Spravato Integration Guide
A guide for getting the most from your Spravato (esketamine) treatment — before, during, and after each session.
Set Your Intention
What do you wish to receive from this session?
Write this in your journal before your session. Return to it during your two-hour observation period.
Spravato (esketamine) is an FDA-approved nasal spray for treatment-resistant depression. It's a close relative of ketamine — specifically the S-enantiomer, which has a stronger affinity for the NMDA receptor. Like ketamine, it creates a window of neuroplasticity where your brain can form new connections and break free from rigid thought patterns.
Spravato is always administered in a certified clinical setting under medical supervision, with a mandatory two-hour observation period after each dose. This structure is part of what makes it safe — and it also creates a built-in space for reflection and integration.
The Science
How Esketamine Works in the Brain
Esketamine blocks NMDA receptors, triggering a cascade that increases Brain-Derived Neurotrophic Factor (BDNF) and activates the mTOR pathway — both of which promote the growth of new synaptic connections. Like ketamine, it temporarily quiets the Default Mode Network (DMN), the brain region responsible for rumination, self-referential thinking, and habitual thought loops. This combination creates a window of neuroplasticity: a period where rigid patterns become flexible and new pathways can form. Integration is how you guide those new connections toward lasting change.
Sticking with the Program Matters
Research shows that treatment adherence is one of the strongest predictors of success with Spravato:
The full treatment protocol — twice weekly for 4 weeks, then tapering to weekly or biweekly — is designed to give your brain the repeated exposure it needs to build lasting change. Patients who complete the full induction phase show significantly greater improvement than those who stop early.
The mandatory observation period after each Spravato session is a gift — a built-in window for rest, reflection, and integration.
Your experience speaks in many languages. Use these as a starting point — simply notice, without judgment.
Use these after each session and in the days that follow. You don't have to answer all of them. Let the ones that pull at you lead the way.
Spravato follows a structured protocol. Each phase builds on the last.
Twice weekly sessions. This is where the foundation is built. Consistency here is critical.
Once weekly. Your brain consolidates the changes. Many people notice shifts becoming more stable.
Weekly or every other week, based on your response. Ongoing treatment reduces relapse risk by 51%.