What to Expect at Your First Spravato Treatment

Starting Spravato (esketamine) treatment can feel both exciting and nerve-wracking. You've likely tried many treatments for your treatment-resistant depression, and this one is different. Here's exactly what to expect so you can feel prepared and confident walking into your first session.

Before Your First Appointment

The Evaluation Process

Before you can receive Spravato, you'll need to be evaluated to confirm you're a good candidate. This includes:

Review of your depression history and previous treatments
Confirmation of treatment-resistant depression diagnosis
Medical history review (blood pressure, cardiovascular health)
Discussion of what to expect and answering your questions
Insurance verification and prior authorization

Pre-Treatment Instructions

Do This Before Your Appointment

Don't eat for 2 hours before treatment (to reduce nausea risk). A light snack before that is fine.

Arrange transportation. You cannot drive for 24 hours after treatment—this is not optional.

Wear comfortable clothing. You'll be resting for about 2 hours.

Bring headphones or eyemask if you'd like—many patients find relaxing music helpful.

Clear your schedule. Plan for 2.5-3 hours total, including check-in and checkout.

Arriving at the Clinic

When you arrive for your first Spravato session, here's what happens:

1. Check-in: You'll complete any remaining paperwork and confirm your ride home is arranged.
2. Baseline vitals: A staff member will take your blood pressure. This is important because Spravato can temporarily raise blood pressure.
3. Depression assessment: You may complete a brief questionnaire about your current symptoms (this helps track progress).
4. Get comfortable: You'll be settled into a private, comfortable treatment room with a reclining chair.

The Treatment Session

Self-Administering the Medication

Spravato is a nasal spray that you administer yourself under supervision. Here's exactly how it works:

56mg or 84mg

Starting dose (provider determines)

2-3 devices

Sprays per session (5 min apart)

~15 min

Total administration time

A staff member will hand you each device and instruct you on use. It's simple: you'll spray once in each nostril, wait 5 minutes, then repeat with the next device. The process is straightforward, and you'll have guidance throughout.

What You'll Feel During Treatment

This is usually what patients are most curious (and nervous) about. Here's an honest look at common experiences:

Dissociation (Most Common)

A feeling of being "disconnected" from your body or surroundings. Patients often describe it as dreamlike, floaty, or like watching yourself from outside. This typically starts 15-30 minutes after administration and fades within 1-2 hours.

Dizziness/Light-headedness

Common in the first hour. This is why you'll be seated/reclined throughout. It typically resolves before you leave.

Altered Perception

Some patients notice colors looking brighter, sounds seeming different, or a changed sense of time passing. These effects are temporary.

Nausea

Affects some patients, especially if they ate too close to treatment. This is usually mild and treatable if it occurs.

Elevated Blood Pressure

Temporary increase that's monitored throughout. Usually returns to normal before discharge.

"Most patients describe the experience as unusual but not unpleasant. The dissociative effects can actually feel calming—like a brief mental vacation. Going in with the right expectations makes a big difference."

The 2-Hour Monitoring Period

After administration, you'll rest for about 2 hours while staff monitors you. During this time:

Stay in your comfortable chair—don't try to walk around
Staff will check your blood pressure periodically
Close your eyes, listen to music, or simply rest
Let staff know if you need anything (water, blanket, nausea help)
The effects will gradually diminish over this period

Many patients bring headphones with calming playlists. Others prefer the quiet. There's no "right" way to spend this time—do what feels comfortable.

Before You Leave

Before discharge, staff will:

✓ Take your blood pressure to ensure it's returned to acceptable levels
✓ Assess that you're stable and alert enough to be discharged
✓ Confirm your ride is here (you will NOT be allowed to leave alone)
✓ Remind you: no driving, operating machinery, or making important decisions for 24 hours
✓ Schedule your next appointment (typically 3-4 days later in the initial phase)

After Your First Treatment

Here's what to expect in the hours and days following:

Same Day

• You may feel tired—a nap is fine
• Avoid alcohol
• Eat a light meal when you feel ready
• Take it easy; no major activities

Next Few Days

• Most people feel normal by next morning
• Some notice mood improvement already
• Others don't feel different yet (normal)
• Prepare for your next session

When Will You Feel Better?

This varies by individual. Some patients notice improvement after their very first session. For others, it takes several treatments before the benefits become clear. The initial treatment phase involves sessions twice weekly for 4 weeks—give it time to work.

Clinical studies show significant improvement in many patients within the first few weeks. But unlike the rapid relief some experience, others see gradual, cumulative benefits. Your provider will assess your response and adjust your treatment plan accordingly.

Tips for a Successful First Session

1. Go in with an open mind. The experience is different from anything else, and that's okay.
2. Don't fight the dissociation. Let it happen—resisting can make you more anxious.
3. Have music or a podcast ready that you find calming and familiar.
4. Ask questions beforehand. The more you understand, the less anxiety you'll have.
5. Commit to the process. One session isn't enough to judge effectiveness.