The Spravato® Session Playlist Guide
A phase-by-phase guide to using music intentionally during esketamine treatment — written by a conservatory-trained musician who has been through it.
Most Spravato® patients receive no guidance on music. They're handed a recliner, given the nasal spray, and left to figure out what to listen to on their own. Some put on a familiar playlist. Some use a guided meditation. Some sit in silence.
None of those are wrong, exactly — but they're also not optimized. And when you're spending significant time and money on a treatment that works in part through neuroplasticity and emotional processing, "not optimized" matters.
This guide is what I wish I'd had before my first session. It covers the three phases of a Spravato® session, what music works at each phase and why, the single most important rule (no lyrics), and practical tips for headphones and setup.
The short version: slow, lyric-free, emotionally expressive music — matched to each phase of the session — consistently produces better outcomes than random playlists or silence.
The three phases of a Spravato® session
A standard session runs 90 minutes. The music you need changes significantly across that arc.
Onset
The medicine is beginning to take effect. Your sense of time and space starts to soften. This is not the moment for dramatic music.
Goal
Ease the transition. Reduce anticipatory anxiety. Let the medicine do its work without musical interference.
What works
- Ambient / drone
- Minimal classical (Satie, Pärt)
- Gentle acoustic guitar
- Soft piano — no melody peaks
What to avoid
- Anything with lyrics
- Sudden dynamic shifts
- Driving rhythms or percussion
- Familiar songs with emotional associations
Keep tempo under 70 BPM. Slower is almost always better here.
Peak
The dissociative state is at its deepest. The default mode network — the brain's self-referential narrator — is quieted. This is the therapeutic window.
Goal
Support emotional depth and openness. Music here actively shapes the valence and arc of the experience.
What works
- Orchestral / cinematic (Hans Zimmer, Max Richter)
- Modal jazz (Miles Davis Kind of Blue era)
- Post-classical (Nils Frahm, Ólafur Arnalds)
- World music without familiar lyrics
What to avoid
- Any lyrics in a language you understand
- Guided meditations or spoken word
- Abrupt tempo changes
- Comedy, novelty, or ironic music
60–90 BPM works well. The music can be more emotionally expressive here — swells and dynamics are appropriate.
Integration
The medicine is wearing off. Awareness is returning. The mind is beginning to process what just happened.
Goal
Ground the experience. Support a gentle return. Create space for reflection without re-engaging the analytical mind too quickly.
What works
- Acoustic guitar (fingerpicking)
- Gentle folk — instrumental only
- Soft piano with space between notes
- Nature soundscapes as a bridge back
What to avoid
- Anything that demands attention
- Upbeat or energetic music
- News, podcasts, or spoken content
- Abrupt silence — fade out gradually
Return toward 60 BPM or below. Think of this as a musical decompression chamber.
The most important rule: no lyrics
This is the single biggest mistake patients make. Here's why it matters so much.
Language re-engages the default mode network
Spravato® works in part by quieting the brain's default mode network — the system responsible for self-referential thought, rumination, and the inner narrator. Lyrics, especially in your native language, immediately re-activate that network. You start processing meaning, remembering associations, forming opinions. The therapeutic window closes.
Familiar songs carry emotional anchors
A song you know well is never just music — it's a memory, a person, a time in your life. During a Spravato® session, those associations can hijack the experience entirely. You're no longer in the therapeutic space; you're reliving something specific. That's not always bad, but it's unpredictable and hard to guide.
Words compete with internal imagery
The dissociative state often produces visual or symbolic inner experiences. Lyrics introduce a competing narrative — a story running parallel to your own. Purely instrumental music supports rather than competes with whatever the mind is processing.
Guided meditations are the worst offenders
Many patients assume guided meditations are ideal for Spravato® sessions. They're actually counterproductive for the same reason as lyrics, amplified: a voice is giving you instructions, which demands compliance and analytical processing. Save guided meditations for before or after the session.
The exception: lyrics in a language you don't speak.
Foreign-language vocals can work during the peak phase because your brain processes them as tonal texture rather than semantic content. Portuguese fado, Tibetan chant, and certain world music traditions can be deeply effective. The key is that you're not parsing meaning — you're hearing sound.
Headphones and setup
Practical tips for getting the most out of your listening setup in the treatment room.
Over-ear headphones are strongly preferred over earbuds — they create a more immersive soundstage and are more comfortable for 90 minutes of lying still.
Volume should be moderate — loud enough to be present, quiet enough that you could hear someone speak to you if needed. Roughly 50–60% of max volume is a good starting point.
Noise-cancelling headphones can help in a busy clinic environment, but make sure staff know you're wearing them so they can get your attention if needed.
If you use your phone as the music source, enable airplane mode or Do Not Disturb before the session starts. A notification mid-peak is jarring.
Queue your playlist before the session — don't leave yourself searching for music once the medicine takes effect.
Some patients prefer no headphones at all, especially early in treatment. That's valid. The goal is comfort and openness, not compliance with a protocol.
Ready-made playlists for every phase
Five curated playlists built specifically for Spravato® sessions — available on Apple Music, Spotify, and YouTube Music. Free.
Nothing here replaces guidance from your prescriber or treatment team.