Key takeaways
- Spravato can cause a dissociative, dreamlike feeling. You may feel floaty or detached, but you stay aware of what’s happening around you.
- Most sensations are temporary. Dissociation, mild visual changes, and drowsiness typically fade within a couple of hours.
- Dissociation is part of how Spravato is thought to work. By temporarily disrupting rigid thought patterns, it may help the brain form new connections.
- You’re never alone during treatment. A trained care team monitors you for at least two hours after every dose.
Spravato typically causes a dreamlike, floaty sensation called dissociation, where you feel briefly detached from your body, thoughts, or surroundings while staying aware of what’s happening. This usually begins within 5 to 10 minutes of treatment and fades within one to two hours. A trained care team monitors you the entire time to help you feel safe and supported throughout the session.
If you’re considering Spravato® (esketamine) to treat your symptoms of depression, it’s natural to wonder what does Spravato feel like before your first session. Many people experience relief from their symptoms within hours or days of starting treatment, but the experience itself is unlike anything most patients have tried before.
It’s common to feel a little nervous about the unknown. Will Spravato make you feel high or out of control? Could you have a bad reaction? Questions like these are completely normal, and clinicians who specialize in this treatment hear them often. Knowing what to expect can make the experience feel far less intimidating.
What is Spravato?
Spravato, also known as esketamine, is a prescription nasal spray approved to treat adults with treatment-resistant depression or major depressive disorder. The U.S. Food and Drug Administration first approved Spravato in March 2019 for use alongside an oral antidepressant, and later expanded approval in January 2025 to include use as a standalone treatment for adults with major depressive disorder who haven’t responded to at least two oral antidepressants.
Spravato is closely related to ketamine, a medication long used as a general anesthetic in clinical settings. Interest in ketamine as a depression treatment grew after patients receiving it for other purposes reported feeling emotionally better, which eventually led researchers to study esketamine specifically for depression.
How does Spravato work?
Spravato works differently than traditional antidepressants. Most antidepressants target serotonin, while Spravato targets the glutamate system, a chemical messenger in the brain involved in learning, memory, and mood regulation.
According to its FDA prescribing information, esketamine is a non-competitive antagonist of the NMDA receptor. Although the exact way it relieves depression isn’t fully understood, this glutamate-related mechanism is believed to help the brain form new connections more quickly than conventional medications.
This process may help many people feel better within hours or days, even when other treatments haven’t helped before. A full treatment plan typically spans about 13 weeks, starting with a four-week induction phase of twice-weekly sessions before gradually tapering.
Many patients continue with occasional maintenance sessions afterward. In Spravato’s long-term maintenance study, patients who continued treatment had a significantly longer time to relapse of depressive symptoms than those switched to a placebo nasal spray.
What happens during a Spravato session?
A single Spravato session lasts about two hours. After your vitals are checked, you’ll self-administer the nasal spray and settle into a reclined chair. The room is kept dim and quiet, and you’ll be offered comfort items like a blanket, an eye mask, or noise-cancelling headphones.
Some patients listen to calming playlists, while others journal, meditate, or simply rest. A call button stays within reach in case you need anything. Throughout the two-hour window, your care team checks in regularly to monitor your safety and offer reassurance if any thoughts or feelings come up.
You won’t be allowed to drive or operate machinery for the rest of the day after treatment, so plan for a ride home in advance. It’s also a good idea to rest, avoid alcohol, and skip strenuous activity for the remainder of the day.
What does Spravato feel like?
Patients often describe the Spravato experience as dreamlike. This temporary state, called dissociation, can make you feel disconnected from your body, thoughts, or surroundings, even though you remain aware of what’s going on.
According to Spravato’s FDA prescribing information, dissociative or perceptual changes are the most common psychological effect of treatment, occurring in 61% to 84% of patients depending on dose, and these effects are transient, typically occurring only on the day of dosing.
This dissociation usually begins within the first 5 to 10 minutes of treatment and can last 30 to 90 minutes, though some patients notice lingering effects for up to two hours.
Here’s what many people report feeling during a session:
- Floaty or dreamlike sensations: Time may feel like it’s moving differently, or you may feel like you’re watching your own thoughts from a distance.
- Mild visual or sensory changes: Some people notice brighter colors or more pronounced sounds. This is different from full hallucinations and tends to be mild.
- A sense of disconnection: Things can feel surreal or trance-like. You’re aware of your surroundings but not fully grounded in the moment.
- A deep sense of calm: Some patients describe emotional release, with problems that once felt overwhelming now seeming more manageable.
- Waves of emotion: Temporary anxiety or a fear of losing control can happen, especially during a first session when the sensations feel unfamiliar. Your care team watches closely and helps you stay calm.
- Fatigue or grogginess: Feeling tired or mentally foggy as the medication wears off is common.
Most patients find these sensations easier to recognize and tolerate after their first session or two.
How does dissociation help treat depression?
Dissociation isn’t just a side effect to push through. Researchers believe it may be connected to how Spravato works. By briefly disrupting rigid thought patterns, the dissociative state may give the brain a window to interrupt negative thinking loops and form new neural connections, a process sometimes called synaptic plasticity. This is one reason your clinical team monitors not just your physical safety, but also your emotional experience during this window.
What if you have a difficult reaction to Spravato?
A severe reaction to Spravato is uncommon, especially in a controlled clinical setting, but the first session in particular can feel intense for some patients. While rare, some people experience more intense dissociation, confusion, panic, or a temporary rise in blood pressure during treatment.
When this happens, your care team is trained to help in several ways:
- Calm reassurance: Clinicians speak gently and remind you that these sensations are a temporary medication effect, not a loss of control.
- Grounding techniques: You may be guided through deep breathing or asked to name what you see and hear to help you feel present.
- Environmental adjustments: Dimming lights, reducing noise, or adjusting your seating position can ease discomfort.
- Vital sign monitoring: Your blood pressure and other vitals are tracked throughout your session, and in rare cases anti-anxiety medication may be used if needed.
- A post-session debrief: After treatment, you’ll have time to rest and talk through the experience, which can help guide adjustments to future sessions.
Most patients tolerate Spravato well from the start, and others find that the experience becomes more familiar with each session.
“The first session is almost always the hardest, simply because it’s the unknown,” said Joshua Flatow, MD, medical director and chief psychiatrist at Pacific Mind Health. “Once patients realize the sensations are temporary and that our team is right there with them, most settle into the experience quickly. By the second or third session, it often starts to feel familiar rather than unsettling.”
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 research author.
Ready to take the next step? Schedule a free consultation today to see if Spravato or ketamine is right for you.
Frequently asked questions
What does Spravato feel like during treatment?
Most people describe a dreamlike, floaty sensation called dissociation. You may feel briefly detached from your body, thoughts, or surroundings, but you stay aware of what’s happening around you. These sensations typically begin within 5 to 10 minutes and fade within one to two hours.
Is the dissociation from Spravato dangerous?
No. Dissociation is a known and expected effect of Spravato, which is why treatment is only given under direct clinical supervision with at least two hours of monitoring after each dose. Your care team watches your vital signs and emotional state throughout the session.
How long does the Spravato feeling last?
Dissociative effects typically begin within the first 5 to 10 minutes after treatment and resolve within 30 to 90 minutes, though some grogginess can linger for up to two hours. Most patients are cleared to leave about two hours after their dose.
Will I feel high or hallucinate on Spravato?
Spravato can cause mild visual or sensory changes, such as brighter colors or heightened sounds, but this differs from full hallucinations for most patients. The most common effect is dissociation, a feeling of being mentally detached rather than intoxicated.
What if I have a bad reaction during my session?
Severe reactions are uncommon. If you experience intense dissociation, anxiety, or other discomfort, your care team can use grounding techniques, adjust the environment, and monitor your vitals closely. Most patients tolerate Spravato well, especially after their first session.
