A Spravato treatment session follows a structured, in-clinic protocol built around patient safety. Spravato (esketamine) is an FDA-approved nasal spray for treatment-resistant depression, and every session at Scottsdale TMS Therapy takes place under direct medical supervision inside a REMS-certified treatment center. Here is what happens from check-in to discharge.
Every Spravato session starts with a brief clinical check-in. Before your dose, clinical staff complete a few quick steps:
This baseline matters because Spravato can raise blood pressure temporarily, so your care team needs a starting point to monitor against.
Spravato is administered in-clinic only, under direct medical supervision, as required by the Risk Evaluation and Mitigation Strategy (REMS) program that governs esketamine. Scottsdale TMS Therapy holds that certification. Once your vitals and dose are confirmed, you’ll move to a private treatment room for administration.
Spravato is self-administered as a nasal spray, but only under direct healthcare-provider supervision inside the clinic. You’ll receive the device from clinical staff and use it yourself, following their guidance while a provider stays present the entire time.
The FDA requires exactly this setup, a patient-administered device with a provider watching throughout, as a condition of REMS certification. Scottsdale TMS Therapy holds that certification, so the on-site monitoring equipment, trained staff, and documented protocol the FDA requires are already in place.
Clinical staff remain in the room throughout administration and check in with you directly to confirm you’re tolerating the dose well.
During treatment, most patients notice changes in perception, alertness, or mood shortly after administration. Common effects include:
These effects are a known part of how esketamine works and are why direct supervision is required throughout the session. Effects vary from person to person and session to session, so what you notice on your first visit may differ from later ones.
Clinical staff stay nearby to monitor for these effects and respond if anything feels more intense than expected.
A Spravato session includes a minimum two-hour monitoring period after administration. The FDA’s REMS program sets that minimum, and Scottsdale TMS Therapy follows it for every patient.
During this window, clinical staff track your blood pressure, alertness, and any dissociative or sedative effects to confirm you’re stable before you leave. Administration itself takes only a few minutes; the observation window accounts for most of your time at the clinic.
Because of the lingering effects, you should not drive or operate machinery for the rest of the day. NAMI notes patients need a full night’s rest before driving the next day again, so arrange for a caregiver or family member to drive you home before treatment.
After the two-hour monitoring window, clinical staff assesses whether you’re ready to be discharged. They’ll check that your blood pressure has returned to a stable range and that any dissociative or sedative effects have eased enough for you to leave safely.
Once cleared, you’ll be discharged into the care of the companion or driver you arranged in advance. You should not attempt to drive yourself home. Your care team uses each session to track your progress and confirms the date and time of your next scheduled session before you leave.
How many sessions you’ll need depends on where you are in your treatment plan, since Spravato follows its own dosing schedule separate from other treatments at the clinic. Mayo Clinic and the American Academy of Family Physicians describe a general esketamine dosing pattern with two phases:
Your psychiatric provider will confirm your specific schedule and adjust the pace as your care progresses. Spravato’s dosing timeline is distinct from TMS therapy’s session structure, so your provider will walk you through each schedule separately.
Spravato’s safety comes from the REMS-certified monitoring protocol required for every session, which manages known risks like dissociation, sedation, and temporary blood pressure increases in real time.
As a REMS-certified clinic, Scottsdale TMS Therapy keeps the monitoring equipment, trained staff, and documented protocols the FDA requires in place for every session.
Results vary by individual, and no specific outcome can be guaranteed. The REMS structure provides a supervised environment where any side effect is caught and managed by clinical staff before you leave.
A Spravato session follows the same core structure every time: a pre-treatment check-in, in-clinic administration under direct supervision, a two-hour monitoring period, and a clearance check before you head home with your driver.
If you’re considering Spravato for treatment-resistant depression, our team can walk you through how Spravato works at Scottsdale TMS Therapy or review the dosing schedule in our Spravato dosage guide.
Coverage varies by plan, so most patients confirm benefits before scheduling. You can verify your insurance coverage before your first visit. Call (480) 841-9279 to book a consultation.
If you are in crisis, call or text 988.
Dr. Vines has practiced psychiatry in Arizona for for over 25 years and has experience working with diverse populations that include children, adolescents, adults, geriatrics, SMI patients, and the chemically dependent.
October 21, 2026
