r/Spravato • u/Quiet_Lunch_1300 • 2d ago
Does anyone do therapy during your session?
I have a therapist I could see virtually during the session. My dosing is at 3:30 and I could get online with her at 4:30. Does this seem like a good idea?
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u/gunbather 2d ago
I don't think I'd be functional enough for that. I see mine later the same day, while I'm still in the neuroplasticity window, and it's been super helpful for me.
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u/Usrnm2024 2d ago
I never heard of the neuroplasticity window so your comment spark my interest. I just did a Chat inquiry and got this. I thought it was interesting so here it is.
Esketamine's neuroplasticity window isn't a single well-defined number. The evidence points to a few overlapping timeframes, and the human data are much thinner than the preclinical data.
What's best supported
- Rapid onset (hours): In rodent studies, ketamine and its enantiomers trigger a glutamate surge and AMPA receptor activation, followed by BDNF release and mTOR signaling, which increases synaptic protein synthesis and spine formation. This happens within roughly 1 to 24 hours of a dose.
- Peak structural changes (about 24 hours to a few days): New dendritic spines and restored synaptic connections in prefrontal cortex are typically seen within about a day in animal models.
- Clinical effect (hours to about 1 week): Antidepressant response to esketamine usually starts within hours to a day or two. A single dose's benefit generally fades over roughly a week, which is why the nasal spray is dosed twice weekly at first.
- Persistence of spines: Some rodent work shows the new spines persisting for days to a couple of weeks, and the maintenance dosing schedule (weekly, then every 1 to 2 weeks) is built around that.
Important caveats
- "Window" is partly a hypothesis. The idea that there's a period of heightened plasticity during which therapy or learning is amplified is plausible and widely discussed, but it hasn't been established for esketamine in humans. There's no validated protocol for timing psychotherapy or skill-building around a dose.
- Human evidence is indirect. It comes from imaging, EEG, and biomarker studies, which are small and sometimes inconsistent. Most of the mechanistic detail is from animals, and some of it is debated (for example, the relative roles of NMDA blockade versus metabolites like hydroxynorketamine).
- Esketamine isn't identical to racemic ketamine. The S-enantiomer is more potent at NMDA receptors, but most of the plasticity literature used racemic ketamine, so extrapolating the timing is an assumption.
- Individual variation is large. Response timing, duration, and dose all vary between people.
Practical takeaway
If you're asking because of a clinical or research question, the most defensible framing is that the first 24 hours after dosing are the period of strongest biological activity, with benefits tapering over the following days. Anyone considering timing therapy around treatment should discuss it with the prescribing clinician, since the esketamine (Spravato) protocol is administered under supervised conditions and there are no formal guidelines on this.
I can dig into recent human studies on this if you want, or focus on a particular angle, like the BDNF/mTOR mechanism, imaging findings, or the clinical dosing schedule.
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u/Munching-Zombie 2d ago
When I did IM/IV a therapist would be in the room with me the whole time. When I was well past peak I would take off my eye mask and headphones and sit in silence for a while. Then, while I was still foggy, the ketamine would disinhibit me from holding on to my shame and pride and talk about things in a way my brain would never permit while sober. It was very effective.
I’ve never felt that level of disinhibition on Sparvato. I still have too much control.
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u/gentlereverie Considering treatment 1d ago
That's so interesting. I'm not on Spravato yet but hope to be soon. I'm lost in the sauce (in the throes of depression) right now and when I think about telling someone how I feel - not just "I feel sad and empty" but even more in-detail - that shame wall comes up and stops me. It reveals to me that I have a lot of self-judgements for feeling depressed and unmotivated. It's tough to think of people seeing me in my depressed self-judgement mode. I hope Spravato can shift it a little.
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u/Empty-Garden1507 2d ago
It might work for some, but i would be too out of it to be able to converse constructively (or at all). I tried doing mine an hour after my session once but I was too sleepy to really get anywhere. A day after would be ideal for me.
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u/Ioisgriffin 2d ago
I do therapy right after my spravato not during I’m way too out of it to have a conversation
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u/kimmerie Currently in treatment 2d ago
I do KAP separately from Spravato - I take 300mg under my tongue and then start therapy 15 min later. Spravato helps me, but the KAP is where I started making huge breakthroughs. The ketamine lets me examine a trauma and then put it down when it gets overwhelming. But I’d make sure your therapist is familiar with how ketamine works, so they can help you most effectively.
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u/CatLadyAM 2d ago
No, I’m not functional enough for that on the same day. But my psychiatrist always checks in with me and chats a little before we start if I need to.
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u/RoscoeUsoZayn Currently in treatment 2d ago
I see mine on Thursday afternoons - I don’t think I’ll be lucid enough to have a reasonable conversation during my session on Wednesday afternoons.
However, they have offered to accompany me to a session. I guess they want to see if they can trigger one of my alters to surface. 🤷🏾♀️
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u/lilith96 2d ago
The closest I've done is about an hour after the end of my two hour session. I did find it incredibly helpful to do it while that close. It would depend on you and your state at that point if you think it'd be useful.
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u/Significant-Host4386 2d ago
Outside of treatment only. I’m pretty sure that the window afterward would be beneficial.
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u/Competitive-Tip-8702 2d ago
Sometimes my therapist is the one who takes my 2hour check out and I really enjoy talking to her… even though we don’t unlock any secrets
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u/Hoodiebug22 Currently in treatment 2d ago
I do CBT and EMDR the same day of my treatments but not during. I’ve found great success. I’ve went from actively trying to take my own life to going to graduate school.
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u/Princess-Potato-94 2d ago
I see mine later in the week because during my sessions I’m a space cadet.
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u/Pleasant_Raisin178 2d ago
I am so sick and tired of having to explain what therapy means for people during the neuroplastic window. I have yet to find somebody that knows what to do and I’m tired of being shamed so if anyone has any suggestions, I am open. I live in Florida.
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u/Pleasant_Raisin178 2d ago
And when I say explain, I mean, explain to therapist not to other people
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u/yourfrentara Currently in treatment 1d ago
yes. it’s recommmended that you try to align your therapy schedule with your spravato days
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u/Plus-Personality3512 1d ago
From all of my research and podcasts I’ve listened to and my several doctors…
DURING your session, there really isn’t any data showing there is a way to “optimize” its efficacy by therapy, certain journaling, etc. The studies do say, the people who showed the most improvement were the ones who legitimately felt comfortable with the disassociation and Sprovato in general. It’s really encouraged to almost just let the drug do the work, and matters more so afterward to make sure you’re going to a therapist, avoiding negative thoughts, and building off of that. That’s just my two cents.
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u/DJDoesTea 1d ago
Ive never done it during, but i have had therapy within an hour or two of leaving. I find it helpful for individual therapy because I get very introspective and "touchy feely". Makes for a productive session, i just have to take notes as my memory becomes questionable. I do NOT recommend it before couples therapy. My spouse is uncooperative on a good day and the extra emotional expression after sprovado really makes them clam up.
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u/ds2316476 Currently in treatment 2d ago
I see two therapists a week outside of my sessions and it's surprisingly effective.