I have been putting off writing this post for a while, not because I didn’t want to write it, but because I am having a hard time finding the best way to describe my experience with Spravato. Let’s start with the basics, though, which is that Spravato is a nasal spray version of esketamine, which is a drug used to treat depression and anxiety. It is given in a supervised setting, and my understanding is that it is used only for people who have tried multiple other treatments and have had limited to no success. I started taking it near the beginning of last year, with a frequency of between twice a week to once a month, so I think I have a fair bit of experience with it.
Before I get started, just keep in mind that I am not a doctor and everything below is just my own experience and opinions. I also go into some pretty hard topics, so please skip this one if you are not comfortable with that.
Treatment Room
To start off, I will go over what it is like to get treatment at the place that I go to. This is partly to give you an idea of what it is like to get treatment and partly so you can make sure the place you are going to is as good as the one that I found. The room that the treatment takes place in has a few recliners with little tables next to them for your stuff, with little dividers between the chairs for privacy. The room has at least one employee in the room at all times keeping an eye on the people doing the treatment. They check your blood pressure, pulse, and oxygen levels a few times over the course of the treatment. They also make sure we have some candy since the spray tastes pretty bad.
Once you are all checked in, you get your first of three doses that are given five minutes apart. It’s recommended that you have an eye mask, headphones, and some simple music without words picked out to listen to during the treatment. The treatment usually works out so you hang out during the first 15 minutes until you get all of your doses; then you put on your eye mask and headphones for about 45 minutes. After that, most people usually write in a notebook, read, or just nap until the full two hours is up and they are allowed to leave. In general, it is a very peaceful and relaxing experience.
Not sure where else to mention this, and this seems like as good of a place as any, but when you leave the treatment room, you are not allowed to drive until you have a good night’s sleep. This means you either need someone to drive you home or order a ride share. It’s a bit annoying, but I totally understand it because I am extremely relaxed after the treatment and I am not in the mood at all to deal with traffic.
First Dose
Trying to think back to the first dose is hard for me because I was in such a bad place. I wasn’t sleeping well, I was in constant high levels of pain, extremely depressed, high levels of anxiety, and I was experiencing suicidal thoughts. All of that mixed together makes my memories of the timing of events fuzzy in terms of what led up to the first dose, but I clearly remember the day after because it was such a sudden change. The first time you go in for Spravato, you only get a smaller test dose to see how your body reacts to it, and I remember that day thinking that it wasn’t very impressive. There wasn’t any pain relief during the dose, there wasn’t any “high,” I didn’t feel all warm and fuzzy, nothing. I left the office thinking, “At least I didn’t have any reactions, so I can go to the full dose next time.” One more thing to mention is that my nerve pain actually flared during that first dose, but sitting still normally did that, and you have to sit still for about two hours, so I hadn’t thought about bringing a soft blanket to sit on or anything to help with the pain.
So I left the office that day kind of disappointed, but then something amazing happened about two or three hours later. The burning pain that had been building up to a completely unbearable point over the last few months was suddenly a mild tingle. It caught me off guard with the sudden change, and I really didn’t believe it at first. The pain reduction lasted into the next day, but the pain slowly started to build back up. The way I think about it after all this time is that the Spravato resets all of the chronic pain back to a zero, and then it may or may not build back up over time based on other meds and factors. On the next visits, I went up to a full dose, and the pain relief would kick in during the visit instead of later that day.
Effect on Depression and Anxiety
Besides the pain reset, the other huge change was that the depression and anxiety meds that I was on also suddenly started to actually work. Until then, it was hard to tell that they had any effect at all. It wasn’t clear if it was because I was in a crazy amount of pain or something else, but the Spravato made the trial and error of the med adjustments so much easier. I was able to tell right away with each adjustment and could give feedback on what changes I was experiencing. The best part was that I was able to go completely off Gabapentin, which was the med that was causing me a lot of side effects and was involved with my suicidal thoughts. From what I hear from others, Spravato is a lifesaver to others as well for the same reason, so I highly recommend it for people who have tried multiple other treatments and it felt like nothing was working.
The Trip
I don’t think I can fairly talk about Spravato without talking about the actual experience. This is the part that everyone wants to know since everyone has heard about ketamine in the news and assumes it is the same thing. It really isn’t, but that doesn’t mean it doesn’t have its own experience. I think it is a bit unique for everyone, but I am going to try to cover a few different experiences to give some examples of what it has been like for me. I can’t promise it will be like this for you because it is pretty different for me, but I have a general idea of what to expect.
The Ignore It
This is probably the one you wouldn’t expect the most, and I am not the only one who does this one. Sometimes you just aren’t in the mood for taking the nap or zoning out. Like sometimes the doc will be free and have time to sit and chat in the room with me, or I might just feel like reading a book instead. I have even seen someone playing games on their phone, but I think that is kind of pushing it. When you ignore the effect, you just have to remember what it feels like to feel your body and use muscle memory to move around and talk.
Talking feels like you are hearing someone else talking, and it sounds like your voice is traveling down a long hallway, but people say I sound mostly normal. It’s pretty wild though because I can’t feel most of my body, so I am controlling it mostly on instinct, and I have to shut one eye because they won’t work together at all. Everything looks a little different, but in general I can still see if I focus.
I will say that this is probably the worst way to experience the trip, but it doesn’t seem to diminish the effect of the drug. To me, it’s just like skipping out on some of the fun that you get as a bonus, so you are not getting the full experience if you go with this method. I would say I go with this option one out of six times or so, so it really isn’t my preferred method.
The Out Of Body
Alright, let’s get to the fun ones. For this one, I make sure to have my jazz music ready to go and my blackout eye mask on. As soon as I take the last dose, I put everything on and lie back, making sure that I can’t see any light around the edges of the mask. As soon as the high starts, from the head down, I start to lose feeling. For me, that doesn’t just mean I can’t feel my body, but it also means all the nerve pain and burning sensations are washed away. It feels amazing because it feels like I am being dipped into a cool spring of water until everything is replaced with nothing. At that point, I just feel like a consciousness, floating in a black void.
The void doesn’t last long though, and it is quickly replaced by something… And this part is what I think is unique for everyone. For me, I generally see two main things, and I see them very consistently. I see either repeating structures made of glowing purplish/bluish metal that go off in all directions or stone slabs with symbols on ceilings and floors that go off in all directions. In that state, I can’t “look” around because I don’t have a body, so I can’t blink, shut my eyes, or turn my head. I basically just float along in a direction and I get to be amazed by the beauty of the structures. I really wish I could read what the symbols say, but my brain says they are Aztec, but I don’t know anything about Aztec symbols, so that doesn’t make sense.
This is my favorite kind of trip because it is so relaxing and nothing breaks the zen of it. I just float along, and the only thing that might change is the color might change a little bit along with the color. Like I mentioned, I can’t turn or affect what I am seeing at all. I have tried many times, and the only thing I can do at all to mess with it is to take the eye mask off, but that ruins the whole experience and you can’t go back into it. I think of it almost like putting on VR goggles because it feels so immersive. I think the craziest thing about it is that during this and some of the other trip types, the lack of body means your consciousness feels like it is infinitely small. It makes the universe feel so big, but at the same time, you feel like you are somehow connected to all of it. When I come out of this trip, I always have a sense of oneness with the world that is something I can’t put into words adequately. I feel like if someone walked up to me and cut my arm off right then, I could easily forgive them because it was just part of the workings of the universe.
The Slideshow
This one is going to be tricky to explain. It’s a bit of a mix of the Infinite Improbability Drive from The Hitchhiker’s Guide to the Galaxy and soap bubbles. Now I need to try to make that make sense, so stick with me on this one. With this one, instead of losing your body, you feel it turn into something like a cloud, paper, water, dirt, or something else that is inanimate. It kind of goes along with the idea that you can’t feel it though because it becomes something you can’t control anymore. The last one I had, I turned into a children’s picture book where it was a drawing of clouds, and I was made a construction paper cutout of a cloud. I could feel the grain of the paper, the texture of the ink, the smell of the paper and ink. Then the breeze of the wind as I started to move across the page.
For this kind of trip, the important thing is to not panic because you can fall out of it pretty easily, so you just have to go with it. That is why I call it the slideshow because if you stick with it, you will start to go to the next slide. And that is where the soap bubbles part comes in. For me, I slide forward until I hit the edge of reality, which could be the edge of the child’s book or it could be something I can’t see at all, like I am hitting the edge of a photograph. It stretches thin and looks like a soap bubble. Then it “pops,” and for me, I get the strangest sensation over all of my senses as the next location pops into focus.
This trip is what I think people sound like when they talk about trips on mushrooms, which is something I haven’t done before so I can’t compare. I compare it to the Hitchhiker’s thing because each one is completely random and seems like totally different realities. I took notes for the last one just so I could put them into this post, and they were:
Kid’s book -> Alien Jellyfish Barber Shop -> Deep Underwater -> Forest under Shallow Water -> Inside an organ (heart maybe? Looked like it was beating) -> Spravato ran out
This kind of trip is interesting, but it isn’t my favorite. Not that you get to pick them or anything. And it isn’t like I am upset when I get this one. I am just usually left confused, and most of the time I have no idea what I just saw. It’s like I just looked into a bunch of other universes for a few minutes at a time. It’s like going to a new restaurant where you are like, it’s good, but I wouldn’t go back.
The Memories
Alright, this post is getting way too long, so I will go over one last trip, and this is more of a mini trip that comes up randomly with the others. This one is why you should be going to therapy while doing Spravato because you can unlock memories that you were repressing that you didn’t even know you had at all. They will suddenly come out while you are under the effects of the treatment, and it can be a bit of a shock. The good news is that since your body is disconnected, you don’t get all of the body reactions that come along with negative emotions. There is a lot of interesting science about how our bodies handle emotions, and a lot of the fear, fight-or-flight response stuff is more of a body thing than a mind thing. So the good news is that Spravato lets you objectively look at the memories without your body getting in the way. That doesn’t mean it will be easy, but it can really help. Again, that is why I think it’s important to work with a therapist, and I just wanted to mention it because I think it’s really an important part of the healing process.
Wrapup
All said and done, do I recommend Spravato? Heck yes! I would do it again in a heartbeat. For people out there that are really struggling, it is a literal lifesaver, and I really hope it keeps gaining adoption. I have been surprised how many doctors that I have been talking to who see it on my chart and ask me about it. The only downside is seriously just the can’t-drive-afterwards thing, but given the alternatives, it is completely worth it. Anyway, that’s all for now. Maybe I will write about some of my other trips in the future if people keep bugging me about it.