For people who have tried multiple antidepressants without finding relief, Spravato® (esketamine) offers a new and effective option. While it can bring rapid improvement in depressive symptoms, patients often wonder about its long-term effects of Spravato.
Approved by the US Food and Drug Administration (FDA), Spravato is used for adults with treatment-resistant depression as well as major depressive disorder (MDD) with suicidal thoughts or behaviors.
Spravato is a nasal spray given in a clinical setting under medical supervision. It works by targeting glutamate, one of the brain’s most important chemical messengers, to help restore healthy brain communication and mood regulation.
Understanding the potential benefits and long-term side effects of Spravato helps patients make informed decisions about whether this treatment is right for them.
How Spravato works and how it’s given
Spravato acts on the brain’s N-methyl-D-aspartate (NMDA) receptors, which are part of the glutamate system. By blocking these receptors, it increases glutamate activity in the brain, helping promote new neural connections and improve mood.
Each treatment involves self-administering the nasal spray under medical supervision. Sessions usually occur twice a week for the first four weeks, then gradually taper from there during maintenance treatment.
Because Spravato can temporarily raise blood pressure and cause drowsiness, patients remain in the clinic for about two hours after each session for monitoring. Blood pressure and breathing are checked regularly to ensure safety before the patient goes home.
Common side effects and risks
Like any medication, Spravato can cause side effects. Most are mild and temporary, improving shortly after treatment.
Common short-term side effects include:
- Dizziness or lightheadedness
- Feeling “disconnected” (dissociation)
- Nausea or vomiting
- Headache
- Sleepiness or fatigue
Less common but more serious side effects can occur, which is why medical supervision is required during every treatment.
Potential serious risks include:
- Temporary increases in blood pressure
- Sedation or drowsiness
- Short-term cognitive impairment (trouble concentrating or feeling “foggy”)
- Rarely, respiratory depression (slow or shallow breathing)
- Worsening depression or suicidal thoughts, especially in young adults
Spravato is a Schedule III controlled substance, meaning it has some potential for misuse. Patients are carefully screened before starting treatment, and every dose is administered in a clinical setting to ensure safety.
If a patient experiences worsening mood, thoughts of self-harm, or new symptoms, they should contact their healthcare provider right away.
Managing side effects
Most side effects can be managed with support and good communication between patient and provider.
Tips for managing Spravato side effects:
- Report all symptoms to your treatment team. They can adjust dosage or scheduling if needed.
- Plan for rest after each session; avoid driving or operating machinery until the next day.
- Stay hydrated and eat a light meal before treatment to minimize nausea.
- Have a support person available to drive you home or check in afterward.
Clinics closely monitor blood pressure, heart rate, and breathing during treatment. This careful oversight helps prevent and manage potential complications quickly.
Patients should also inform their healthcare provider of any other medications or supplements they’re taking, as these could interact with Spravato or affect its side effect profile.
Long-term side effects of Spravato
Most research on Spravato shows it to be safe and effective over time, especially when used as directed and under supervision. However, understanding the long-term side effects of Spravato is important for anyone considering ongoing treatment.
What studies show so far:
- In long-term clinical trials, Spravato helped reduce depressive symptoms and prevent relapse in adults with treatment-resistant depression.
- Most side effects (like dizziness or dissociation) remained short-lived and did not worsen with continued treatment.
- Blood pressure increases can occur during treatment but typically return to normal within a few hours.
While rare, there are some potential long-term risks to be aware of:
- Vascular effects: Because Spravato can temporarily raise blood pressure, long-term use may need extra caution in patients with heart or vascular conditions.
- Bladder health: Chronic high-dose ketamine use (a related compound) has been linked to bladder issues, though this has not been shown with medically supervised Spravato.
- Cognitive changes: Ongoing studies are assessing whether prolonged exposure could affect memory or cognition, but current evidence does not show lasting impairment.
So far, available data suggests that long-term Spravato treatment is well tolerated, especially when monitored by qualified providers and used only as prescribed.
Summary
Spravato represents one of the most promising advances in depression care in decades. For many adults with treatment-resistant depression or major depressive disorder with suicidal thoughts, it offers relief when other treatments haven’t worked.
Still, patients should have open conversations with their mental health provider about the long-term side effects of Spravato, ongoing monitoring, and the safest path forward.
With careful supervision and personalized care, Spravato can be a safe, effective, and life-changing option for people struggling with severe depression.
Frequently asked questions
Is Spravato safe for long-term use?
Yes. Long-term studies show Spravato can be used safely under medical supervision. Most side effects are mild and temporary, but your provider will monitor you regularly for blood pressure changes and mood symptoms.
Can Spravato cause memory loss or cognitive problems?
Mild confusion or “fogginess” can occur shortly after treatment, but there’s no evidence that Spravato causes lasting memory loss or brain damage when used as prescribed.
Can you become addicted to Spravato?
Spravato has a low potential for misuse compared to other medications, but it’s still classified as a controlled substance. All treatments take place in a clinic to prevent misuse or diversion.
Does Spravato affect your heart or blood pressure long-term?
Spravato can cause temporary increases in blood pressure. Providers monitor each patient during and after treatment to ensure these changes resolve before discharge. Long-term vascular effects are still being studied but appear minimal with proper monitoring.
How long can someone stay on Spravato?
Treatment duration varies. Some people need maintenance treatments for several months or longer to prevent relapse. Your provider will help create a plan tailored to your progress and safety.
Key takeaways
- Spravato® (esketamine) is an FDA-approved nasal spray for adults with treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal thoughts.
- It works differently from traditional antidepressants by targeting the brain’s glutamate system, which helps improve communication between brain cells.
- Spravato is taken alongside an oral antidepressant and administered under medical supervision in a certified clinic.
- Common side effects include dizziness, nausea, and feeling disconnected; more serious effects may include high blood pressure and sedation.
- While studies show strong long-term effectiveness, patients should discuss the long-term side effects of Spravato and ongoing monitoring with their healthcare provider.
Looking for Spravato or ketamine treatment near you?
Pacific Mind Health offers Spravato (esketamine) and ketamine therapy for treatment-resistant depression, major depressive disorder, and more. Our experienced clinicians provide compassionate, evidence-based care to help you feel better.
Ready to take the next step? Schedule a free consultation today to see if Spravato or ketamine is right for you.
