What Is Spravato® and Who Is It For?
Spravato® is the brand name for esketamine, a prescription nasal spray derived from ketamine. It’s sometimes called ketamine nasal spray, but Spravato is the only FDA-approved form of esketamine for depression . Spravato has an approved dosing regimen, safety requirements, and monitoring process.
The FDA has approved Spravato for:
- Adults with treatment-resistant depression (TRD), either alone or with an oral antidepressant.
- Depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior, when used with an oral antidepressant. Spravato is not approved as a replacement for hospitalization when hospitalization is clinically necessary. If you or a loved one are experiencing suicidal ideation you should call 988 to reach the Suicide & Crisis Lifeline.
The TRD indication changed in January 2025, when the FDA approved Spravato as a standalone treatment for adults with treatment-resistant depression. Previously, the it had to be used with an oral antidepressant.
Spravato works differently from many traditional antidepressants, which primarily affect serotonin. Instead, esketamine acts on a different system in the brain involving glutamate and NMDA receptors. Researchers are still learning exactly how these effects lead to improvements in depression, but Spravato offers another treatment approach for people who have not found relief from traditional medications.
What is Spravato Treatment Like?
The Spravato experience is different for each person, but the most recognizable effect is often a temporary change in perception or a feeling of detachment.
Effects usually start soon after you take the nasal spray and fade the same day, and the strongest sensations may not last the entire appointment. The FDA requires at least two hours of observation by a medical professional because you could develop mild to moderate sedation or dissociation. Your provider will be there with you the whole time, checking in on how you’re feeling to make sure you’re comfortable and they’ll help determine when you are clinically stable enough to leave the clinic.
If you’re dealing with treatment-resistant depression and want to talk through your options, our team is happy to help. Most new patients are scheduled within 72 hours of reaching out.
Dissociation, the Most Common Feeling
Dissociation is a temporary feeling of being disconnected from yourself, your thoughts, your surroundings, or your usual sense of time and space.
The FDA prescribing information reports dissociative or perceptual changes, including changes in time or space, derealization, and depersonalization, in 61% to 84% of Spravato-treated patients in clinical studies, depending on the assessment used.
That does not mean every person will have a dramatic dissociative experience. Intensity can vary, and, if anything feels overwhelming, you can tell your care team right away.
Physical and Sensory Effects
The FDA’s current Medication Guide lists several common side effects that you may notice during or shortly after treatment. These can include:
- Dizziness or a spinning sensation
- Nausea
- Sleepiness
- Numbness or decreased sensitivity
- Feeling drunk
- Anxiety
- Increased blood pressure
- Headache
- Vomiting
- Feeling unusually happy or excited
- A lack of energy
These effects usually happen right after the dose and go away the same day. It’s not common to experience all of these side effects, and everyone’s experience is different.
Blood pressure can temporarily rise after Spravato. Most people don’t feel the blood pressure change, which is one of the reasons why it’s important for your clinician to monitor your status. The FDA recommends checking it before treatment and again at about 40 minutes, with additional checks when clinically appropriate.
Hallucinations or other significant perceptual changes can occur in some cases. If you notice something that concerns you, tell the healthcare provider that’s monitoring your status.
Calm, Anxious, or Emotional: All Can Happen
It’s normal to feel anxiety about your first appointment and during your treatment, especially at the beginning when you’re not sure what to expect. Once you’ve had more treatments and are more familiar with the process, many patients report an increased feeling of calm or relaxation.
You may also notice that certain thoughts or emotions feel more prominent while the medication is active. That does not mean you need to analyze them or find a particular meaning in them. You can simply acknowledge the shift and let the experience pass while you move through your treatment.
There is no one correct way to experience Spravato. Any number of thoughts or emotions can come up during treatment. It’s important to understand that anything that comes up typically passes the same day and you are not alone while you’re having your experience.
Individual Variation Is Normal
The intensity of the Spravato experience can vary considerably from one person to another. Your first treatment may also feel different from subsequent sessions as you become familiar with how your body responds and move further into your therapy program.
Most importantly, the intensity of any sensations you might have does not indicate whether Spravato is working. Your provider will look at changes in your depression symptoms over time, rather than using the subjective experience of one particular session as a measure of treatment response.
If the Experience Feels Difficult
Tell the staff right away if you feel uncomfortable.
You do not need to quietly wait for an unpleasant sensation to disappear. The healthcare team is there to monitor you and respond if you become nauseated, anxious, dizzy, excessively sleepy, or otherwise uncomfortable.
Depending on what you are experiencing, the care team may help you adjust your position or the environment around you. This supervised setting is one of the reasons Spravato is administered in a certified healthcare setting rather than taken at home.
Before Your First Dose: Evaluation and Approval
When you’ve decided you’d like to learn more about Spravato, the first step is to schedule an initial appointment with our providers. Your first appointment will be a psychiatric evaluation where one of our providers will review your symptoms, medical history, previous mental health treatments, and current medications to determine whether Spravato is appropriate for you. This is the first step in developing an appropriate treatment plan.
If your clinician determines Spravato is recommended for your symptoms, we will contact your insurance provider for verification and assist you in working through any cost saving opportunities that may be available so we can get prior authorization. Once the insurance approval goes through, your first Spravato treatment will be scheduled.
How to Prepare for Your First Spravato Treatment
One of the best ways to prevent negative side effects from Spravato is to properly prepare for your treatment. While it’s normal to feel some anxiety leading up to your appointment, you can rest easier if you take the following steps:
DO
- Follow your provider’s preparation instructions
- Tell your provider a full list of any medication you take
- Arrange for transportation home
- Plan for at least two hours of monitoring after the dose
- Ask your provider what personal items are permitted
DO NOT
- Eat anything in the two hours leading up to treatment
- Drink liquids in the 30 minutes leading up to treatment
- Take any nasal steroids or decongestant within one hour before your treatment
- Drive or operate machinery until the next day after a restful sleep
- Make strenuous plans immediately following your treatment
One of the benefits of having an initial consultation is to get clear answers on how to make this experience as uncomplicated as possible. Your provider will give you a full list of what to expect and how to prepare. If anything is unclear or you need clarification, please do not hesitate to ask.
What Happens During a Spravato Session?
1. Check-in
When you arrive, we will have you fill out any necessary documentation needed before the treatment begins. Your provider will then talk to you to get a baseline on how you’re feeling and if there’s anything they can do to make you more comfortable before the treatment gets started. Before officially starting the treatment, your clinician will take a baseline blood pressure measurement so they can monitor any changes throughout the treatment.
2. Taking the spray
You’ll give yourself the nasal spray while your technician guides you. The spray itself is quick, but a full dose takes a few rounds. You’ll use one small nasal spray device at a time, then rest for about five minutes before the next one, until your dose is complete. Once the medication has been administered, you will rest in the treatment area while your care team monitors you.
3. Monitoring
Your clinician will monitor you in the treatment area for at least two hours after your dose. They will look for increased levels of sedation, dissociation, any changes in breathing or blood pressure, and any other notable effects the medication has.
Your clinician will determine when it is safe for you to go home. In some instances, the treatment may extend beyond the initial 2 hours if your provider determines you need some extra time to return to your baseline.
4. What To Do During Spravato Treatment
A lot of people receiving treatment for depression can sometimes feel like they need to accomplish something during treatment. This is not the case. You are not expected to do anything over the course of your 2-hour monitoring period other than let the medication work.
Many of our patients find the following helpful to relax during their sessions:
- Keep your eyes closed or bring an eye mask from home
- Bring headphones so you can listen to relaxing music
- Use a favorite blanket to settle in
- Focus on slow, mindful breathing techniques
- Avoid using your phone and keep all notifications turned off
This is not a good time to work, answer important emails, make decisions, or do anything that requires sustained concentration. Your only job during treatment is to rest and let your clinician know if you feel nauseous, anxious or uncomfortable in any way.
5. Heading home
When your provider determines that you are ready, you will leave with the person who is taking you home. Even if you feel alert or awake, you will need someone else to drive you home. Do not drive until the following day after a restful night’s sleep.
After Your Session: The Rest of Your Day
You may feel tired, foggy, or somewhat disconnected after treatment. These effects generally improve the same day, although everyone responds to treatment differently. Do not drive or operate machinery, and avoid tasks requiring full alertness until the next day after a restful sleep. Call your provider for anything unusual right away and for anything more serious like chest pain, shortness of breath, a sudden severe headache, vision changes, or seizures you should call 911 or go to your nearest emergency room to be evaluated.
Your Treatment Schedule and What Comes Next
The FDA-recommended Spravato schedule generally starts with twice-weekly treatments during weeks 1 through 4, followed by once-weekly treatment during weeks 5 through 8. After that, treatment may continue once weekly or every two weeks based on your individual response. Your prescribing provider will help to determine the best schedule for you.
For treatment-resistant depression, Spravato may be prescribed alone or alongside other formats of depression treatment. It’s important to talk to your provider about any and all medication you’re currently taking because that may affect your treatment plan and schedule.
Results and response times vary. Clinical studies have found improvement in depressive symptoms as early as 24 hours in some patients, but that does not mean everyone experiences noticeable improvement after the first treatment. Providers look at symptom changes over time rather than judging treatment success by how the medication felt during one appointment.
We also offer TMS therapy, another FDA-cleared option for depression that hasn’t responded to medication. Our providers can help you decide which treatment fits your history and symptoms. Your psychiatric provider can help determine which treatment is appropriate based on your history and current symptoms.
Common Questions About the Spravato Experience
Dissociative and perceptual changes are among the most common psychological effects reported with Spravato, but full hallucinations are uncommon at the doses used in treatment. You may experience altered perception, dissociation, or a feeling of being drunk or detached, but a dramatic hallucination is not something every patient experiences. The medication is administered under supervision because it has a strong potential for misuse which can feel intimidating to those who want to avoid medication that may make them feel high. Talk to your healthcare provider during the initial evaluation about any concerns.
The most noticeable acute effects, such as dissociative feelings, generally occur during the 2-hour monitored treatment period and will likely resolve the same day. Tiredness or fogginess may continue after you leave, so plan on taking the rest of the day at a slower pace. Antidepressant effects are different and are evaluated across repeated treatments.
No. The intensity of dissociation does not reliably tell you whether Spravato is working for your depression. A person may have noticeable perceptual effects without an immediate improvement in mood, while another person may have relatively mild sensations and still respond to treatment. Talk with your provider about changes in your depression symptoms rather than using the intensity of the Spravato experience as a measure of effectiveness.
Many commercial plans and Medicare cover Spravato, but coverage and authorization requirements vary by plan. Our team provides insurance verification so you don’t need to. Some plans may require prior authorization before treatment begins. You can verify your insurance with us before scheduling treatment.
Yes. Advanced Psychiatric Health offers Spravato® (esketamine) nasal spray for appropriate patients with treatment-resistant depression. Advanced Psychiatric Health has offices across Florida including; Tampa, Orlando, Naples, Westchase, Wesley Chapel and more. Patients self-administer the nasal spray in an APH office under healthcare-provider supervision and remain at the office for monitoring after treatment. We typically start patients on a twice-weekly treatment plan for four weeks, followed by weekly treatment and then less frequent maintenance based on your individual response.
Spravato can cause sedation and dissociation and has a high potential for misuse. Every dose must be administered under direct supervision, followed by a period of monitoring before you are allowed to leave.
That requirement can feel inconvenient, but the REMS program exists so you don’t need to figure out the treatment on your own. A healthcare provider will be there every step of the way to make sure it is administered properly and any side effects can be monitored and addressed.
Conclusion
Knowing what to expect and what Spravato feels like can take some of the uncertainty out of your first appointment. While you might wonder what Spravato is like, you will not need to experience the effect alone.
If you are considering Spravato after other depression treatments have not provided enough relief, Advanced Psychiatric Health can evaluate whether it is an appropriate option for you. Most patients can see an APH provider within 24-72 hours of contacting the practice. Request an appointment to discuss your options with an APH provider.