How Spravato Is Administered: A Step-by-Step Guide for New Patients
Reviewed by Nick Marino, Medical Director, Allay Health and Wellness
Starting a new treatment brings up a lot of questions. What actually happens during a session? How long does it take? What will you feel, and when can you go home? For new patients exploring Spravato, these are completely reasonable things to want answered before your first appointment. The Spravato administration process is structured, supervised, and designed with patient safety at every stage.
This guide walks through exactly what happens from your first evaluation to the moment you leave the clinic. No vague reassurances. Just a clear, honest walkthrough.
What Spravato Is and Who It Is Approved For
Before discussing the administration process, the approval scope matters. Spravato is an FDA-approved esketamine nasal spray. It is approved for two specific indications. The first is treatment-resistant depression in adults who have not responded adequately to at least two oral antidepressants. The second is depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior.
Spravato is not approved for PTSD, chronic pain, anxiety, or other conditions. Any clinic that suggests otherwise is not following FDA guidelines. For a detailed overview of eligibility requirements, visit our page on Spravato criteria.
Step 1: The Clinical Evaluation
The Spravato administration process begins well before your first session. A licensed provider conducts a full clinical evaluation. This includes a review of your mental health history, current and past medications, previous treatment attempts, and your overall medical health.
This step determines whether Spravato is appropriate for your situation. Not every patient with depression will qualify. Providers use the evaluation to confirm that you meet the FDA-approved criteria and that no contraindications are present. Do not skip this step or work with any clinic that does. A thorough evaluation protects your safety and sets a clear clinical foundation for treatment.
Step 2: REMS Enrollment and Certification
Spravato is only available through the FDA’s Risk Evaluation and Mitigation Strategy program, known as REMS. Every clinic that administers Spravato must be enrolled and certified under this program. Patients are also enrolled in the REMS program before their first session.
This requirement exists because Spravato can cause serious side effects, including dissociation and sedation, that require clinical monitoring. REMS certification means the clinic has met safety standards and that staff are trained to manage these effects properly.
Before committing to any clinic, confirm their REMS certification. This is not optional. It is a federal safety requirement built into the Spravato administration process. Our team at Allay Health and Wellness is a certified Spravato provider serving West Palm Beach and surrounding Palm Beach County communities.
Step 3: Preparing for Your Appointment
Your provider will give you specific instructions before your first session. Follow them closely. Most patients are advised to avoid eating for at least two hours before their appointment. Certain medications may also need to be timed differently on treatment days. Your provider will clarify this based on your individual medication list.
Plan your transportation before your appointment. You will not be able to drive on the day of your Spravato session. This is a firm safety requirement, not a suggestion. Arrange for a trusted person to take you home after each visit. For more detail on this requirement, read our page on driving after Spravato treatment.
Step 4: Arriving at the Clinic
When you arrive for your Spravato session, a member of the clinical team will check you in and review your current health status. They will ask how you are feeling that day, whether you have followed pre-session instructions, and whether anything has changed with your medications or health since your last visit.
A baseline blood pressure reading is taken before treatment begins. Blood pressure can increase during the Spravato administration process, so this measurement establishes a starting point for comparison during monitoring. The clinical environment should feel calm and professional. You will be seated or reclined in a comfortable position for the duration of the session.
Step 5: Administering the Nasal Spray
Spravato is self-administered as a nasal spray under the direct supervision of a licensed clinician. The device comes pre-loaded with the prescribed dose. A staff member will walk you through how to use it correctly for your first session. The standard dose is either 56 mg or 84 mg. Your provider determines the appropriate starting dose based on your evaluation. The device delivers the medication in two sprays, one into each nostril, with a short pause between doses.
You do not inject anything. You do not receive an IV. The nasal spray delivers the medication through the nasal mucosa and into the bloodstream directly. For patients curious about how this differs from IV ketamine infusions, our comparison page on Spravato vs. ketamine for depression explains the key differences clearly.
Step 6: The Monitoring Period
After administering Spravato, patients remain at the clinic for a mandatory monitoring period of at least two hours. This is a non-negotiable part of the Spravato administration process. It exists because the medication can cause dissociation, sedation, nausea, dizziness, and blood pressure changes in the period following administration.
Clinical staff monitor your blood pressure and overall status at regular intervals during this period. They remain present and available if you experience any discomfort or unexpected reactions. Most patients experience the strongest effects within the first hour. By the end of the monitoring period, the acute effects have typically subsided enough for discharge. You will not be released until a clinician confirms you are stable and ready to leave safely.
What Dissociation Feels Like During Sessions
Dissociation is one of the most commonly reported effects of the Spravato administration process. Knowing what to expect helps reduce anxiety before your first session. Patients often describe dissociation as feeling detached from their surroundings or from their own thoughts. Some report perceptual changes, such as sounds feeling different or time moving at an unusual pace.
These effects are temporary. They typically peak within the first 40 minutes and reduce significantly before the monitoring period ends. Staff are trained to support patients experiencing these effects. You are not alone during this time, and the clinical team will check on you throughout the session.
Step 7: Being Cleared for Discharge
Before you leave, a clinician reviews your status one final time. They check your blood pressure, assess your alertness, and confirm that the acute effects of the session have resolved to a safe level. If everything looks stable, you are cleared for discharge. A responsible adult must be present to drive you home. No exceptions apply to this requirement. Patients who cannot arrange transportation should reschedule rather than attempt to drive.
How Session Frequency Works Over Time
The Spravato administration process follows a structured schedule that adjusts as treatment progresses. During the initial induction phase, sessions are typically scheduled twice per week for the first four weeks. After that, frequency generally reduces based on your clinical response and provider assessment.
Maintenance sessions may follow on a weekly or biweekly basis, depending on your individual progress and needs. Your provider will review your response at each stage before recommending any schedule changes. For a full explanation of how this schedule is structured, visit our page on how often Spravato treatment is scheduled.
Insurance Coverage for Spravato
Spravato is often covered by insurance, which makes it more accessible than many new patients expect. Because it is FDA-approved, insurers are more likely to cover it than off-label treatments. However, coverage depends on your specific plan, diagnosis, and whether prior authorization is required. Coverage may apply. Verify directly with your insurer before beginning treatment. Our clinic assists with benefit verification and prior authorization support where possible.
Crisis Resources
If you are experiencing thoughts of self-harm or suicidal ideation, please do not wait for a scheduled session. Contact the Suicide and Crisis Lifeline immediately by calling or texting 988. Spravato is not emergency care. It is a structured clinical treatment that requires scheduling, evaluation, and ongoing supervision.
Start the Spravato Administration Process at Allay
Knowing what to expect makes every step feel more manageable. At Allay Health and Wellness, our licensed team guides new patients through the full Spravato administration process with clarity and clinical oversight.
We serve patients in Palm Beach Gardens, West Palm Beach, and surrounding Palm Beach County communities. Coverage may apply. Verify with your insurer before your first appointment.
Address:11000 Prosperity Farms Rd, Suite 101, Palm Beach Gardens, FL 33410
Phone: (561) 421-6444
Email: [email protected]
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Spravato is FDA-approved for treatment-resistant depression and for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior. Treatment eligibility, outcomes, and side effects vary by individual and require evaluation by a licensed healthcare provider. No outcomes are guaranteed. If you are in crisis, call or text 988.
