Northeast Health Services is dedicated to supporting your mental health. If you are experiencing suicidal thoughts, we encourage you to reach out for immediate support through your local crisis services by dialing 988, contacting your local emergency services, or visiting your local emergency room.
For people living with difficult-to-treat depression, when two or more antidepressants have not provided relief, Spravato® (esketamine) offers an alternative that works differently from traditional medications. Approved by the FDA in 2019, it is the first nasal spray for adults with difficult-to-treat depression and can also be used in adults with major depressive disorder who experience suicidal thoughts.
Unlike medications that work mainly on serotonin or norepinephrine, Spravato® targets glutamate, a brain chemical tied to mood regulation. This new approach has given hope to many people who have struggled to find relief.
The Spravato® timeline: what to expect
Understanding the treatment timeline helps take away some of the unknowns. Here is how the process typically unfolds:
- Assessment and intake: Before treatment begins, you will meet with a psychiatric provider for a comprehensive evaluation. This includes a review of your symptoms, history with medications, and medical background. The intake process helps ensure Spravato® is a safe and appropriate option for you.
- First session: Spravato® is given as a nasal spray under provider supervision. Many people begin to feel lighter or notice reduced depressive symptoms within the same day. Others may not notice immediate changes.
- First two to four weeks: Treatment is usually scheduled twice weekly. This intensive phase gives the medication the best chance to take hold. Some people experience noticeable relief by the end of the first week, while others begin to feel improvement after several sessions.
- Weeks five to eight: Sessions typically shift to once weekly. At this stage, many people begin to feel steadier, with increased energy and reduced depressive symptoms. This is often when daily routines and relationships start to feel more manageable again.
- Maintenance phase: After the first eight weeks, most people move to sessions every one to two weeks. The goal of this stage is to maintain progress and prevent relapse.
It is important to know that everyone’s response looks different. Your provider will work with you to determine how long treatment should last and how often you should come in. Regular monitoring and open conversations help ensure that care is always tailored to your needs.
What does Spravato® treatment feel like?
Spravato® is self-administered in a clinic as a nasal spray. Once taken, you remain on-site for at least two hours while providers monitor blood pressure, mood, and overall safety.
Many describe the experience as unusual but manageable. Some feel lightheaded or detached, while others describe a wave of calm or emotional release. Some people experience dissociation, which means feeling disconnected from thoughts or surroundings.¹ These sensations are temporary and fade as the medication wears off.
To make the experience more comfortable, many people bring headphones, an eye mask, or a journal. Providers are present throughout the session to provide reassurance and support.
Does Spravato® cause a high?
Spravato® is not meant to create a high. While it shares similarities with ketamine, it is carefully administered in a clinical setting with close monitoring. The possibility of misuse is very low because each dose is given under medical supervision.
How long does treatment last overall?
Spravato® is not a single-dose treatment. The structured timeline usually follows this progression:
- Weeks 1–4: Two sessions each week
- Weeks 5–8: One session each week
- Ongoing: Maintenance sessions every one to two weeks, based on progress
Your provider will regularly check how you are responding and make adjustments as needed. Some people continue long-term maintenance, while others taper gradually once they are stable. Again, every timeline is different, and your provider will work with you to design a plan that feels realistic and effective for you.
What are the disadvantages of Spravato®?
Like any treatment, Spravato® has some side effects. These may include dizziness, nausea, drowsiness, and temporary dissociation. Blood pressure can increase during a session, which is why monitoring is required.
Another consideration is logistics. Since you cannot drive after treatment, you need someone to bring you home. The time commitment of in-clinic monitoring can also feel demanding compared to a daily pill.
But for many people who have tried multiple medications without success, that investment of time brings real relief. When depression has limited your daily life for years, the chance to reclaim energy, relationships, and joy is worth the extra effort. Spravato® provides an opportunity for meaningful change when hope has felt out of reach.
How to get the most out of Spravato®
Spravato® works best as part of a broader treatment plan. Continuing oral antidepressants, engaging in therapy, and building daily routines that support sleep and activity all improve results. Communication with your provider is essential. Adjustments to frequency or lifestyle habits can strengthen the benefits of treatment.
Programs like Spravato® With Me also provide additional education and resources to help people feel more supported throughout treatment.
Care for difficult-to-treat depression at NEHS
Spravato® treatment provides a structured timeline with clear milestones, from the first assessment through maintenance. Some people notice improvement quickly, while others need several weeks before changes become clear. With consistent care, support, and patience, Spravato® can bring relief to people living with difficult-to-treat depression who have struggled to find answers in the past.
Northeast Health Services is here to help you manage your mental health. For new clients, please click here to schedule an appointment. For existing clients, please click here and find your office location to contact your office directly.
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