What a Spravato session is actually like
Two to two and a half hours, start to finish, every time. Here is what happens in that window, what the label says about how it may feel, and why you need someone to drive you home.
Last reviewed against the FDA label and SPRAVATO REMS programme materials on .
The short answer
Plan for about two and a half hours. You check in, your blood pressure is taken, you spray the medication yourself while a healthcare professional watches, and then you stay and are monitored for at least two hours.
Most of the noticeable effects — dissociation, dizziness, sedation — start within the first forty minutes or so and ease over the monitoring period. That period is why you are there, and it is not shortened because you feel fine.
You cannot drive afterwards. The label instructs that you not drive or operate machinery until the day after the dose, following a restful sleep. Arrange your lift before the appointment, and arrange it for every session, not just the first.
A session, step by step
Before you arrive
Eat and drink lightly, and sort out your ride
Sites commonly advise limiting food for a couple of hours before and fluids shortly before dosing, because nausea is a common effect. Your site will give you its own guidance — follow theirs over ours. Confirm who is collecting you.
Check-in
Registration and a baseline blood pressure reading
Blood pressure is measured before dosing. If it is above the threshold your clinician is working to, they may postpone the dose that day. This is routine rather than alarming.
Dosing
You spray it yourself, while someone watches
The device is a nasal spray, and you administer it. A healthcare professional is present throughout and confirms each device is used correctly. It takes a few minutes.
First 40 minutes
When effects are usually most noticeable
Dissociation and sedation, if they occur, typically begin shortly after dosing and are most pronounced in this window. Blood pressure is usually checked around the 40-minute mark. Most sites keep the room quiet and dim, and you are not expected to do anything.
The two-hour window
Monitored observation
You stay where staff can see you for at least two hours from dosing. Effects generally fade across this period. Bring nothing you need to concentrate on — most people find reading or screens unappealing for the first hour.
Discharge
A clinician decides you are ready
Discharge is a clinical judgement, not a stopwatch. If you are still dizzy or dissociated at two hours, you stay longer. Nobody is annoyed by this.
The ride home
Someone else drives
Not negotiable, and it applies after every session. This is the single most common logistical problem people hit, because it needs a second person twice a week during the first month.
The rest of the day
Plan on doing very little
The label instructs no driving or operating machinery until the next day after restful sleep. Most people treat the remainder of the day as unproductive and plan accordingly.
Dissociation, which is the part people are most anxious about
Dissociation is the effect people have heard about, worry about most, and are told about least clearly. It is worth demystifying, because the anticipation is often worse than the experience.
Dissociation means a temporary sense of being detached — from your body, your surroundings, or your sense of time. People describe it in very different ways: feeling that the room is further away than it should be, that time is stretching or skipping, that their limbs are not quite theirs, that sounds seem distant. Some people find it interesting. Some find it uncomfortable. Some barely notice it.
What is consistent, and what the label reports, is that it is temporary and dose-related. It typically begins soon after dosing, peaks in the first forty minutes or so, and resolves over the monitoring period. This is precisely why the two-hour window exists: you are being observed through the part where it is happening.
Some things that are true and are worth knowing in advance:
- You remain able to communicate. This is not anaesthesia or unconsciousness. If something feels wrong, you can say so, and staff are there specifically to be told.
- Feeling strange is expected rather than a sign something has gone wrong. Knowing this ahead of time makes a real difference to how people experience the first session.
- The first session is usually the most disconcerting, mostly because it is unfamiliar.
- Tell your clinician how it went. Dissociation is one of the things that informs dosing decisions, and they can only weigh what you report.
If anxiety about this is a significant barrier for you, that is a reasonable thing to raise with your prescriber before the first session rather than to sit with alone.
Side effects the label reports
The FDA prescribing information lists the adverse reactions observed in the clinical trials. The ones reported most commonly in adults with treatment-resistant depression include:
- Dissociation
- Dizziness
- Nausea
- Sedation
- Vertigo
- Reduced sensation or numbness (hypoaesthesia)
- Anxiety
- Increased blood pressure
- Vomiting
- Feeling drunk
Two framings are important here. First, this is what the trials recorded, not a prediction of what any individual will feel — some people experience several of these, some very few. Second, most of these are the effects the monitoring period is designed around: they occur in the window when you are being watched, and they generally resolve within it.
The blood-pressure effect is the one with the most clinical weight, and it is why your blood pressure is checked before dosing and again during monitoring. It is also why the label contraindicates the drug for people with certain vascular conditions — covered on the eligibility page.
The full list, including the less common reactions and the boxed warnings, is in the prescribing information linked below. It is worth reading before your first session, and it is a better source than any summary including this one.
The typical dosing schedule
| Phase | How often | What it is for |
|---|---|---|
| Weeks 1–4 (induction) | Twice a week | The initial course, after which response is typically assessed. |
| Weeks 5–8 | Once a week | Continuing treatment at reduced frequency where there has been benefit. |
| Week 9 onwards (maintenance) | Every week or every two weeks | Ongoing treatment, with frequency individualised by the prescriber. |
This is the general shape described in the prescribing information. Actual scheduling is individualised — your prescriber sets it, and it may differ from this. Every one of these sessions includes the full two-hour monitoring period and the driving restriction.
Common questions
- Can I take a taxi or a rideshare home instead of having someone collect me?
- Ask your treatment site — practice varies, and some sites want you accompanied rather than simply not driving. What is not variable is that you must not drive yourself. Settle this with the site before your first appointment rather than at discharge.
- Will I be unconscious or unable to talk?
- No. This is not anaesthesia. People remain able to communicate throughout, which is part of why the monitoring period works — staff can ask how you are and you can tell them.
- Can I go back to work afterwards?
- The label instructs no driving or operating machinery until the next day after restful sleep, and most people find the rest of the day unproductive. Plan on the day being written off, particularly during the twice-weekly induction period.
- Does it hurt?
- The administration itself is a nasal spray, so no injection and no infusion line. Some people find the spray itself briefly unpleasant, and a bad taste afterwards is commonly reported.
- How long before I know whether it is working?
- Response is generally assessed after the first four weeks of twice-weekly dosing, which is how the pivotal trials were designed and how the label describes the induction phase. This varies between people and is a question for your prescriber.
- Do I have to do the two hours every single time?
- Yes. It is a REMS requirement that applies to every session regardless of how many you have had or how you feel that day.
Sources
- SPRAVATO (esketamine) prescribing information (revised 04/2025) (opens in a new tab) — US Food and Drug Administration
- SPRAVATO REMS programme (opens in a new tab) — SPRAVATO REMS (manufacturer-operated)
- 988 Suicide & Crisis Lifeline (opens in a new tab) — 988 Suicide & Crisis Lifeline
Last reviewed against the FDA label and SPRAVATO REMS programme materials on .