By Madison Avenue TMS & Psychiatry - Published on July 16, 2025

Last updated on July 16, 2025

A step-by-step guide for patients beginning Spravato treatment for treatment-resistant depression (TRD)

If you’ve been struggling with depression that hasn’t improved with traditional antidepressants or therapy, you’re not alone. Treatment-resistant depression is real, and according to recent research, about one-third of patients with major depressive disorder (MDD) did not respond to two or more oral antidepressants. 

If you can relate, you may be a candidate for a treatment that’s helping people find relief when other options haven’t worked: Spravato (esketamine).

Spravato is an FDA-approved nasal spray for adults with treatment-resistant depression or MDD with suicidal thoughts or behaviors. Self-administered under the supervision of a mental health or healthcare professional, it works differently from traditional antidepressants by targeting glutamate, a neurotransmitter associated with mood regulation.

As a certified Spravato treatment center, our team at Madison Avenue TMS & Psychiatry created this step-by-step guide to help you know what to expect at your first Spravato appointment and beyond, to help you feel more confident and at ease.

Before Your First Spravato Appointment

Do I need an initial evaluation to be eligible for Spravato?
Yes, before being prescribed Spravato, it is important to complete a comprehensive psychiatric evaluation. Your mental health provider will review your mental health history, current symptoms, previous medications, and overall medical history to determine whether you’re a candidate for the medication.

“We always take time to understand a patient’s full journey,” says Dr. David Woo, head clinical psychiatrist and founder of Madison Avenue TMS & Psychiatry. “This helps us understand what treatment options the patient is open to and allows us to craft a tailored treatment plan to meet their needs.”

Is Spravato covered by insurance?
Spravato is typically covered by most commercial insurance plans and Medicare Advantage, but it does require pre-authorization. 

“Our administrative team will work with your insurance provider to confirm coverage, submit paperwork, and ensure eligibility before your first dose,” says Dr. Woo. “We also help patients enroll in financial assistance programs like the Spravato WithMe Support Program, if applicable.”

Do I need to prepare for my first Spravato treatment session?
You’ll need to arrange transportation for the day of your appointment, as patients are not allowed to drive or operate heavy machinery after treatment. They should also refrain from making any major decisions until the following day. 

On the day of your appointment, we recommend that you:

• Wear comfortable clothing
• Bring a valid photo ID and insurance card
• Avoid alcohol and cannabis use
• Eat and hydrate normally unless told otherwise by your provider
  

During Your First Spravato Appointment 

What happens when I arrive at my first Spravato appointment?
“Once you arrive at our office, our front desk team will check you in and escort you to your private, quiet treatment room with a comfortable, reclining chair,” says Jessica Sokolovsky, Spravato Administrator at Madison Avenue TMS & Psychiatry. “From there, we will walk through what the session will include and answer any questions you may have.”

How is Spravato administered?
Spravato is self-administered, and your clinician will guide you through the administration process. “You will spray one squirt in each nostril,” Sokolovsky says. 

Once you have self-administered, you will sit comfortably in a reclining chair for the remaining two hours of your appointment, which will be monitored. 

Why is a monitoring period part of Spravato treatment?
Spravato is a REMS (Risk Evaluation and Mitigation Strategy)-certified medication, meaning the FDA requires that it be administered in a certified clinic under medical supervision for at least two hours. This ensures that any adverse reactions, such as the potential side effects mentioned below, are addressed on-site during your appointment. 

During the two-hour monitoring period, you are welcome to read, listen to music, or simply relax. Your team will monitor your blood pressure, comfort level, and overall response to the medication periodically throughout the visit. 

What are the benefits and side effects of Spravato?
Patients struggling with treatment-resistant depression who take Spravato may experience a significant reduction of depressive symptoms from their very first appointment. Many patients report:

• Noticeable mood improvements during their treatment sessions or within the first few weeks
• Relief from depressive symptoms that didn’t respond to other treatments
• Greater clarity, energy, and motivation
  

As with any treatment, there are potential side effects with taking Spravato, such as:

• Dizziness or lightheadedness
• Temporary dissociation (a floating or “out-of-body” feeling / feeling detached from one’s thoughts, feelings, or surroundings) 
• Nausea
• Increased blood pressure
• Perceptual changes, such as distortions of time and space
• Visual or auditory hallucinations
  

While there are common benefits and side effects with Spravato, each person’s experience with the treatment will be unique. “Our staff is here to support you through your Spravato experience and help you feel at ease throughout your appointment,” says Sokolovsky.

After Your First Spravato Appointment: Follow-Up and Treatment Schedule

How often do I have to schedule Spravato treatments?
Spravato treatment follows a structured schedule:

• Weeks 1–4: Two sessions per week 
• Weeks 5–8: One session per week
• Week 9 and Beyond: Maintenance sessions every 2-4 weeks, based on your progress
  

How will I know if Spravato is working?
As the patient, it is important for you to track your progress, symptoms, and any side effects throughout your Spravato treatment. 

“Open communication is key,” Dr. Woo emphasizes. “We always encourage patients to let us know how they’re feeling physically, emotionally, and mentally, both during their sessions and in between appointments. This gives us the opportunity to customize your treatment plan to best fit your needs.” 

Take the First Step Toward Relief

Starting a new treatment for depression can feel overwhelming, or it might even feel futile if you haven’t had success with past treatments. But Spravato is specifically meant for treatment-resistant depression and is helping many patients finally find relief after years of struggling. Our team at Madison Avenue TMS & Psychiatry is here to support you through every step of your mental health journey. If you think Spravato may be right for you, call us at (212) 731-2033 or visit madisonavetms.com to schedule a consultation.

Madison Avenue TMS & Psychiatry