients find that the experience becomes more comfortable and familiar over time.
The Two-Hour Monitoring Period
After administration, you will remain at the facility for at least two hours. During this time, staff will periodically check your blood pressure — typically at 40 minutes, one hour, and two hours after dosing. They will also assess how you are feeling and watch for any adverse effects.
During this time, you can:
- Close your eyes and rest
- Listen to music
- Sit quietly with your thoughts
- Journal if you feel inclined (though writing may be difficult during the peak effects)
Most of the pronounced effects subside within 60 to 90 minutes. By the end of the two-hour monitoring period, most patients feel largely back to normal — perhaps a bit tired or spacey, but functional.
After the Session
When the monitoring period is complete, the staff will do a final assessment and make sure you are feeling stable. Even though you will likely feel mostly normal, you will not be able to drive yourself home. The FDA requires that you not drive or operate heavy machinery until after a full night's sleep. Arrange for a ride home in advance — this is non-negotiable.
For the rest of the day, take it easy. Many patients feel drowsy or emotionally tender after their session. Some feel a subtle sense of lightness or hopefulness. Others feel tired and need to rest. All of these responses are normal.
Avoid making important decisions, drinking alcohol, or taking sedating medications for the rest of the day. Eat a light meal when you feel ready, and stay hydrated.
The Treatment Schedule
Spravato follows a structured dosing schedule:
- Weeks 1-4: Twice weekly sessions
- Weeks 5-8: Once weekly sessions
- Week 9 onward: Once weekly or once every two weeks
Your provider may adjust this schedule based on your response. The treatment is designed to be used alongside an oral antidepressant — Spravato is not intended as a standalone treatment.
What Results to Expect
Many patients notice some improvement within the first week or two of treatment, though the degree varies. Some feel a meaningful shift after just a few sessions, while others notice a more gradual building of benefits over the first month.
The most common improvements patients report include:
- A lifting of the heavy, oppressive feeling of depression
- More interest in activities and people
- Better sleep
- Reduced anxiety
- A sense of possibility or hope that had been absent
- More energy and motivation
Spravato is not a cure, and it does not work for everyone. But for patients with treatment-resistant depression, it represents a genuinely different approach that has helped many people who had run out of options.
Your Experience Is Your Own
Every patient's Spravato journey is unique. Some find the dissociative experience pleasant and even therapeutic. Others find it unusual but tolerable. A small number find it uncomfortable. There is no "right" way to experience it. What matters is the overall trajectory of your mood and functioning over the course of treatment.
If you have questions or concerns at any point — before, during, or after your sessions — speak up. Your treatment team is there to support you, and the more they understand about your experience, the better they can tailor your care.
References
- Mayo Clinic: Treatment-Resistant Depression — Mayo Clinic overview of treatment-resistant depression, including esketamine nasal spray
- NIMH: Depression Overview — National Institute of Mental Health information on depression symptoms and treatment
- NIMH: Cracking the Ketamine Code — NIMH feature on the research behind ketamine and esketamine as rapid-acting antidepressants