The Spravato Clinician Guide: Supporting Patients with Curated Audio is a structure for clinicians to apply the use of specially curated, lyric-free music to assistance during Spravato sessions for patients to feel safe and emotionally supported, and to help them with grounding. During the 2 hour sessions of Spravato, clinicians are able to aid patients in their comfort and tolerance of the drug's effects through sound that is designed to work with the drug's effects on the central nervous system.
Listening to Spravato, founded by a conservatory-trained musician and Spravato patient Justin Page, has developed these resources. We have converted the science of this audio into steps that clinics can use for each phase of induction, maintenance, and monitoring, though we largely cover the maintenance phase below.
What Is the Spravato Clinician Guide: Supporting Patients with Curated Audio?
This guide is designed for clinicians, and outlines a method for using music to support patients during Spravato treatment. Rather than having patients play a random song, or play a guided meditation, this guide uses music that complements the sedative and dissociative nature of esketamine.
The American College of Clinical Pharmacology states that Spravato was approved by the FDA for treatment resistant depression on March 5, 2019, to be used in conjunction with an oral antidepressant. The FDA approved its use for major depressive disorder as a monotherapy in 2025, UTHealth Houston's Psychiatry Department states. This may be the most recent evidence supporting the use of an audio protocol for a broader population.
Why Does Curated Audio Matter During Spravato Sessions?
Clinically, music is so much more than just "comforting." One 2024 study published in PubMed argues that "intranasal esketamine therapy with music listening" helps to alleviate anxiety and lower blood pressure in a sample of participants. It helps patients develop a greater tolerance to higher doses of the medicine. For clinicians, developing a patient's tolerance is of the utmost concern when discussing the administration of their medicine.
Sedation and dissociation are expected side effects. The 2025 FDA label notes that 48% to 61% of patients experienced some level of sedation, whereas 0.3% to 0.4% of patients experienced loss of consciousness. Curated music provides the patient with a steady focal point to help them ground, and potentially, self regulate, during the sedated and dissociated state.
Grounding
Curated music provides the patient with a steady focal point to help them ground, and potentially self regulate, during the sedated and dissociated state.
Autonomic regulation
Music listening during intranasal esketamine therapy helps to alleviate anxiety and lower blood pressure, per a 2024 PubMed study.
Dose tolerance
Patients who listen to curated music develop a greater tolerance to higher doses of the medicine, which is of the utmost concern for clinicians.
How Should Clinicians Match Audio to the Spravato Dosing Protocol?
The FDA approved the following dosing protocol for Spravato, with an induction phase (weeks 1-4) with twice-weekly doses of 56 mg or 84 mg, and a maintenance phase (weeks 5-8) with weekly doses of 56 mg or 84 mg. Given the nature of the protocol, the use of music during the induction phase should focus on predictability.
During the induction phase, the use of music should focus on predictability. What is your favorite music to listen to that calms you and reduces stress? That music would be perfect for the first few sessions to make patients feel less anxious while they learn more about the sensory responses to the medicine.
The goal of the maintenance phase is to offer the patient flexibility. Once clinicians understand the patient's response pattern, they can allocate some genre options. Patterns can help the patient's recovery process.
Clinicians should consider that not all patients prefer constant sound. The guide treats purposeful silence as a valid and clinically supported choice.
What Should Clinicians Tell Patients Interested in Music-Assisted Spravato?
When addressing Spravato, clinicians should consider that the medicine will quiet the language center of the patient's brain, and therefore, the patient should not listen to any music that contains vocals. This will avoid competition in the brain. Before the session, clinicians should have a short briefing to help patients understand and trust the music and the process that is about to occur.
Explain the reasoning
Tell patients that the music is selected to work with the medicine and not to compete with it. Spravato quiets the language center of the brain, so these patients should not listen to any music that contains lyrics.
Set volume
Patients should be able to adjust the volume of their music to their preference. The volume can be adjusted depending on the patient's level of comfort, as well as with the sessions the patient attends as they become more accustomed to the dissociative state.
Offer opt-out
Silence should be an option. Some patients prefer silence, and others may find music more grounding. Both should be valid.
Normalize the experience
Advise patients that drowsiness and dissociation is monitored. The prescribing label states that 48% to 61% of Spravato patients experience sedation. Interpreting this figure as normal may help calm anxiety prior to treatments.
Debrief briefly
A couple of post-session queries aids in refinement of the following session's selection of audio. The question "How did the music feel?" is often enough to offer something relevant for the following session of record.
All of these discussion points are centered around the theory of music in Spravato sessions, which is described in detail in the book Listening to Spravato, published March 12, 2026, and offers clinicians a methodological structure for implementing music to assist patients in achieving more emotional and therapeutic outcomes grounded in security and stability. You can access the author's Listening to Spravato curated playlists to begin the process of developing your clinic's audio library.
Access, Cost, and Why Comfort Supports Adherence
21 million adult Americans suffer from major depressive disorder as cited by Johnson & Johnson, and that is a large clientele where losing them to treatment attrition is a significant clinical concern. Thoughtful, well-supported sessions via the use of comfort, or ease, to patients can help them adhere to the full course of treatment.
For most of the treatment sessions that are covered by commercial insurance, the patient pays between $10 and $125 after satisfying the deductible, and the monthly cost to the patient doesn't exceed $500, as stated by Healing Maps. There is a cost-free improvement to the quality of care when you use curated playlists since they require just a list, which is shared via headphones.
Efforts to keep patients engaged pay off as data shows 22.5% of patients taking Spravato achieved remission compared with 7.6% of patients taking the placebo after 4 weeks, as reported by Renal & Urology News. The sensory issues some patients experience cause them to not want to be induced and, consequently, do not want to complete the necessary induction phase.
Building an Audio Protocol Into Your Clinical Workflow
To minimize distractions caused by staff switching playlists, it's recommended that a staff member create a consistent approach to audio that can be consistently supported by any staff member that may be in attendance.
Curate, don't improvise
Create and maintain 2-3 lyric free playlists rather than pulling from a general streaming service. Consistency across staff reduces variability in the patient experience.
Document preferences
Each patient's preferred genre and volume should be documented in the patient's session record. This allows staff to easily adjust the audio appropriately.
Train the team
Ensure staff know how to utilize the audio effectively without disrupting the patient.
Review quarterly
Based on patient feedback and other session tips, evolve the playlists used during induction to the needs of the patient.
This small change puts a great emphasis on the patient experience and costs little more than a pair of headphones and the music library.
Frequently Asked Questions
Is there scientific evidence that music helps during Spravato treatment?
Yes. A study published in 2024 on PubMed claims that listening to music during intranasal esketamine therapy decreased anxiety and lowered blood pressure, and increased tolerance to higher doses. The mechanism is consistent with known effects of esketamine on the default mode network. Music, in this case lyric-free, is a non-verbal, constant, and regulatory anchor that helps with autonomic regulation without reactivating the language-processing regions that the medication is calming.
Why should the music be lyric-free?
Music with lyrics is a reactivation of the self-referential network within the default mode network, and therefore, a distraction from the process which the drug is intended to encourage. Lyrics interrupt the medically induced process of deep relaxation and dissociation. Music devoid of lyrics injects needed support and emotional presence to patients in a verbal-less manner.
Do patients have to listen to music the whole session?
The opposite of music is silence and intentional silence is clinically valid. Some patients prefer to have music during the onset and peak of the procedure, but be silent during integration. Others prefer to have music during the whole procedure. The most important part of this is for intent to be clearly communicated prior to administration of the procedure.
How much does Spravato treatment cost with insurance?
According to Healing Maps, most patients insured through commercial insurance spend $10 to $125 on a Spravato session after meeting their deductible with average monthly costs of $500. It has low barriers to adoption -- all you need is a vetted playlist and headphones -- making it one of the easier quality-of-care enhancements a clinic can implement.
Can Spravato be used without an oral antidepressant now?
Yes, it is possible. The FDA approved Spravato for treatment resistant depression in adult patients in conjunction with an oral antidepressant in 2019. In 2025, the FDA approved Spravato to be a monotherapy for major depressive disorder, per UTHealth Houston's Department of Psychiatry. This approval expands the population eligible to receive an appropriate audio prescription.