Starting something new in mental health care takes courage, especially when that something involves a medication that works differently from anything you’ve taken before. If you’re preparing for your first Spravato session, it’s completely normal to feel a mix of hope and uncertainty. This guide is here to help you walk in feeling informed and ready.
Before Your First Spravato Treatment
The night before your first Spravato session can feel long. You might find yourself reading the same articles twice, wondering what you’ve signed up for. That’s normal, and the best thing you can do to quiet that noise and feel in control of the journey is to channel that energy into a few simple preparations.
Set an Intention
One of the most meaningful things you can do before your first session is set an intention. Your intention is not a goal in the clinical sense, but more of a personal direction. Spravato creates a state of neuroplasticity and openness, and your intention acts as a compass. A thread for the experience to follow.
Even a simple word like “clarity,” “release,” or “presence” gives the session somewhere to go. If you’re not sure what your intention is, that’s okay. Talk to your Kadelyx care team before your session. Finding your intention together is part of what we’re here for.
The Practical Checklist
There are a few logistics to handle before you arrive that will make everything run more smoothly.
- Arrange transportation: You can’t drive yourself home after the session. The medication causes temporary sedation and dissociation, and you’ll need someone to take you home.
- Eat a light meal before your session: You should eat two hours before your session, but avoid anything heavy. Nausea is a possible side effect, and a full stomach can make it worse.
- Avoid recreational drugs and alcohol: They can unpredictably alter the effects of esketamine and blunt the neuroplasticity response that makes the treatment effective in the first place.
- Wear comfortable clothing: You’ll be lying down for approximately two hours. You’re welcome to bring an eye mask, too. Many patients find that blocking out light helps them settle into the experience more easily.
- Leave your schedule open afterward: Most patients feel well enough to resume light activity later in the day, but plan for rest and don’t schedule anything demanding immediately after.
You can also prepare a feel-good playlist for your session. Many of our patients say music enhances the experience, so it’s worth giving it a shot.
What Happens During the Session
The session itself is more constrained and more supported than most first-time patients expect, and you won’t be navigating it alone.
Arriving and Getting Set Up
You’ll be welcomed into our Spravato group treatment room, which is a calm shared space designed to feel relaxed and nothing like a hospital waiting room. You’ll share the space with up to six people, but there is no expectation to interact with or share your experience with others in the room. Your session is yours, and quiet reflection is completely welcome.
Before administering the medication, your Kadelyx care team will take you through a brief clinical check-in, reviewing your current medications, any changes since your last visit, and how you’ve been feeling.
For first-time patients, this includes a fuller intake:
- Your medical history
- Mental health background
- A talk about what’s brought you here
This will be the foundation of your treatment plan. Once you’re settled in, your care team will take your blood pressure, which is standard protocol, as Spravato can cause a temporary increase in some patients. The session begins when you’re ready.
Administering the Medication
Spravato comes in an FDA-approved nasal spray device. Each device delivers 28mg of esketamine across two sprays, one in each nostril. Depending on your prescribed dose, you may use one or two devices. The administration takes about 10 minutes, and you will self-administer the nasal spray with the guidance of your care team.
Some patients notice a mild bitter taste at the back of the throat or slight nasal irritation right immediately after. This is normal and passes quickly.
What the Experience Feels Like
The medication begins to take effect within 5 to 15 minutes. What follows is different for everyone, but there are some experiences worth knowing about in advance.
- Dissociation: You may feel a sense of distance from your body, from the room, or from your ordinary sense of self. Time may feel different. Familiar things may feel strange. This can range from mild to more pronounced, depending on your sensitivity and dose.
- Perceptual change: Some patients experience visual or sensory shifts. Colors may seem more vivid, shapes may blur slightly, or sounds may feel different. These effects are temporary and resolve as the medication clears.
- Emotional material: It’s common for emotions, memories, or insights to surface during a session. Some of this may be surprising or intense. It may also be peaceful, clarifying, or quietly meaningful. Whatever arises is worth noting, as this is often where the therapeutic work happens.
- Sedation: Many patients feel deeply relaxed, and some become quite sleepy. That’s completely normal. You’re in a safe space with your care team nearby, and you’re encouraged to rest into the experience.
Your only job during the session is to be present with whatever arises. You don’t need to direct it, make it productive, or figure anything out in real time.
What to Expect After Your First Session
What happens from the moment the medication starts to wear off though the days after you leave is just as much a part of the process as the medication itself.
Right After the Session: The Observation Period
After administration, you’ll remain at the clinic for at least two hours of monitored observation. This is a clinical requirement to ensure you’re stable and ready before you leave. During this time, the effects of the medication gradually wind down. Before you’re discharged, your care team will assess how you’re feeling and confirm you’re ready to go.
The Hours After
Some patients feel a notable change after their first treatment. They feel lighter, clearer, and more emotionally open than they’ve felt in a long time. Others don’t notice much at all initially. Both are completely normal. Spravato is not a one-session treatment, and a single session is rarely where the full picture emerges.
Journaling and Integration
If you can, write down anything you noticed during the session before you sleep, like images, feelings, thoughts, or moments that felt significant. Integration is the process of making meaning from what arises in a session, and your notes become valuable material for that work. Your care team will help you integrate what came up in the context of your broader treatment.
The Treatment Schedule
The standard induction phase for Spravato for treatment-resistant depression is twice weekly for four weeks, followed by once weekly for four weeks, and maintenance sessions as needed. Most patients begin to notice noticeable improvement in their depressive symptoms within the first four weeks of treatment.
You Don’t Have to Figure This Out Alone
The uncertainty before the first session is real, and it’s one of the most common things patients share with us. What we’ve seen, again and again, is that walking in informed and supported makes a meaningful difference in both comfort and outcomes. Your Kadelyx care team is here before, during, and after every session. Whether you have questions before you start or you’re ready to book your first appointment, reach out. We’ll meet you where you are.
Frequently Asked Questions First-Time Patients Ask
Will I Lose Control During the Session?
No. The dissociative effects of Spravato can feel unfamiliar, but you remain aware and able to communicate with your care team throughout. The experience is more like a waking dream than a loss of control.
What if the Experience Feels Overwhelming?
Tell your care team. They are present for exactly this reason. Most patients find that having someone nearby, even without speaking, is enough to feel grounded. The effects are temporary and will pass.
What if I Don’t Feel Anything?
Some patients, particularly at lower doses or in their first session, experience minimal perceptible effects. This doesn’t mean the medication isn’t working at a neurological level. Your care team will monitor your response and adjust the protocol if needed.
Can I Continue My Other Medications?
In most cases, yes. Spravato is typically prescribed alongside an oral antidepressant. Your care team will review your full medication list during intake and flag any interactions to be aware of.
Is Spravato Covered by Insurance?
Spravato is typically covered by BCBS, UHC, Aetna, and Cigna insurance for adults with treatment-resistant depression and major depressive disorder with suicidal ideation. If you’re unsure about your coverage, our team can help you navigate that conversation before you commit to anything.
