If you’ve been living with depression that hasn’t budged despite trying antidepressant after antidepressant, you already know how exhausting that cycle can be. You start a new medication, wait six to eight weeks to see if it helps, and then start over when it doesn’t. It’s discouraging, and it’s fair to wonder if anything will actually work.
Spravato treatment is different from what you’ve likely tried before, and once you understand the process, most of the mystery (and worry) disappears. You’ll receive a nasal spray under medical supervision, spend about two hours at the office for monitoring, and go home the same day. Many people notice a shift in their mood within days or weeks, not months. Here’s a walk-through of what actually happens, from your first appointment to your ongoing sessions.
Spravato (esketamine) is an FDA-approved nasal spray for treatment-resistant depression. It works differently than pills like SSRIs or SNRIs. Instead of slowly adjusting serotonin levels over weeks, it targets a different brain pathway (glutamate) that appears to help form new neural connections quickly. That’s part of why relief can show up faster than it does with traditional antidepressants.
It’s not a treatment you take home, though. Because of the way it affects the body in the hours after a dose, Spravato is only given in a certified medical setting, with a provider monitoring you the entire time. At Gianan Health, Spravato is offered under direct clinical supervision at our Bolingbrook location, so you’re never navigating this alone.
Your first visit isn’t just about the medication. It starts with an evaluation to confirm Spravato is a good fit for you, usually because standard antidepressants haven’t worked well enough on their own. This is also when your provider reviews your health history, current medications, and any concerns you have about the process.
A few practical things to plan for ahead of time:
Arrange a ride home, since you cannot drive yourself after treatment
Eat a light meal beforehand, but avoid a heavy meal right before your appointment
Clear your schedule for about two and a half hours (treatment plus monitoring)
Wear comfortable clothing, since you’ll be seated or reclined for most of the visit
Many patients pair Spravato with ongoing psychotherapy or medication management, since the combination tends to support longer-lasting results. Your provider will talk through what that looks like for your specific situation.
On treatment days, you’ll check in and self-administer the nasal spray under a nurse’s guidance, using a specific number of sprays based on your dose. Because it’s a spray, not an injection, there’s no needle involved, which is a relief for a lot of people who were bracing for something more invasive.
After the spray, the actual work is simply resting. Most patients describe the experience as dreamlike, floaty, or a bit disconnected from their surroundings. It’s not something to be alarmed by; it’s the medication doing its job, and it passes.
During the two-hour monitoring window, a member of the clinical team will check your blood pressure and ask how you’re feeling at set intervals. You’ll stay in a private, comfortable space, sometimes with dimmed lighting or noise-canceling headphones available if that helps you relax. At Gianan Health, certified therapy dogs are also on hand during sessions for patients who find their presence calming.
It’s normal to feel a little strange during and shortly after your dose. The most commonly reported effects include:
Dissociation or a sense of detachment (the most frequently reported effect)
Dizziness or drowsiness
Nausea
Mild increase in blood pressure
Headache
These effects generally fade within the two-hour observation period. By the time you’re cleared to leave, most patients feel steady enough to head home, though you’ll still need someone else behind the wheel for the rest of the day since your reaction time and judgment can be temporarily affected.
Spravato follows a set schedule, not a one-and-done appointment. The typical pattern looks like this:
Induction phase (weeks 1–4): Two sessions per week
Maintenance phase (weeks 5–9): One session per week
Ongoing maintenance (week 9 and beyond): One session every one to two weeks, based on how you’re responding
That might sound like a lot at first, especially compared to popping a daily pill. But this front-loaded schedule is intentional. It gives your brain repeated exposure during the window when esketamine appears to be most effective at building new connections, which is part of why people often notice improvement faster than with standard antidepressants.
This is usually the question on everyone’s mind, and it’s a fair one after years of trial and error with other medications. Some patients report noticing a lift in mood within the first one to two weeks of induction, though everyone’s timeline is a little different. Your provider will track your symptoms at each visit using standardized questionnaires, so progress isn’t just a feeling; it’s something you can actually see documented over time.
If your symptoms aren’t shifting the way you’d hoped after several weeks, that’s useful information too. It doesn’t mean nothing will work; it just means your treatment plan may need adjusting, whether that’s dose changes, adding therapy, or exploring options like TMS alongside or instead of Spravato.
Treatment-resistant depression can make it feel like you’ve already tried everything. Spravato offers a different mechanism, a structured plan, and a clinical team that monitors you every step of the way, so you’re never left guessing what comes next.
If you’re wondering whether this could be the option that finally works for you, the first step is simply a conversation. Book an appointment with our team, and we’ll review your history together to determine whether Spravato treatment is the right fit.
About the Author
Catherine Gianan,
PMHNP-BC, FNP-BC
September 16, 2026
