How Is Spravato Administered? What Happens During a Session

If you’re considering Spravato, you might be asking yourself, “how is Spravato administered?” The answer is that you use esketamine nasal spray yourself, just like a nasal spray for allergies. Unlike other self-administered nasal sprays, however, Spravato is taken in a REMS-certified clinic. It cannot be administered at-home, because a trained technician monitors a patient for about two hours after. Continue reading to learn how the supervised administration process works. 

Quick answers

• Spravato (brand name for esketamine) is a nasal spray that you take yourself, and it's FDA-approved for treatment-resistant depression.
• However, you cannot take it at home. Instead, a patient self-administers Spravato at a certified treatment center.
• Each session requires you to spend over two hours at the clinic, because a trained technician monitors a patient during treatment.

How the Spravato administration process works

During the first Spravato treatment session, a technician can guide a patient through how to use the Spravato nasal spray .“Usually what I say to a new patient is that if they've ever used nasal sprays for seasonal allergies or anything else, it's very similar.” Carlene MacMillan MD, FCTMSS, DFAACAP, co-founder at Radial and board-certified psychiatrist.

For Spravato specifically, the administration process includes:

• The device: Spravato is a single-use nasal spray, says Dr. MacMillan. Each device contains 28mg of esketamine. The prescribed dose when starting out is 56mg (two devices), but it can increase to 84mg (three devices). The prescribing provider determines the dose.
• The technique: Insert the device into one nostril, block the other, tilt your head back a little bit, and then spray. While someone may take up to three devices during one session, it’s not “boom, boom, boom,” says Dr. MacMillan, “There are like pauses in between, so someone will spray one canister, wait five minutes, then do the other.” She adds that at Radial, they have lollipops on hand because the spray can travel to the back of the throat, and some people prefer something to wash out the taste.
• The setting: Spravato is administered inside a certified treatment center. A trained technician is present throughout to watch for any adverse effects.

What happens during the monitoring period

“At any certified Spravato site that you go to, they should check vital signs, like heart rate, blood pressure, and oxygen saturation, right before you begin treatment, at a certain point that’s a little bit more than midway through the treatment, and then again before you leave,” says Dr. MacMillan. 

The center will also check for any signs of dissociation or perceptual shifts, which are reported in Spravato reviews from patients. While the experience can feel different, signs like dissociation are not a cause for concern—so long as they occur in a certified clinic where the patient is being monitored. 

“The safest place to be when taking Spravato is in a practice like Radial,” says Dr. MacMillan, “We take care to have the nice chair, the lighting, and all of that set up for you so you can focus solely on the treatment.” That especially sounds nice compared to home, where background noise is constant and a child or pet could pop in at any time.

How to prepare for a Spravato session

Before the first Spravato session, there are a few ways to prepare:

• Food: Refrain from eating for 2 hours before treatment, and avoid drinking fluids for 30 minutes before each treatment. 
• Medication: “Don’t skip any medications unless instructed by a provider,” advises Dr. MacMillan. She also mentions that a healthcare provider may prescribe Zofran (to be taken in advance) when necessary to offset any nausea.
• Transportation: Arrange a ride home in advance, because patients cannot drive for the rest of the day after a treatment.

You also don’t have to prepare alone. At Radial, the prescribing provider can help you to feel prepared for your first Spravato treatment. Pre-treatment discussions address any concerns or questions you might have about the risks, benefits, and outcomes of Spravato treatment. 

To learn more about Spravato and if it’s an appropriate option for you, contact a provider who is certified to administer it, like the team at Radial. 

​​Disclaimer: One medical reviewer listed on this article, Steve Harvey, MD, is a paid speaker for Johnson & Johnson, the manufacturer of Spravato.