Ketamine 101: What to Expect from Spravato® & IV Ketamine
An overview of what ketamine and Spravato® (esketamine) are, how they differ, typical session flow, who they're for, and what to expect before, during, and after your first visit.
Clinically Reviewed: Board-Certified Psychiatrist |Next Review: February 2026
Key Takeaways
- Ketamine and esketamine (Spravato®) work on the glutamate system and can produce rapid improvement in depression.
- Spravato® is FDA-approved for treatment-resistant depression and for depressive symptoms with acute suicidal ideation; IV ketamine for depression is off-label but widely used.
- Sessions are in-clinic with monitoring; you need a ride home and cannot drive until the next day after sleep.
- Typical Spravato® induction is twice weekly for about 4 weeks, then evaluation and possibly maintenance or taper.
- Screening for contraindications (e.g., aneurysm, substance use) and medical stability is required before starting.
In a Crisis?
If you're in crisis or having thoughts of hurting yourself, reach out now: call or text 988 (Suicide & Crisis Lifeline, 24/7).
What Ketamine and Spravato® Are
Ketamine is a medication that affects the glutamate system (NMDA receptors) in the brain—different from serotonin/norepinephrine antidepressants. It can produce rapid improvement in depression, sometimes within hours to days. Spravato® (esketamine) is the S-enantiomer of ketamine, delivered as a nasal spray and FDA-approved for (1) treatment-resistant depression (TRD) in adults with an oral antidepressant, and (2) depressive symptoms in major depressive disorder (MDD) with acute suicidal ideation or behavior. IV ketamine for depression is off-label but widely used and studied; it's the same drug given by infusion in a clinical setting.
Both are given in-clinic under medical supervision. You'll need monitoring during and after the dose, a ride home, and no driving until the next day after a full night's sleep.
Spravato® vs IV Ketamine in Brief
Spravato® is a nasal spray; you administer it yourself in the clinic under staff guidance, then stay for about 2 hours of observation. IV ketamine is an infusion (typically 40–60 minutes) plus monitoring. Spravato® has FDA approval and REMS (risk evaluation and mitigation) requirements; IV ketamine is off-label for depression. Insurance coverage differs; your team can help you understand options. For more detail, see Spravato® vs. IV Ketamine.
Typical Session Flow
For Spravato®: You'll receive the nasal spray in-clinic, then rest while staff monitor blood pressure and any side effects for about 2 hours. For IV ketamine: An IV is placed, the infusion runs (often 40–60 minutes), and you're monitored during and after. In both cases, you may feel dissociation (dreamy, detached), dizziness, or nausea; these are common and monitored. You must have a responsible adult to drive you home and must not drive or operate machinery until the next day after sleep.
Before starting, you'll complete a medical and psychiatric screening to check for contraindications (e.g., aneurysm, AVM, brain bleed, allergy, certain substance use) and stability for treatment.
Who It's For and First-Visit Expectations
Spravato® is for adults with TRD (inadequate response to at least 2 antidepressants) or with MDD and acute suicidal ideation/behavior. IV ketamine is often offered in similar situations. You'll have an evaluation to confirm indication, review medications, and complete safety screening. Bring a list of your medications, any relevant medical history, and plan for a ride home after each session. Learn more about candidacy in Who Is a Candidate for Ketamine Treatment?
Frequently Asked Questions
Will ketamine hurt?
Spravato® is a nasal spray; you may feel mild taste or nasal discomfort. IV ketamine is given through a vein; the infusion itself doesn't hurt. During treatment, many people experience dissociation (feeling detached or dreamy), which is expected and monitored.
Can I drive after a session?
No. You cannot drive or operate machinery until the next day after a full night's sleep. Arrangements for a ride home are required for every Spravato® and IV ketamine session.
How often are sessions?
Spravato® induction is typically twice per week for 4 weeks; then your team will evaluate and may continue weekly or less often. IV ketamine frequency varies by protocol and response.
Is Spravato® or ketamine covered by insurance?
Spravato® is FDA-approved and often covered for treatment-resistant depression and depressive symptoms with acute suicidal ideation. IV ketamine is usually off-label and coverage varies. Our team can help verify your benefits.
Who is ketamine for?
Spravato® is approved for adults with treatment-resistant depression (inadequate response to ≥2 antidepressants) or depressive symptoms with acute suicidal ideation/behavior. IV ketamine for depression is off-label but used in similar situations.
What happens during a Spravato® session?
You receive the nasal spray in-clinic, then remain under observation for about 2 hours. Vital signs and any side effects are monitored. You must have a ride home and cannot drive until the next day.
Can I take my other medications?
Most people continue their antidepressant with Spravato®. Your doctor will review all medications and any interactions before starting. Do not change doses without your prescriber's guidance.
How fast might I feel better?
Some people notice improvement within hours to days—faster than with many antidepressants. Response varies; your team will track symptoms and adjust the plan as needed.