What a Spravato (Esketamine) Nasal Spray Session Is Really Like

Before You Walk In

A Spravato (esketamine) nasal spray session takes place at a certified clinic, runs at least two and a half hours from check-in to discharge, and moves through three phases: a pre-dose check, self-administration of the spray under staff supervision, and a required two-hour monitoring period while the medication takes effect. Reading a clinical description of esketamine is one thing. Knowing what a Spravato nasal spray session is really like, from the moment you arrive to the moment someone drives you home, is another.

Esketamine is the active ingredient in Spravato, an FDA-approved nasal spray for treatment-resistant depression that acts as an NMDA receptor antagonist, a drug class that blocks a specific brain receptor involved in mood regulation. It is the only ketamine-derived medication with full FDA approval for psychiatric use, and unlike other forms of ketamine therapy, it follows a standardized protocol. You cannot take Spravato home. Every dose is given at a certified healthcare facility under direct medical supervision.

Arriving at the Certified Facility

You will check in at a certified healthcare facility, which could be a psychiatrist's office, a hospital outpatient clinic, or a specialized mental health center enrolled in the FDA's Risk Evaluation and Mitigation Strategy (REMS) program for Spravato. According to the FDA, Spravato must be administered under direct observation of a healthcare provider at a certified site, with monitoring for at least two hours after each dose.

Most providers recommend arriving a few minutes early, especially for your first visit, to confirm your identity and sign consent forms. Staff will check your blood pressure before dosing, since esketamine can temporarily raise it, and readings are checked multiple times during the visit. If your blood pressure is too high beforehand, your provider may delay treatment. If you're working through a first appointment checklist, confirming your ride home and any blood pressure medication timing are two items worth double-checking in advance.

Preparing for the Spray

Most providers recommend not eating for at least two hours before your session and avoiding liquids for at least 30 minutes beforehand, which lowers the risk of nausea, one of the more common Spravato side effects. Skip nasal decongestants or corticosteroid sprays for at least an hour before dosing, since they can interfere with absorption.

You'll be guided to a treatment area, often a private or semi-private room with a recliner, blankets, and dim lighting, and some facilities offer eye masks or headphones with calming music. Unlike an IV ketamine infusion, where a nurse administers the medication directly, Spravato is self-administered. Staff walk you through the technique and remain with you throughout.

What the Experience Feels Like

The spray tastes bitter and medicinal, since some of it drips down the back of your throat, though the taste fades quickly. Effects typically begin 15 to 20 minutes after the last spray. Here is what many patients report, though the experience varies from person to person and can even vary between your own sessions.

The Onset

You may first notice heaviness in your body or a subtle shift in awareness. Colors might seem slightly different, sounds can feel more distant, and you may feel a gentle detachment from your surroundings, as though the world has gone slightly soft or unreal.

The Peak

Effects tend to peak 20 to 40 minutes after administration, when dissociation, a temporary sense of detachment from your body or surroundings, is most pronounced. Patients commonly describe:

• A floating sensation, as though your body is lighter than usual or gently drifting
• Altered perception of time, where minutes feel stretched or compressed
• Visual changes, such as distorted shapes, brighter colors, or patterns behind closed eyes
• Emotional shifts, from calm and clarity to sadness, nostalgia, or relief surfacing
• Dreamlike, free flowing thoughts that connect ideas in unusual ways

The Two-Hour Monitoring Period

After dosing, you remain at the facility for at least two hours, which the FDA requires for every Spravato administration. Staff check your blood pressure at roughly 40 minutes, one hour, and two hours after dosing, and periodically ask how you're feeling. During this window you can close your eyes and rest, listen to music, or sit quietly; journaling is possible but often difficult during peak effects. Most pronounced effects fade within 60 to 90 minutes, and by the end of the monitoring period most patients feel close to normal, if a little tired or spacey. For context on how this compares to other formats, see how ketamine session length varies by treatment type.

Treatment Schedule and What to Expect Over Time

Spravato follows a structured schedule: twice weekly for weeks 1 through 4, once weekly for weeks 5 through 8, then once weekly or every other week from week 9 onward, adjusted based on your response. It is prescribed alongside an oral antidepressant rather than as a standalone treatment; see our overview of the ketamine treatment process for how this fits into a broader care plan.

Many patients notice some improvement within the first week or two, though the pace varies. Commonly reported changes include a lift in the heavy feeling of depression, more interest in daily activities, better sleep, reduced anxiety, and a renewed sense of possibility. Spravato is not a cure and does not work for everyone, but for patients with treatment-resistant depression, defined by Mayo Clinic as depression that has not responded to at least two different antidepressant treatments, it offers a different mechanism after other options have been tried. According to the National Institute of Mental Health, ketamine-based treatments are being studied as rapid-acting options because they can improve mood within hours rather than the weeks typically required by standard oral antidepressants.

Your Experience Is Your Own

Some patients find the dissociative effects pleasant or even meaningful, others find them tolerable but strange, and a smaller number find them uncomfortable. There is no single right way to experience Spravato. What matters most is the overall trajectory of your mood and functioning across the treatment schedule, not any one session. If something feels off before, during, or after a session, tell your treatment team. Reviewing our guide to preparing for treatment before your first visit can also help you know what to expect.