Every SPRAVATO® (esketamine) treatment center in the country follows the same FDA safety program. The medication is given in a certified healthcare setting, under direct observation, with at least two hours of monitoring after every dose. Those rules are the floor, not the ceiling.
What differs from one clinic to the next is everything around those two hours: how prepared you feel walking in, how you are supported while the medication takes effect, and whether the visit includes real therapy and connects to the rest of your care. Here is how we approach it at NextGen Psyche and Wellness, and why.
New to SPRAVATO®? Start with our earlier post, Why Depression Can Improve in Hours, Not Weeks, which explains how it works and who may be a candidate.
1. You Know What to Expect Before You Arrive
Uncertainty makes anxiety worse, and anxiety can shape how a treatment session feels. So before your first visit, we walk you through a simple preparation checklist:
- No food for 2 hours and no liquids for 30 minutes before your appointment
- A trusted adult to drive you home (no driving yourself, rideshare, or public transit alone)
- Comfortable, loose clothing
- Your own headphones and a calming playlist or guided "happy place" recording
- Plan for about 2.5 to 3 hours in the office
- No alcohol or non-prescribed sedating substances for 24 hours beforehand
2. Ten Minutes of Grounding Before the First Spray
We don't rush to dosing. Before the first device, we spend about ten minutes preparing you:
- Explaining what you may feel, such as a dreamy or "floaty" sensation, changes in perception, dizziness, or nausea, and that these effects usually peak within 30 to 40 minutes and fade within about two hours
- Teaching a simple grounding technique you can use if the experience feels intense, such as naming objects in the room, slow paced breathing, or a hand on your chest
- Getting your music cued up, your headphones fitted, and your chair positioned comfortably
- Answering your last questions before we begin
People who know what is coming, and have a tool ready, tend to feel much more at ease during treatment.
3. Your Soundtrack, Your "Happy Place"
Your environment matters. You'll rest in a reclining chair with a blanket, an eye mask if you'd like one, and your own relaxation playlist or guided imagery playing through your headphones. If you forget yours, we have options ready. The goal is simple: a calm, private, predictable space.
4. Optional Virtual Reality Relaxation
Technology is part of how we practice. With your consent, we can offer a VR headset with calming, immersive environments during the first 30 to 60 minutes of monitoring. Some people find it helps them settle. If it adds any disorientation, we simply stop. It's always your choice.
5. Monitoring That Actually Watches
We check your blood pressure, heart rate, breathing, and oxygen level before treatment, and again at about 40 minutes (when the medication peaks), 60 minutes, 90 minutes, and 120 minutes. We also note how sedated or dissociated you feel at each check.
No one leaves before the two-hour mark, even if they feel fine. And if your blood pressure is still elevated or you're not steady on your feet, we keep you longer. Two hours is the minimum, not the goal.
6. We Measure Your Progress, Not Just Your Vitals
Depression can make it hard to notice gradual improvement. That's why we track your symptoms with standardized depression and safety questionnaires at your visits, so we can both see objectively whether treatment is working and adjust the plan with real data, not guesswork.
7. Psychotherapy During the Final Phase of Your Session
At many clinics, the last part of the visit is simply waiting to be cleared. We use that time differently. As the medication's effects begin to fade, you meet with a therapist for a focused psychotherapy session, or a guided VR therapy session, as part of the same visit.
- Making sense of the experience. What did you notice or feel? There's no "right" way to respond.
- Connecting it to your goals. Thoughts, memories, or emotions that surfaced are linked to what you're working on, using approaches like CBT.
- VR-guided therapy option. Immersive, therapist-guided VR can be used for relaxation, skills practice, or gentle exposure work, depending on your plan.
- One small next step. You leave with a concrete, realistic goal for the next 24 to 48 hours.
Research suggests esketamine may open a temporary window when the brain is more flexible and open to change. Pairing that window with therapy, instead of an empty waiting room, is one of the most important ways we try to turn a treatment session into lasting, real-life change.
8. One Clinician Who Knows Your Whole Story
SPRAVATO® is not a stand-alone service here. It is one part of a complete psychiatric plan. As your psychiatric nurse practitioner, I also manage your oral antidepressant, sleep, anxiety, ADHD, trauma, and any other conditions that affect your mood, and I bring therapy skills like CBT into our work. You won't be handed off between a "spray clinic" and a separate prescriber who never talk to each other.
9. Care in Your Language
We provide care in English, Spanish, and Tagalog. Understanding exactly what is happening during treatment shouldn't depend on which language you think in.
10. Safety First, Every Visit
Before you leave, we re-check your safety, confirm your ride, and review your at-home instructions: no driving or operating machinery until the next day after a restful night's sleep, no alcohol for the rest of the day, and who to call after hours. You'll leave with your next appointment already scheduled.
What I See in My Practice
Everyone responds differently, and some people notice changes early. But in my experience, about three months of consistent treatment is often the magic number, when the biggest shift tends to happen. Many patients describe it the same way: like the difference between night and day.
"It was like night and day. There was a dark cloud hanging over me my whole life, and I thought that was just part of life. It literally lifted off my head."
A NextGen patient, shared anonymously
Individual experiences vary. Not everyone responds to SPRAVATO®, and results are not guaranteed.
What a Visit Looks Like at a Glance
- Check-in and safety review. Vitals, symptom questionnaires, and a medication check.
- Grounding (about 10 minutes). What to expect, a coping tool, music and comfort set up.
- Treatment. You use the nasal spray devices yourself under our direct guidance, with short rests in between.
- Monitoring (at least 2 hours). Relax with your music, eye mask, or optional VR while we check on you regularly.
- Psychotherapy or VR therapy (final phase). A session with a therapist, or guided VR therapy, as effects fade, ending with one small goal for the next day or two.
- Safe discharge. Final checks, then home with your driver.
Is SPRAVATO® Right for You?
If you're an adult who has tried two or more antidepressants without enough relief, it may be worth a conversation. We'll review your history, medical conditions (including blood pressure), and current medications, and decide together whether it's a safe and appropriate fit.
Call 626-371-3053 or email info@nextgenpsycheandwellness.org to schedule a consultation at our office at 5222 Balboa Ave., #43, San Diego, CA 92117.
If you are in crisis or having thoughts of harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911. SPRAVATO® is not a substitute for emergency or hospital care. This article is for educational purposes and is not medical advice. SPRAVATO® has important safety information, including risks of sedation, dissociation, increased blood pressure, respiratory depression, misuse, and suicidal thoughts and behaviors in young adults. It is available only through a restricted program (SPRAVATO® REMS). Talk with a qualified clinician about whether it is right for you.