Spravato (esketamine nasal spray) produces a distinctive altered state that most people describe as feeling spacey, floaty, or dreamlike. The sensations typically begin within minutes of the nasal spray and peak around 40 minutes in, then gradually fade over the next hour or so. You’ll be monitored in a clinic for at least two hours after each dose, and the experience can range from mildly strange to profoundly disorienting depending on the person and the dose.
What the Session Actually Feels Like
The most common word patients use is “dissociation,” which in practice means feeling temporarily detached from your body, your surroundings, or both. Some people feel like they’re watching themselves from a distance. Others describe it as being in a waking dream, where the room looks slightly unreal or time seems to slow down or speed up. People have reported feeling strange, woozy, loopy, or like they’re floating. Some experience a sense of deep peacefulness or even something they describe as a spiritual or blissful state.
The physical sensations are just as varied. Dizziness, numbness or tingling, nausea, and a heavy or weightless feeling in the limbs are all commonly reported. Your blood pressure typically rises during the session, which is why the clinic checks it before dosing, again around the 40-minute mark, and as needed until the monitoring period ends. Most people also notice some degree of blurred vision or sensitivity to light and sound, which is why many clinics offer eye masks or dim the lights in the treatment room.
Not everyone finds the experience pleasant. For some, the sense of detachment feels unsettling rather than calming, particularly during early sessions before they know what to expect. The intensity also varies from session to session. Your first treatment may feel stronger simply because everything is unfamiliar.
How Long the Effects Last
The acute dissociative effects typically peak around 40 minutes after dosing and resolve within about 90 minutes for most people. By the end of the two-hour monitoring window, most patients feel clearheaded enough to leave the clinic, though you cannot drive, operate machinery, or make important decisions for the rest of the day. You’ll need someone to take you home.
Some residual grogginess, mild headache, or a “foggy” feeling can linger into the evening. Research on the closely related compound ketamine has found that subtle effects on processing speed can persist up to 24 hours after a single session. Most people feel fully back to normal by the next morning, but it’s worth planning a low-key evening after treatment.
Why It Feels This Way
Spravato works by blocking a specific type of receptor in the brain that normally responds to glutamate, the brain’s primary excitatory chemical messenger. When these receptors are blocked, a cascade of events unfolds. Glutamate release actually increases through an indirect pathway, which triggers a burst of activity in neural circuits involved in mood. This surge stimulates the brain to produce growth factors that help rebuild connections between nerve cells, essentially reversing some of the synaptic “pruning” that occurs in chronic depression.
The dissociative feelings are a direct consequence of this same receptor blockade. The brain’s normal system for integrating sensory information with your sense of self is temporarily disrupted, which is why the world can feel unreal or your body can feel distant. Researchers at Yale have shown that this process also triggers the rapid regrowth of dendritic spines (the tiny branches on nerve cells that form connections with other neurons), which may explain why mood improvements can happen so much faster than with traditional antidepressants.
When the Antidepressant Effect Kicks In
The dissociative experience during a session is temporary and separate from the antidepressant benefit, though researchers are still debating how much the two are connected. In clinical trials, measurable improvements in depression scores appeared as early as four hours after the first dose. For patients with major depression and active suicidal thoughts, statistically significant improvement was documented within 24 hours of the first session.
This speed is what sets Spravato apart. Traditional antidepressants like SSRIs typically take weeks to produce noticeable changes. Across multiple large clinical trials, remission rates ranged from 27% to 50%, with many patients noticing a shift in their mood within the first few sessions. That said, Spravato is approved specifically for treatment-resistant depression in adults (meaning other medications haven’t worked adequately) and for depressive symptoms in adults with major depression accompanied by acute suicidal ideation. It’s always used alongside an oral antidepressant rather than as a standalone treatment for suicidality.
What the Clinic Setting Looks Like
Because of the dissociative effects and blood pressure changes, Spravato can only be administered in a certified healthcare setting under a restricted distribution program. You won’t be handed a prescription to take home. Instead, you’ll sit in a treatment chair in either a private room or a shared space with other patients, depending on the clinic’s setup. The nasal spray is self-administered under supervision, and then you settle in for the two-hour observation period.
Many clinics create a calming environment with recliners, blankets, dimmed lighting, and the option to wear an eye mask or listen to music. Bringing headphones and a playlist you find soothing can help shape the experience in a positive direction, especially if the dissociation feels disorienting. Staff will check on you periodically, take your blood pressure, and make sure you’re comfortable before clearing you to leave.
Tips for Your First Session
Avoid eating a large meal for about two hours before your appointment, since nausea is one of the more common side effects. Wear comfortable clothes and plan to do very little afterward. Some people find the floating sensation more manageable when they close their eyes and focus on music rather than trying to fight the feeling or stay alert. Resistance to the dissociation tends to make it feel more uncomfortable, while leaning into it often makes the experience feel neutral or even pleasant.
The intensity of side effects tends to decrease with repeated sessions as your body adjusts to the medication. Most treatment schedules start with twice-weekly sessions for the first month, then taper to weekly or biweekly. Many patients report that by the third or fourth session, the dissociation feels much milder and more predictable, even routine.