Spravato® (esketamine) is a prescription nasal spray that’s changing the way treatment-resistant depression (TRD) and major depressive disorder (MDD) are managed.
For people who haven’t found relief from traditional antidepressants, Spravato offers a new option that works differently in the brain to improve mood and reduce depressive symptoms.
Like any medication, Spravato side effects can occur. Understanding what to expect helps people feel more prepared and can make treatment as effective as possible.
Understanding Spravato
Spravato (esketamine) is a nasal spray approved by the US Food and Drug Administration and used in adults with major depressive disorder and treatment-resistant depression. It’s typically prescribed alongside an oral antidepressant, as the combination tends to produce the best results.
Spravato belongs to a class of medications called NMDA receptor antagonists, which target brain pathways involved in mood regulation. Because it works differently from traditional antidepressants, some people experience rapid symptom improvement, even within hours or days of treatment.
While this medication can be life-changing, it’s important to understand and manage potential side effects to ensure treatment remains safe and effective.
Common Spravato side effects
Most people tolerate Spravato well, but some may experience temporary side effects during or shortly after treatment.
The most common Spravato side effects include:
- Dizziness or feeling lightheaded
- Nausea
- Fatigue or sleepiness
- Temporary increases in blood pressure
- Feeling “spaced out” or disconnected (called dissociation)
These effects usually appear soon after the nasal spray is administered and typically fade within one to two hours. Because of this, patients remain at the clinic for two hours for monitoring until it’s safe to go home.
Patients are encouraged to rest at home after treatment. They cannot drive or operate heavy machinery for the remainder of the day. Any tiredness or fogginess will usually fade by morning. Light walking is fine, but strenuous exercise should wait until the next day.
If dizziness, nausea, or dissociation feel uncomfortable, providers can adjust dosing schedules or offer ways to make the experience more manageable.
Managing adverse effects safely
Spravato side effects are usually mild and manageable with a few precautions:
- Avoid alcohol for 24 hours before the session and after treatment
- Eat a light meal 1-2 hours before treatment
- Stay hydrated
- Wear comfortable clothing
- Advise the provider if there are any changes to medication
- Have someone drive you home after sessions since sedation or dizziness can occur.
- Rest after treatment and don’t drive or operate machinery until the next day.
- Communicate openly with your care team about any discomfort or emotional changes.
- Plan for downtime after treatment
Because Spravato is always administered under medical supervision, providers can monitor and address side effects right away.
Serious Spravato side effects to know
While serious side effects are uncommon, they can happen and should be taken seriously. These include:
- Breathing problems (respiratory depression)
- Worsening depression or suicidal thoughts
- Sudden increases in blood pressure
- Severe allergic reactions (such as rash, shortness of breath, or swelling)
Spravato and increased blood pressure
Spravato can temporarily raise blood pressure, especially within the first hour of treatment. Most of the time, this increase is short-lived and returns to normal on its own.
People with a history of high blood pressure or heart disease should tell their provider before starting Spravato. Providers check blood pressure and other vitals before, during, and after treatment to ensure they stay within safe ranges.
Drug interactions and allergic reactions
Some medications and supplements can interact with Spravato, potentially increasing side effects like sleepiness, dizziness, or blood pressure changes. It’s important to share a complete list of all prescriptions, over-the-counter medicines, and herbal products with your provider.
Though rare, allergic reactions can occur. Seek immediate medical help if you notice symptoms such as:
- Rash or hives
- Difficulty breathing
- Severe headache or chest pain
Your healthcare team will review your medical history carefully to reduce the risk of drug interactions or allergic reactions.
Bladder and cognitive effects
Long-term use of Spravato may sometimes cause bladder irritation or frequent urination. While this is rare, anyone experiencing new urinary symptoms should mention them to their provider during follow-up visits.
Some people also report feeling foggy or “out of it” for a short time after treatment. These effects usually fade as the body adjusts, but they’re important to monitor and discuss with your provider if they persist.
Other considerations and precautions
Because Spravato can cause sedation and dissociation, it’s only administered in a certified clinic under supervision. This controlled setting ensures that people are supported and monitored throughout each session.
Those with a history of substance use disorder, certain vascular conditions, or uncontrolled high blood pressure should discuss risks and benefits thoroughly before starting treatment. Regular check-ins help keep care personalized and safe.
When to talk to your provider
Reach out to your healthcare provider right away if you experience:
- Persistent dizziness, nausea, or headache
- Signs of high blood pressure (such as severe headache or blurred vision)
- Shortness of breath or chest discomfort
- Mood changes, worsening depression, or suicidal thoughts
Prompt communication helps ensure Spravato side effects are managed quickly and treatment remains on track.
Summary
Spravato is a breakthrough option for people living with major depressive disorder or treatment-resistant depression. While Spravato side effects are possible, most are short-lived and manageable under professional supervision.
With regular monitoring, open communication, and personalized care, Spravato can offer new hope for those who haven’t found relief with traditional antidepressants.
Key takeaways
- Spravato side effects are usually mild and include dizziness, nausea, and temporary increases in blood pressure. These typically resolve within two hours.
- Serious side effects are rare, but it’s important to report any unusual symptoms right away.
- Close monitoring during each session helps ensure safety and comfort.
- People with high blood pressure or heart conditions should discuss risks and precautions before starting treatment.
- With careful management, Spravato can be a safe and effective treatment for people with depression that hasn’t improved with other medications.
Looking for Spravato® treatment near you?
Pacific Mind Health offers Spravato® (esketamine) therapy for treatment-resistant depression and major depressive disorder at our Long Beach and Irvine locations. Our experienced clinicians provide compassionate, evidence-based care to help you feel better.
Ready to take the next step? Schedule a consultation today to see if Spravato is right for you.
