If you’ve tried antidepressants without getting the relief you hoped for, you may have heard about Spravato® and wondered what it involves.
The steps in Spravato treatment can feel unclear from the outside, and that uncertainty can make it harder to take the first step. This article walks you through the process from start to finish, so you know exactly what to expect.
What is Spravato and who is it for?
Spravato is the brand name for esketamine, a nasal spray approved by the Food and Drug Administration (FDA) to treat adults with treatment-resistant depression (TRD) and major depressive disorder (MDD).
Spravato is self-administered under clinical supervision in a certified healthcare setting. Every dose is followed by at least two hours of on-site monitoring, a requirement of the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program.
Spravato is closely related to ketamine, and both work on the brain’s glutamate system, which can bring relief much faster than antidepressants.
Ketamine is not approved by the FDA and is used “off label” to treat depression, anxiety, post-traumatic stress disorder (PTSD) and other conditions. At Pacific Mind Health, it is administered and monitored in exactly the same way as Spravato.
What are the steps in Spravato treatment?
Both Spravato and ketamine follow similar steps in treatment.
Step 1: Finding out if you’re a candidate
Most people who consider Spravato have already been through multiple rounds of antidepressants without enough improvement. If that sounds familiar, the first step is to call Pacific Mind Health and have a conversation with one of our team members.
We’ll ask about your symptoms, if you have a diagnosis, what medications you’ve tried, and your insurance details. Then they will schedule you for a full evaluation.
Before your evaluation, gather the names of medications you’ve tried and a brief description of your current symptoms. This gives your provider a clearer picture and helps move the evaluation along more efficiently.
Step 2: Your psychiatric evaluation
A full medical and psychiatric evaluation allows your provider to consider whether Spravato or intranasal ketamine is appropriate for you.
They will ask about your symptom history, past treatment responses, current medications, and any medical conditions that could affect treatment, such as uncontrolled high blood pressure, a history of psychosis or mania, or pregnancy.
Spravato is always used in combination with an oral antidepressant, so your provider will also discuss whether any adjustments to your current medications make sense before starting.
If you are looking for a medication-free option, your provider will discuss whether ketamine therapy is right for you.
Step 3: Preparing for your first session
Before your first dose of Spravato or ketamine, there are a few practical things to take care of. If you’ve been approved for Spravato, your clinic will confirm your provider will confirm enrollment in the FDA’s REMS program and review any safety considerations.
Other logistics include:
- Fasting: No solid food for at least two hours before treatment, and no liquids for at least 30 minutes beforehand.
- Transportation: You cannot drive yourself home. You’ll need to arrange a ride for every appointment, and you should avoid driving and other activities until the following day.
- Time: Plan to be at the clinic for two hours, and plan to rest at home afterward.
- Medications: Let your care team know about any additional medications you are taking. Avoid any sedating medications as well as alcohol on treatment days.
Step 4: What happens during a session
Each visit follows a consistent rhythm. You’ll check in, have your vitals taken and do a brief symptom check with a nurse or clinician. Then you’ll be seated or reclined in a calm, low-stimulation space and shown how to use the nasal spray device if you haven’t used it before.
Once you self-administer, the monitoring period begins. Most patients report side effects that can include dissociation, a dreamlike or detached feeling, mild dizziness, mild some nausea, changes in perception, or a sense of warmth.
These symptoms peak within about 40 minutes and typically resolve within one to two hours. Staff will check your blood pressure at regular intervals and are there throughout if you need anything.
Many patients find it helpful to bring headphones, an eye mask, or a light blanket and simply rest during the session. It’s generally not a good time for work tasks or intense screen time. By the time you’re discharged, most effects have faded. You’ll need to arrange for someone to drive you home, and you should take it easy for the rest of the day.
Step 5: Ongoing treatment
Your Spravato and ketamine treatment consists of three distinct and necessary phases. Each visit follows the same format as your first session, with your care team checking your vitals and tracking your progress before treatment.
Sticking to your appointment schedule is vital to maintaining the benefits of treatment.
There are three phases of treatment:
- Phase 1: Induction Most of the early work of Spravato or ketamine happen in this phase. You’ll typically have treatments twice a week for four weeks. Regular appointments help your symptoms improve and guide the next steps in your treatment.
- Phase 2: Optimization After successful completion of your induction phase, your provider will reduce the amount of treatments to one a week for 8 to 12 weeks.
- Phase 3: Maintenance Congratulations! Many patients see real progress now. Sessions are typically reduced to once per week or every two weeks. Attending every appointment maintains results and prevents symptoms from returning.
It’s important to note that each patient’s treatment plan is individualized according to their unique needs.
If treatment isn’t providing enough relief or you can’t tolerate the side effects, your care team will make adjustments until you are comfortable and making progress. The most important thing to remember is to follow your treatment plan and attend all of your appointments.
Frequently asked questions
How soon might I notice results after starting Spravato?
Some people notice a shift in mood within 24 hours of their first or second session. For others, it takes several sessions over two to four weeks before changes become clear.
Can I keep working while going through the Spravato induction phase?
Many people do continue working during treatment, but most find it helpful to schedule sessions later in the day or on less demanding days, since you can’t drive afterward and may feel tired. If possible, planning for a half-day or full day off on treatment days during the first month gives you time to adjust before you know how your body responds.
What should I bring to my Spravato appointments?
For the session itself, consider headphones, an eye mask, or a light blanket, something that helps you rest comfortably in a quiet space. Avoid bringing work tasks, and make sure to schedule a ride home with a friend or family member.
What happens if I miss a session?
Keeping your appointments is the key to treatment success. If you need to miss an appointment, call the clinic as soon as you know so they can reschedule you. Larger gaps early in the induction phase — especially in the first few weeks — may slow your progress, so prompt rescheduling is encouraged.
Is Spravato the same thing as ketamine?
They’re related but not identical. Spravato (esketamine) is derived from ketamine and is FDA-approved specifically for TRD and MDD with suicidal ideation. Ketamine is used off-label for depression and works through a similar mechanism. Pacific Mind Health offers both to meet the needs of each patient.
Key takeaways
- Spravato is an FDA-approved nasal spray for adults with treatment-resistant depression (TRD) or major depression with suicidal thoughts. always used alongside an oral antidepressant.
- The steps in Spravato treatment include an initial consultation, safety screening, a structured induction phase, and ongoing maintenance sessions.
- Every session takes place in a certified clinic, with at least two hours of on-site monitoring after each dose.
- Intranasal ketamine follows the same in-clinic process and can be another option for people who haven’t found relief with traditional medications.
- Spravato and ketamine both involve three phrases: induction, optimization, and maintenance. Attending all appointments makes it easier to move onto the next phase.
Looking for Spravato or ketamine treatment near you?
Pacific Mind Health offers Spravato (esketamine) and ketamine therapy for treatment-resistant depression, major depressive disorder, and more.
Located in Southern California and serving patients across the state, Pacific Mind Health was founded by Joshua Flatow, MD, a board-certified psychiatrist and published peer-reviewed research author.
Ready to take the next step? Schedule a free consultation today to see if Spravato or ketamine is right for you.
