If you’re considering Spravato (esketamine) for treatment-resistant depression, you may be wondering what actually happens during a treatment session. The process is unlike picking up a prescription at a pharmacy — Spravato is administered in a clinical setting under medical supervision. Knowing what to expect from your first consultation through your ongoing treatment can make the process feel far less intimidating.
Here’s a step-by-step look at what your Spravato experience at Advantage TMS looks like from start to finish.
The first step is a conversation. When you reach out to Advantage TMS, you’ll speak with one of our Spravato intake specialists, who will gather some basic information about you and your history with depression treatment.
From there, you’ll be scheduled to meet with our Spravato Coordinator — either in person or via video call. During this meeting, your coordinator will review your medical history in detail, walk you through how Spravato works, and determine whether it’s the right fit for you.
Spravato is FDA-approved for adults 18 and older who have tried at least two different antidepressants without meaningful improvement. You do not need to be currently taking an antidepressant to qualify. If you have a history of certain medical conditions — such as an aneurysm, arteriovenous malformation, or intracerebral hemorrhage — or a known allergy to esketamine or ketamine, Spravato may not be appropriate for you. Our coordinator will go through all of this with you carefully.
Once our team determines that Spravato is a good option for you, we take care of the logistical work. We coordinate your insurance benefits, review costs and scheduling with you, and arrange for the medication to be shipped directly to our office. Most commercial insurance plans cover Spravato, including both the office visits and the medication itself. (Please note: we do not accept Medicare for Spravato treatment.)
Because Spravato is a controlled substance with specific safety requirements, it must be dispensed and administered through a certified healthcare setting. We’ll guide you through the registration process for the Spravato REMS (Risk Evaluation and Mitigation Strategy) program and handle the coordination so you don’t have to navigate that paperwork alone.
On the day of your first session, plan to be at our office for approximately two hours. When you arrive, our team will get you settled comfortably in our private Spravato treatment room — a calm, upscale space designed with your comfort in mind.
One important thing to arrange ahead of time: you cannot drive yourself home after a Spravato session. Please have a trusted person pick you up or arrange rideshare transportation before your appointment. You may feel sleepy for the remainder of the day, so it’s also a good idea to keep your schedule clear afterward.
Under the guidance of our team, you will self-administer the Spravato nasal spray while seated comfortably in the treatment room. You’ll then relax while we monitor you throughout your session.
During this time, Spravato may cause a brief period of dissociation — some patients describe feeling spacey, dreamy, or euphoric. You may also feel sleepy or experience mild nausea or dizziness. These effects are temporary, and our team monitors you throughout to ensure your comfort and safety. We will not discharge you until these side effects have subsided.
Spravato follows a structured treatment timeline:
Weeks 1–4: Two sessions per week
Weeks 5–8: One session per week
Week 9 and beyond: One session per week or once every two weeks, depending on your progress
Many patients continue treatment for several months to maintain and build on their results. Your provider will work with you to determine the right schedule based on how you’re responding.
Clinical studies show that between 50% and 70% of people with treatment-resistant depression experience noticeable relief from symptoms after Spravato treatment. One of the things that makes Spravato distinct from traditional antidepressants is how quickly relief can arrive, versus the months that oral antidepressants may require.
Our team will check in with you regularly throughout your treatment to track your progress and adjust your plan as needed.
What sets Advantage TMS apart is that Spravato treatment doesn’t happen in isolation. While you’re in our program, you have access to:
Free group therapy led by our full-time licensed clinical social worker, offered twice a week in person or virtually
Free monthly events such as yoga, sound bowls, and trivia nights
Individualized attention from Dr. Rizzo, a board-certified psychiatrist, and Cathi Stephens, a board-certified psychiatric nurse practitioner — both specialize in treatment-resistant depression
These additional layers of support can make a meaningful difference in your outcomes and in how you feel during treatment.
Can I combine Spravato with TMS therapy? Yes — in some cases, combining Spravato and TMS may provide greater benefit than either treatment alone, particularly for those with treatment-resistant depression. Our providers will assess your specific situation and make a recommendation based on your needs.
What if I have a history of substance use? You’ll be asked to share your full medical and substance use history during your initial evaluation. Because Spravato is a psychoactive substance, this information is important for determining whether it is the right treatment for you.
Will Spravato interact with my current antidepressant? Spravato can be taken with or without an oral antidepressant. Your provider will review your current medications during your evaluation.
If you’ve tried antidepressants without success, Spravato may offer the relief you’ve been looking for. At Advantage TMS, we’re here to walk you through every step of the process — from your first phone call to your ongoing care.
Contact us today to schedule a free consultation and find out if Spravato is right for you.
Raza, A. A., Ahmed, G. U., Zafar, H., Akhtar, S. O., Bin Mobin, M., & Samadi, A. (2025). Spravato for Treatment-Resistant Depression: Efficacy and Sexual Side Effect Profile. Neuropsychiatric disease and treatment, 21, 2125–2140. https://doi.org/10.2147/NDT.S548944
Anderson, B., Winokur, A., & Chan, G. (2026). Effectiveness of intranasal esketamine in the treatment of patients with treatment-resistant depression: an observational study based on data collected in a Spravato treatment program at the Institute of Living, Hartford, CT. Psychopharmacology, 10.1007/s00213-026-07016-9. Advance online publication. https://doi.org/10.1007/s00213-026-07016-9
Our office is closed December 25th for Christmas and January 1st for New Years Day. If you have any questions or urgent requests, please email us at info@advantagementalhealth.com.
Please fill out the form if you have a patient interested in learning more about TMS treatment. We appreciate the referral and partnership.
Next Steps:
• Our TMS Coordinator will contact the patient to schedule a complimentary information session.
• If the patient decides to seek TMS treatment with Advantage TMS, we will communicate with you when necessary and the patient will continue to work with you while receiving treatment.
Questions?
• Please don’t hesitate to contact us at 727-600-8093 or info@advantagementalhealth.com
