You’ve made the decision. After trying multiple antidepressants without finding lasting relief, you’re ready to explore advanced treatment options like ketamine infusion therapy or Spravato (esketamine nasal spray). But now practical questions flood your mind: What actually happens during treatment? How will I feel? Can I work? What do I tell my family? How quickly will this work?
These concerns are completely valid, especially when you’re already exhausted from years of treatment that hasn’t worked. The good news is that advanced treatments for treatment-resistant depression follow predictable patterns, and understanding what to expect can reduce anxiety and help you prepare logistically for your first month.
Here’s your comprehensive, week-by-week guide based on FDA-approved protocols and clinical research, designed specifically for patients in the Mobile and Theodore area considering treatment at Wholistic Health.
Before You Begin: The Consultation Phase
Your journey starts with a phone consultation, typically lasting 20-45 minutes. At Wholistic Health, Susan Gillespie, our Family Nurse Practitioner with her Master’s Degree from Georgetown University, uses this time to answer all your questions and concerns, determine if you’re an appropriate candidate for ketamine therapy or Spravato, and formulate a personalized treatment plan.
During this consultation, you’ll discuss your treatment history, current medications, medical conditions, and treatment goals. Certain conditions make ketamine-based treatments inappropriate, including active mania, uncontrolled high blood pressure, aneurysmal vascular disease, or pregnancy. You’ll also discuss practical concerns about cost, scheduling, and what to expect.
Addressing the Fear Factor: Many patients feel nervous about trying a treatment they’ve heard referred to as a “horse tranquilizer” or worry about the dissociative effects. This fear is understandable but often stems from misinformation. At therapeutic doses for depression—which are much lower than anesthetic doses—ketamine and esketamine are carefully monitored and have been used safely for decades in medical settings.
One of our patients described her initial fear this way: “Previously being an addict in active addiction, I was scared of the treatment. The only thing I knew about ketamine was it is a horse tranquilizer and abused as ‘special k.’ If I could go back in time, I wish I could have rescued myself sooner. I would ask myself what I was really scared of because nothing was scarier than the way I was living.”
Week One: The Induction Phase Begins
Treatment Schedule
Whether you choose ketamine infusions or Spravato, the first month follows an intensive induction phase. For Spravato, you’ll have two treatment sessions per week, typically scheduled several days apart (Janssen Pharmaceuticals, 2025). Ketamine infusions follow similar protocols, though your provider may customize the schedule based on your response.
Your First Treatment Session
Before Arrival:
- Avoid solid foods for 6 hours before treatment (ketamine) or 2 hours (Spravato)
- Avoid liquids for 30 minutes before Spravato administration
- Arrange transportation home—you cannot drive yourself
- Wear comfortable clothing
- Consider bringing headphones and something to occupy yourself during the monitoring period
During Treatment: For Spravato, you’ll self-administer the nasal spray under direct supervision. Each treatment involves 2-3 spray devices (56mg or 84mg total dose) with a 5-minute rest between devices. The medication reaches peak concentration in your bloodstream 20-40 minutes after the last spray.
For ketamine infusions, you’ll receive medication through an IV over 40 minutes for mental health protocols. Our trained personnel, including nurse practitioners who monitor your treatment, ensure your safety throughout.
What You Might Experience: Common side effects during and immediately after treatment include dissociation (feeling detached from your surroundings), dizziness, sedation, and transient increases in blood pressure. Research shows these effects peak around 40 minutes and typically resolve within two hours (Wajs et al., 2020).
One patient described the experience: “I never felt nervous about getting the treatment and felt super relaxed and comfortable.” Another noted, “Not every infusion is perfect and there have also been tearful infusions, but I have my life back.”
Post-Treatment Monitoring: You must remain at the clinic for at least two hours after treatment. Your blood pressure will be monitored, and providers assess when you’re safe to leave. You’ll receive water and snacks during recovery. We don’t rush patients—you remain in our care until it’s safe to go home (Janssen Pharmaceuticals, 2025).
When Might You Notice Changes?
Here’s where advanced treatments differ dramatically from traditional antidepressants. While conventional medications require 6-8 weeks to show effects, many patients report noticeable improvements within hours or the first few days after their initial dose.
However, response varies by individual. Some people experience almost instant relief, while others see more gradual improvement over the induction series. Most patients notice significant improvement by their third infusion (Wajs et al., 2020).
Logistics This Week
Work Considerations: Plan to take the remainder of the day off after each treatment. Most patients can return to work the following day, but avoid scheduling important meetings or deadlines immediately after treatment days.
Childcare: If you have young children, arrange for someone else to handle pickup, dinner, and bedtime on treatment days. You’ll be tired and shouldn’t drive.
What to Tell Family: You might simply say you’re starting a new medical treatment that requires observation afterward, similar to getting an infusion for other conditions. You don’t owe anyone detailed explanations, but having basic information ready can reduce stress.
Weeks Two Through Four: Completing Induction
Treatment Frequency
You’ll continue with twice-weekly sessions throughout the induction phase. Many patients find this schedule challenging logistically, especially when depression has already disrupted their ability to maintain routines. This is precisely why Wholistic Health offers weekend and after-hours appointments by arrangement.
Tracking Your Response
Your provider will have you complete depression scales before each treatment. This might seem tedious when you’re struggling, but it serves two critical purposes: it helps both you and your provider understand how treatment is working, and it documents response for insurance purposes.
Keep your own simple notes too. Many patients find it helpful to track:
- Mood/energy level (scale of 1-10)
- Sleep quality
- Ability to complete daily tasks
- Suicidal thoughts (if present)
- Physical symptoms
What Research Shows About This Phase
Clinical trials demonstrate that after completing the four-week induction phase with twice-weekly treatments, the majority of responders achieve meaningful improvement (Wajs et al., 2020). A meta-analysis found that 70% or more of treatment-resistant patients experience significant symptom relief after the initial round of infusions, compared to 40% success rates with traditional antidepressants.
Addressing Common Concerns
“What if I don’t feel better right away?” Some patients respond after the first session; others need the full induction series. If you’re not seeing improvement by the third or fourth session, discuss this with your provider. They may adjust dosing or evaluate whether other factors are interfering with response.
“What if I have a bad reaction?” Side effects like dizziness, nausea, or dissociation are transient and don’t require medical intervention (Janssen Pharmaceuticals, 2025). About 10% of patients require temporary interruption of Spravato infusion due to dizziness, but treatment can resume. Serious adverse events are rare with proper screening and monitoring.
“Can I keep taking my other medications?” Generally, yes. Spravato must be taken in conjunction with an oral antidepressant. Your provider will review all your medications for potential interactions, but most patients continue their existing regimen.
Week Five: Transitioning to Weekly Treatment
The Schedule Shift
If you’ve responded well to the induction phase, your treatment frequency typically reduces to once weekly for weeks 5-8. This is a relief for most patients both practically and financially.
This transition is evidence-based. Research analyzing phase 3 data found that 76% of responders who moved from twice-weekly to weekly dosing continued to improve or maintained their clinical benefit (Wajs et al., 2020).
What This Means Practically
- Easier to schedule around work and family obligations
- Lower weekly time commitment (though still 2+ hours per session with monitoring)
- More time to consolidate the improvements you’ve made
- Continued monitoring of depression scales
If You’re Not Responding
Not everyone responds to ketamine-based treatments, though the success rate is significantly higher than traditional antidepressants. If you’ve completed four weeks without meaningful improvement, your provider should evaluate several factors:
- Was the dose adequate for your body weight and metabolism?
- Are comorbid conditions (anxiety, PTSD, chronic pain) interfering?
- Is bipolar disorder present instead of unipolar depression?
- Would augmentation with other treatments help?
At Wholistic Health, we take a comprehensive approach. Our team, including Dr. Thomasina H. Anderson-Sharpe with over 28 years of experience in alternative medicine applications for mental health, evaluates the whole picture. We look at genetic and lifestyle factors, utilize nutrition, exercise, and stress management alongside advanced treatments, and treat the root cause of persistent problems.
Weeks Six Through Eight: Building on Success
Maintaining Momentum
By now, if treatment is working, you’re likely experiencing something you haven’t felt in years—the ability to taste food, laugh, feel joy, have energy to care for your family. One patient described it: “I went from thinking about taking too much medication, or driving off a bridge, to having more joy than I have in my entire life since I got depressed at 14.”
These weeks are about consolidating those gains while your provider evaluates your ongoing needs.
Planning for Maintenance
As you approach week 9 and beyond, your provider will assess whether you need:
- 56mg or 84mg dosing
- Weekly sessions
- Every-other-week sessions
Research shows that when treatment frequency is reduced from weekly to every other week based on symptom levels, most patients (68%) further improve or maintain clinical benefit (Wajs et al., 2020). Those who need their frequency increased (about 32%) typically respond positively to that adjustment.
Addressing the Two Biggest Barriers
Barrier 1: Cost and Insurance
Advanced treatments sound expensive, and cost concerns prevent many people from even exploring options. Here’s what you need to know:
Spravato (esketamine): FDA-approved specifically for treatment-resistant depression and covered by many major insurance carriers, including Medicare, Aetna, BCBS, and others. Out-of-pocket costs vary by insurance, but manufacturer savings programs can reduce costs to as little as $10 per treatment for eligible patients.
Ketamine Infusions: Insurance coverage varies. Many insurers will partially reimburse the cost. We work with patients to assist with all payment options and offer payment plans through AdvanceCareCard.com.
The question isn’t “Can I afford this?” but rather “Can I afford not to try this when traditional treatments have failed?” Calculate the cost of lost work days, reduced productivity, strained relationships, and diminished quality of life. For many patients, advanced treatments prove cost-effective when weighed against years of inadequate response to conventional approaches.
Barrier 2: Time Commitment and Scheduling
The induction phase is time-intensive—no way around it. Twice weekly for four weeks, with each session requiring 2+ hours including monitoring, represents a significant commitment.
However, consider this: you’ve probably spent months or years trying medication after medication, waiting 6-8 weeks for each to potentially work, experiencing side effects, and never achieving remission. Two months of intensive treatment that actually works is a bargain compared to years of inadequate response.
We offer weekend and after-hours appointments by arrangement precisely because we understand that people with severe depression often can’t easily navigate standard business hours. We also understand that arranging transportation can be challenging, which is why we allow rideshare services for post-treatment transportation home.
Three Essential Action Steps This Week
- Clear Your Schedule: If you’re planning to start treatment, look at the next 4-8 weeks and identify the twice-weekly slots that work best. Block those times now, before other obligations accumulate. Treat these appointments as non-negotiable as you would chemotherapy or dialysis.
- Build Your Support Team: Identify at least two people who can provide transportation on short notice. Have backup plans for childcare, pet care, and other responsibilities on treatment days. The less logistical stress, the more you can focus on healing.
- Call for Your Consultation: Stop waiting for the “right time” or for things to get worse. If you meet criteria for treatment-resistant depression (two adequate antidepressant trials without remission), you’re eligible now. Call 251-276-4185 to schedule your free phone consultation. Use that 20-45 minute conversation to ask every question, voice every concern, and determine if advanced treatment is right for you.
What Happens After the First Month
Your treatment doesn’t end after eight weeks. Most patients continue with maintenance treatments—initially weekly or biweekly, eventually tapering to monthly or as-needed based on symptom monitoring. Some people maintain remission with infrequent boosters; others need more regular sessions.
The key is that ongoing treatment is tailored to your individual response. This isn’t like traditional antidepressants where you take the same pill daily for years. It’s responsive, flexible, and adjusted based on how you’re doing.
One patient noted: “I have had a few relapses that I think came from not getting booster infusions. It seems like every few weeks is what is best for me. During these relapses, a few were severe and I would have had zero hope if I didn’t know that there is a way out. I immediately called Susan and once even had to call the on-call number. These relapses were very short lived thanks to Susan. It’s easier to have hope when you know it’s possible to feel ok.”
Final Thoughts: Hope and Practical Action
Starting advanced treatment for treatment-resistant depression requires courage. You’re trying something new after multiple disappointments, investing time and money, navigating logistics while barely functioning, and hoping this will be different.
Individual results vary—that’s a medical fact, not a disclaimer. Not every treatment works for every person. But the evidence is clear: ketamine-based treatments have higher success rates for treatment-resistant depression than any other available option, with the added benefit of rapid response for many patients.
At Wholistic Health, located in Theodore serving the greater Mobile area, we’ve seen patients go from active suicidal ideation to functioning as employees, partners, and parents. We’ve watched people who doom-scrolled for treatments regain the ability to laugh and taste food. We’ve supported individuals through the scary decision to try something new and celebrated when they discovered there really is a way out.
Your first month will be intense. It will require logistical planning, schedule adjustments, and vulnerability. But it may also be the month that changes your life.
We’re here to guide you through every step. Call us today.
References
Janssen Pharmaceuticals, Inc. (2025). Spravato (esketamine) nasal spray prescribing information. FDA Package Insert. https://www.drugs.com/pro/spravato.html
Wajs, E., Aluisio, L., Morrison, R., Kornfield, R., Hough, D., Turkoz, I., Turkoz, L., Daly, E., Trivedi, M., Thase, M.E., Wiegand, F., & Sheehan, D.V. (2020). Managing esketamine treatment frequency toward successful outcomes: Analysis of phase 3 data. CNS Drugs, 34(8), 883-893. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387766/
Dennis, C.L., & Chung-Lee, L. (2006). Postpartum depression help-seeking barriers and maternal treatment preferences: A qualitative systematic review. Birth, 33(4), 323-331. https://pubmed.ncbi.nlm.nih.gov/17150072/
Important Note: Results vary by individual. This guide is for informational purposes only and does not guarantee specific outcomes. If you’re experiencing a mental health emergency, call 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room. Wholistic Health is located at 7272 Theodore Dawes Rd, Suite B, Theodore, AL 36582. Call 251-276-4185 to schedule your consultation today.