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 hard-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, one of the main excitatory chemicals in the brain. This approach has given hope to many people who have struggled to find relief from traditional depression treatments.

The Spravato® Timeline: What to Expect

It can be scary to start a new depression treatment like Spravato®, but understanding the timeline and what to expect can help take away some of the unknowns. Usually, you’ll receive a comprehensive evaluation to ensure Spravato® is safe and appropriate for your symptoms, then the first month or so will involve twice-weekly treatment sessions.

Here is how the Spravato® treatment process typically unfolds:

Consultation Call

A member of the interventional intake team will call you to collect information about any current medications, medical history, and previous diagnoses to ensure Spravato® is an appropriate fit.

Full Evaluation

If approved for moving forward after the consult call, a psychiatric provider will meet with you for a full evaluation and to further discuss fit of treatment, cost, and verification of benefits before you start treatment.

First Spravato® Session

Spravato® is given as a nasal spray under supervision from a licensed medical provider. The session (and all subsequent sessions) involves self-administering a nasal spray, then staying under supervision for the next two hours to ensure no major side effects ensue afterward.

Many people begin to feel lighter or notice reduced depressive symptoms within the same day, while others may not feel any differences for a few days.

First 2-4 Weeks of Treatment

Treatment is usually scheduled twice weekly for the first few weeks to a month. 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 5-8 of Spravato® Treatment

Sessions typically shift to once a week after the first month or so. 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?

Many Spravato® clients have described 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 initial intensity of 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 the feeling of being “high,” though some clients have reported feeling somewhat dreamlike, lightheaded, or mildly euphoric for a short time right after administration. While it shares similarities with ketamine, Spravato® 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 Spravato® Treatment Last Overall?

Spravato® is not a single-dose treatment, with the initial phases of treatment lasting at least eight weeks. Your provider will regularly assess how well 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 to Consider When Seeking Spravato® Treatment

Like any treatment, Spravato® can come with some side effects. The most common include temporary dizziness, nausea, and drowsiness right after receiving treatment, but you’ll be monitored after treatment, and your provider can help you deal with any effects if they arise. Another factor to consider is that you cannot drive after treatment, so you’ll need someone to bring you home.

Remember that, for many people who have tried multiple medications without success, dealing with these negatives can bring real relief not found elsewhere. When depression has inhibited your daily life for years, the chance to reclaim energy, relationships, and life satisfaction is worth the extra time and effort.

How to Get the Most Out of Spravato®

Spravato® works best as part of a broader depression treatment plan. Continuing oral antidepressants, engaging in therapy, and building daily routines that support sleep and activity all improve results. Communication with your care team is essential. Adjustments to frequency of therapy, Spravato®, and certain lifestyle habits can strengthen the benefits of treatment overall.

Care for Difficult-to-Treat Depression at NEHS

With consistent care, support, and patience, Spravato® can bring relief to people living with hard-to-treat depression who have struggled to find answers in the past. Our experts have helped thousands of people recover from depression through our holistic services, with teams dedicated to working together to ensure a comprehensive care plan for each client’s unique symptoms.

Northeast Health Services is here to help you manage your mental health. For new clients, call us at 508.794.8711 or fill out a brief form and schedule your first appointment. For existing clients, find your office location to contact them directly.

Source:

1. NIH. Managing dissociative symptoms following the use of esketamine nasal spray: a case report.