What to expect at your first Spravato session
A first Spravato (esketamine) visit is a supervised nasal spray dose, then monitoring until two hours have passed and blood pressure is back to baseline. Skip food for two hours and liquids for 30 minutes before dosing. Plan a ride home, because driving waits until the next day. After that, visits run twice a week for four weeks.
Updated · Checked by the Covered Mind editorial team against cited sources
Timeline of the first visit hour by hour, what you feel, what the clinic monitors, and how to prepare.
Key facts
- Last checked:
- Sources listed: 1
- Reading time: About 2 minutes
- Before dosing: No food for two hours and no liquids for 30 minutes
- Monitoring: After two hours
- Driving: You cannot drive until the next day
- Next visits: Two sessions a week for four weeks
| Fact | Value |
|---|---|
| Last checked | |
| Sources listed | 1 |
| Reading time | About 2 minutes |
| Before dosing | No food for two hours and no liquids for 30 minutes |
| Monitoring | After two hours |
| Driving | You cannot drive until the next day |
| Next visits | Two sessions a week for four weeks |
Before you arrive
Check your plan's rules in the coverage checker or read Spravato coverage by insurer. Verified clinic listings will appear on the Spravato overview.
- No food for two hours and no liquids for 30 minutes before dosing, to reduce nausea.
- Take your usual oral antidepressant.
- Skip nasal decongestants that day; if you have a cold, tell the clinic.
- Arrange a ride. You cannot drive until the next day after a full night's sleep.
- See driving and monitoring rules for observation length by treatment.
What happens when you arrive for your first Spravato session?
You sign the REMS enrollment form, review the consent, and the nurse checks your blood pressure. Readings above about 140/90 delay dosing until they settle. If your plan needs approval before this visit, How do I get Spravato approved by my insurance? walks through the steps.
Dosing (15 to 20 minutes)
You sit in a recliner. The nurse hands you the first device; you spray once in each nostril, then wait five minutes for the second device (and a third for the 84 mg dose). You do not sniff hard and should not blow your nose for the rest of the session.
Monitoring (20 minutes to 2 hours)
Within 15 to 20 minutes most people feel dissociation: detachment, a floating sensation, altered sense of time, sometimes vivid thoughts. It peaks at about 40 minutes and fades by 90. Sedation and nausea are common; dizziness on standing is why you stay seated. Blood pressure is rechecked at 40 minutes and before discharge. Bring headphones and an eye mask; many clinics dim the lights. Side effects and safety: Spravato, ketamine and TMS has the full list of effects and warnings.
When can I leave after Spravato?
After two hours, once the nurse confirms you are alert and blood pressure is back to baseline, you leave with your ride. Expect to feel tired that evening. Antidepressant effect, when it comes, is often noticed within the first week or two.
What is the schedule after the first visit?
Two sessions a week for four weeks, then weekly, then every one to two weeks. Each visit is billed separately. See Spravato cost and Spravato: the complete guide.
Related reading: Maintenance for Spravato, ketamine and TMS and Questions to ask a Spravato, ketamine or TMS clinic.
Related
Checked by the Covered Mind editorial team · · Editorial policy
Cite this
Covered Mind. "What to expect at your first Spravato session." https://www.coveredmind.com/guides/what-to-expect-first-spravato-session. Last checked Sep 1, 2026.
This site provides general information about insurance coverage and treatment options. It is not medical advice, not a guarantee of coverage, and not a substitute for talking with a clinician or your health plan.