What to Expect During Your First Spravato Session?
If you’re preparing for your first Spravato appointment, you’re likely feeling a mix of hope and uncertainty about this innovative treatment option. During your initial session, you’ll self-administer a nasal spray under medical supervision, remain at the treatment facility for at least two hours for monitoring, and experience the medication’s effects while healthcare professionals ensure your safety and comfort. The entire process is carefully structured to maximize therapeutic benefits while minimizing risks, and understanding what happens can help ease any anxiety you might be feeling.
Spravato (esketamine) represents a breakthrough in treating treatment-resistant depression and depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior. For many people who haven’t found relief with traditional antidepressants, this FDA-approved therapy offers new hope. Let’s walk through everything you need to know about your first experience with this treatment.
Before Your First Spravato Appointment
Preparation is essential for a successful treatment experience. Your healthcare provider will have already confirmed that you’re an appropriate candidate for Spravato treatment, which means you’ve likely tried at least two other antidepressants without adequate response or you’re experiencing severe depressive symptoms.
Before your appointment, avoid eating for at least two hours. Having food in your stomach can increase the risk of nausea and vomiting during treatment. You should also arrange for reliable transportation home, as you won’t be able to drive yourself after the session. The medication can affect your attention, judgment, thinking, reaction speed, and motor skills for several hours.
Wear comfortable clothing and plan to be at the facility for approximately three hours. Bring something to occupy your time during the monitoring period afterward, such as music, a book, or headphones for relaxation. Some facilities provide recliners or comfortable seating areas specifically designed for post-treatment rest.
Understanding the Spravato Nasal Spray Administration
The actual administration of the nasal spray is straightforward but requires following specific instructions. Your healthcare provider will hand you the nasal spray device and guide you through the self-administration process. Each device contains a single dose, and you may need to use two or three devices depending on your prescribed dosage.
Here’s how taking Spravato works: You’ll hold the device horizontally, insert the tip into one nostril, and press the plunger while breathing in gently through your nose. After administration, you’ll rest for five minutes before using the second device in the other nostril if your dose requires it. The healthcare team remains present throughout this process to ensure proper technique and provide immediate assistance if needed.
The medication absorbs quickly through the nasal passages, and you’ll typically begin feeling effects within 20 to 40 minutes. These effects can include dissociation (feeling detached from your thoughts, feelings, space, and time), dizziness, sedation, and changes in perception. While these sensations might feel unusual or uncomfortable initially, they’re expected responses to the medication and will diminish as the drug’s effects wear off.
What Happens During Your First Session
Your first session establishes the foundation for your ongoing treatment journey. After you administer the nasal spray, healthcare professionals will monitor your vital signs, including blood pressure, which can temporarily increase. This monitoring is mandatory and ensures your safety throughout the treatment.
During the two-hour observation period, you’ll rest in a supervised setting. Many patients describe feeling relaxed, drowsy, or experiencing altered sensations. Some people find the experience pleasant and meditative, while others might feel anxious or uncomfortable. Both reactions are normal, and the medical staff is trained to help you through any challenging moments.
You won’t be alone during this time. Healthcare providers will check on you regularly, assess your symptoms, and ensure you’re responding well to the medication. If you experience any concerning symptoms, they can provide immediate intervention. This level of supervision is one reason why Spravato treatment requires administration in a certified healthcare setting rather than at home.
Potential Side Effects to Anticipate
Understanding potential side effects helps you feel more prepared and less alarmed if they occur. The most common side effects during and immediately after treatment include dissociation, dizziness, nausea, sedation, vertigo, decreased sensation or numbness, anxiety, lethargy, increased blood pressure, vomiting, and feeling drunk.
Dissociation deserves special attention because it’s one of the most frequently reported effects. You might feel disconnected from your surroundings, experience time distortions, or perceive your environment differently than usual. While this can be disconcerting, it’s temporary and typically resolves within an hour or two after treatment. Many healthcare providers consider some degree of dissociation to be part of the therapeutic process.
Most side effects are mild to moderate and resolve on the same day as treatment. However, if you experience severe symptoms or reactions, your healthcare team will adjust your treatment plan accordingly. They might modify your dosage, provide additional monitoring time, or recommend other interventions to improve your experience.
The Broader Context of Mental Health Treatment
Spravato treatment exists within a comprehensive mental health care approach. It’s not a standalone solution but rather part of an integrated treatment plan that includes ongoing antidepressant therapy. You’ll continue taking your oral antidepressant medication alongside Spravato sessions, creating a multi-faceted approach to managing depression.
This combination therapy addresses treatment-resistant depression through different mechanisms. While traditional antidepressants work primarily on serotonin, norepinephrine, or dopamine systems over weeks or months, esketamine acts on the glutamate system and may produce faster results. For individuals struggling with suicidal thoughts, this rapid action can be particularly important, offering relief when it’s most desperately needed.
Your mental health journey with Spravato will be closely monitored by your treatment team, who will assess your progress, manage any side effects, and adjust your treatment plan as needed. Open communication with your providers about your experiences, concerns, and any changes in your symptoms is essential for optimizing your care.
Preparing for Success with Spravato Treatment
Your first Spravato session marks an important step in your mental health treatment journey. By understanding what to expect, preparing appropriately, and maintaining open communication with your healthcare team, you’re setting yourself up for the best possible experience.
Remember that everyone’s response to treatment is unique. Your experience might differ from others’, and that’s perfectly normal. The healthcare professionals guiding your treatment have extensive experience with Spravato and will work with you to ensure you receive the most effective and comfortable care possible. With each session, you’ll become more familiar with the process and better able to navigate the experience, bringing you closer to improved mental health and quality of life.
Is It Possible to Alleviate Suicidal Thoughts by Taking Spravato?
Yes, Spravato has been FDA-approved specifically for treating depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior. Clinical studies have demonstrated that many patients report significant improvement in suicidal thoughts within hours to days of treatment, which represents a dramatic difference from traditional antidepressants that can take weeks to show effects. This rapid relief can be life-saving for individuals in crisis, particularly those with a complex mental health history who haven’t responded to other treatments. Healthcare providers carefully evaluate each patient’s response and adjust treatment protocols for future sessions to maximize therapeutic benefits while ensuring safety and ongoing monitoring throughout the treatment course.
Conclusion
Your first Spravato session is an essential milestone in your healing process, particularly if you’ve tried two or more antidepressants without achieving adequate relief. This FDA-approved nasal spray offers hope for treatment-resistant depression through a carefully monitored protocol administered in a supportive environment by trained mental health providers. While the experience may feel unfamiliar initially, understanding what to expect helps reduce anxiety and allows you to focus on the therapeutic benefits ahead. The first eight weeks of treatment are especially crucial as your body adjusts to the medication and your healthcare team assesses your response, so maintaining consistent attendance and open communication about your medical history and any concerns is essential. Trust the process, lean on your treatment team for support, and remember that taking this step demonstrates courage and commitment to your mental health recovery.
About the Author
Rhonda Richardson, PMHNP-BC
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