Spravato Therapy: A Guide to Safety & Side Effects

For those with treatment-resistant depression, hearing about a medication that works differently can bring a new sense of hope. Spravato (esketamine) functions by targeting the glutamate system in the brain, a pathway distinct from the one most common antidepressants focus on. This unique mechanism is why it can be effective when other treatments haven’t been. But a different mechanism also means a different set of considerations. It’s essential to understand how it interacts with your brain and what to expect during and after a session. Here, we’ll break down the science in simple terms and provide a comprehensive overview of Spravato therapy safety and side effects to help you make an informed decision with your healthcare provider.

Key Takeaways

• It’s a targeted option for treatment-resistant depression: Spravato is not a first-line antidepressant; it’s specifically for adults who haven’t found relief from at least two other medications or are experiencing major depression with suicidal thoughts.
• Treatment always happens in a certified clinic: For your safety, you can’t take Spravato at home. Every session includes self-administering the nasal spray under medical supervision, followed by a two-hour observation period to manage any immediate side effects.
• Proactive communication with your doctor is crucial: Your role is to be an open book about your medical history and any side effects you experience. Knowing the warning signs for serious issues and planning for post-session care, like arranging a ride home, is essential for a safe experience.

What is Spravato and how does it work?

When you’ve tried multiple antidepressants without getting the relief you need, it’s easy to feel discouraged. But it’s important to know there are other paths forward. Spravato is a prescription medication that offers a completely different approach to treating depression. It’s not a daily pill; instead, it’s a nasal spray specifically approved for adults with treatment-resistant depression (TRD) or for those with major depressive disorder (MDD) who are also experiencing suicidal thoughts or actions.

The active ingredient in Spravato is esketamine, a compound that works on different brain pathways than most common antidepressants. This unique mechanism is why it can be effective when other treatments haven’t been. Because of how it works and to ensure your safety, Spravato is only administered in a certified medical clinic under the supervision of a healthcare provider. This controlled setting allows your doctor to monitor your response and manage any side effects on the spot. It’s a structured, supportive process designed to prioritize your well-being. Taking the time to understand how Spravato is used and its effects on the brain is a crucial first step in determining if it’s the right option for your mental health journey.

The basics of esketamine nasal spray

Spravato is the brand name for esketamine, a medication delivered as a simple nasal spray. It’s approved for two specific situations: for adults with treatment-resistant depression who haven’t responded to at least two other antidepressants, and for those with major depressive disorder who are having suicidal thoughts or have recently attempted suicide. Because of its powerful effects, you can’t just pick it up at a pharmacy. Spravato is only given under the direct supervision of a healthcare provider in a certified clinic. After you use the nasal spray, you’ll relax in the office for at least two hours so your medical team can monitor you for any side effects before you head home.

How Spravato interacts with your brain

One of the key differences with Spravato is how quickly it can work. While traditional antidepressants can take weeks to build up in your system, Spravato gets to work right away by helping your brain cells communicate more effectively. It primarily targets a neurotransmitter called glutamate, which is the most abundant chemical messenger in your brain and plays a huge role in mood, learning, and memory. Spravato is believed to work by blocking a specific landing spot on brain cells called the NMDA receptor. This action triggers a surge of glutamate, which in turn helps restore connections between brain cells that may have been damaged by long-term depression. This process is thought to improve brain plasticity—your brain’s ability to adapt and rewire itself—leading to a rapid improvement in mood for many people.

What are the common side effects of Spravato?

Starting any new treatment can feel a little nerve-wracking, so let’s talk openly about what you can expect with Spravato. Most side effects are temporary and occur right after your treatment session while you’re still under medical care. This built-in observation period is designed to ensure your safety and comfort. Your healthcare team will be right there with you to monitor how you’re feeling and help manage any effects that come up. Knowing what’s common can help you feel more prepared and confident as you begin your treatment journey.

Common physical side effects

The most frequently reported physical side effects are generally mild and happen shortly after taking your dose. You might feel dizzy, a bit nauseous, or have a sense of low energy. Some people also experience a temporary increase in blood pressure. This is precisely why your treatment happens in a certified clinic—your medical team will be checking in on you throughout the session. These feelings are closely monitored and typically start to fade before you head home. It’s helpful to arrange for a ride home afterward, as you shouldn’t drive until the next day after a restful sleep.

Common psychological and cognitive effects

It’s also common to experience some temporary changes in your thoughts and feelings during a session. The most notable is dissociation, which can feel like you’re disconnected from yourself, your thoughts, or your surroundings. Some people describe it as a dream-like state. You might also feel some anxiety or confusion. While this can sound unsettling, it’s a known effect of the medication. Your provider is trained to support you through these feelings in a calm, safe environment. You can find more details about the safety and tolerability of SPRAVATO® on their official site.

How long do side effects usually last?

The good news is that the common side effects of Spravato don’t stick around for long. Most of them are short-term and tend to resolve within a couple of hours after your treatment session. By the time your mandatory observation period at the clinic is over, you’ll likely be feeling much more like yourself. According to patient reports and clinical studies, the majority of side effects fade on the same day as the treatment. You can typically expect to feel back to normal by the next morning, ready to go about your day without any lingering effects from the medication.

What are the serious risks of Spravato?

While Spravato can be a powerful tool for treatment-resistant depression, it’s important to go into it with a clear understanding of the potential serious risks. This isn’t about causing alarm, but about empowering you to have thorough conversations with your doctor and make the best decision for your health. Every effective medication comes with a profile of potential side effects, and Spravato is no different. The key is that its administration is highly controlled and monitored, specifically to manage these risks.

Understanding these possibilities ahead of time is a crucial part of the process. It allows you to recognize a potential issue early and communicate it clearly to your healthcare provider. This partnership is central to making your treatment both safe and successful. The risks we’ll discuss are monitored closely during every single treatment session, which is why you can’t take this medication at home. The structure of the treatment—requiring you to be in a certified clinic under medical supervision for a few hours—is designed entirely around your safety. It ensures that if any of these more serious side effects do occur, a medical team is right there to help. So, let’s walk through exactly what those risks are, what your team will be looking for, and what you should be aware of. This knowledge will help you feel fully prepared and confident in your treatment journey.

Blood pressure and heart health risks

One of the most significant effects of Spravato is a temporary increase in blood pressure. This spike typically happens within the first couple of hours after your dose, peaking around the 40-minute mark. For this reason, your healthcare team will monitor you closely, checking your blood pressure before you receive the spray and for at least two hours afterward. In rare cases, blood pressure can become high enough to cause serious issues like chest pain or a severe headache. If your blood pressure is too high before treatment, your doctor may decide to delay your dose until it’s in a safer range.

Potential bladder and urinary issues

Some people may experience bladder and urinary tract problems while using Spravato. It’s important to pay attention to any changes in your bathroom habits. Symptoms to watch for include a frequent or urgent need to urinate, pain during urination, or finding blood in your urine. You might also notice you’re waking up more often during the night to go to the bathroom. Be sure to tell your doctor right away if you experience any of these issues. Open communication helps your provider address any potential problems before they become more serious.

Understanding dissociation and cognitive changes

Spravato can cause temporary psychological effects, most notably dissociation. This can feel like you’re disconnected from your thoughts, your body, or the world around you—some people describe it as feeling spacey, dizzy, or like you’re in a dream. These feelings, along with potential impacts on your memory and concentration, are usually strongest for the first hour or two after treatment. Because of these cognitive changes, you absolutely cannot drive, operate machinery, or do anything that requires your full mental alertness on a treatment day. Plan to rest and wait until after a full night’s sleep before resuming these activities.

The risk of abuse and dependency

Because esketamine is related to ketamine, there is a risk of misuse and psychological dependence. This is a key reason why Spravato is only available through a restricted program and must be administered in a certified healthcare setting. You can’t take it home or get a prescription for it at a regular pharmacy. This controlled environment helps minimize the risk of misuse, which means taking the medication in a way that wasn’t prescribed. Your doctor will monitor you for any signs of dependency, ensuring the treatment remains a safe and effective part of your mental health plan.

Who is a good candidate for Spravato?

Spravato (esketamine) isn’t a starting point for treating depression; it’s a specialized option for adults who haven’t found relief with other methods. Because it works differently than traditional antidepressants, it offers hope in very specific circumstances. Determining if you’re a good candidate involves a thorough discussion with your doctor about your treatment history, current symptoms, and overall health. The goal is to ensure this is a safe and effective path for you. Let’s walk through the main criteria healthcare providers consider.

Defining treatment-resistant depression

If you feel like you’ve tried everything to manage your depression without success, you might be experiencing what doctors call treatment-resistant depression (TRD). This isn’t just a feeling of frustration—it’s a clinical designation. Spravato is specifically approved for adults with TRD. Generally, this means you have tried at least two different antidepressant medications for an adequate length of time and at an adequate dose, but your symptoms haven’t improved enough. It’s a difficult place to be, but having a formal term for it helps guide you and your doctor toward different kinds of treatments for depression like Spravato.

When depression includes suicidal thoughts

Spravato is also an important option for adults with Major Depressive Disorder (MDD) who are experiencing active suicidal thoughts or have recently engaged in suicidal behaviors. In these urgent situations, the fast-acting nature of esketamine can be a critical intervention. Unlike traditional antidepressants that can take weeks to start working, Spravato can help reduce severe depressive symptoms more quickly. The National Alliance on Mental Illness (NAMI) highlights its approval for this specific and serious condition, offering a much-needed tool for crisis care when used alongside a comprehensive treatment plan.

Health conditions that may prevent treatment

Your physical health is a major factor in determining if Spravato is safe for you. You should not use Spravato if you have a history of certain blood vessel diseases, like aneurysms, or have had bleeding in the brain. An allergy to ketamine or esketamine is also a clear reason not to proceed. Additionally, your doctor will be cautious if you have uncontrolled high blood pressure, a history of psychosis, or significant heart or liver disease. A thorough review of your medical history is essential to weigh the benefits against potential risks and ensure your safety during treatment.

How is Spravato given and monitored?

Because of its powerful effects and potential side effects, Spravato isn’t a medication you can pick up at a pharmacy and take at home. The entire process is designed around your safety and is handled in a certified healthcare setting from start to finish. Each treatment session involves self-administering the nasal spray under the direct supervision of a healthcare provider, followed by a mandatory observation period. This structure ensures that any immediate side effects are managed professionally and that you are safe before you head home. Understanding this process can help you feel more prepared and confident as you begin treatment.

What happens during administration?

During your appointment, a healthcare provider will show you how to use the Spravato nasal spray device. You will administer the dose yourself, but always under their watchful eye. It’s a straightforward process, but having a professional present is a key part of the safety protocol. After you’ve taken your dose, you’ll be asked to rest in a comfortable, quiet space at the clinic or office. According to the National Alliance on Mental Illness (NAMI), you must remain at the healthcare setting for at least two hours after each treatment so the medical team can monitor your response to the medication.

How your doctor monitors your session

Your healthcare team will keep a close watch on you throughout the post-treatment observation period. Before you even administer the spray, they will check your blood pressure. They will check it again periodically for about two hours after your dose. This is because Spravato can cause a temporary increase in blood pressure. It’s also important that you communicate how you’re feeling. You should tell your doctor right away if you experience any concerning Spravato side effects like chest pain, shortness of breath, a sudden severe headache, or changes in your vision. This open communication helps your team provide the best possible care.

Why observation after treatment is necessary

The two-hour observation period is a crucial safety measure. The most common side effects of Spravato, such as dissociation (feeling disconnected from yourself or reality), dizziness, and sedation, tend to appear shortly after administration and usually fade within a couple of hours. Medical staff need to watch you for these effects to make sure they resolve properly before you leave. Because of the potential for sedation and impaired judgment, you will not be able to drive or operate heavy machinery for the rest of the day. You’ll need to arrange for a friend, family member, or ride service to get you home safely after every session.

What precautions should you take before starting?

Starting any new treatment is a partnership between you and your doctor. Before your first Spravato session, you’ll work together to ensure it’s a safe and appropriate choice for your care plan. This process involves having an open conversation about your health, reviewing any medications you’re currently taking, and understanding the safety checks that are a part of every treatment. Taking these steps helps build a strong foundation for your therapy and ensures you feel confident moving forward.

Discussing your medical history

Being an open book with your doctor is the best first step. Before you begin Spravato, it’s crucial to have a transparent conversation about your complete medical history. This isn’t just about major illnesses; it includes everything from your allergies to any medications you’re taking. Be sure to mention over-the-counter drugs, vitamins, and even herbal supplements, as they can all play a role. Sharing this information helps your healthcare team get a full picture of your health, ensuring that Spravato therapy is a safe and effective option for you. It’s all about making sure your treatment plan is tailored specifically to your needs.

Reviewing potential drug interactions

Next, you’ll want to take a close look at your current medications with your doctor. Some drugs can have negative interactions with esketamine, so it’s important to be thorough. Certain medications, especially some types of antidepressants (like MAOIs), pain relievers, and anxiety medications, may not be compatible with Spravato or might require your doctor to adjust the dosage. These drug interactions can sometimes lead to unwanted effects like a spike in blood pressure or increased sedation. To stay safe, make a detailed list of every single thing you take—prescriptions and otherwise—and bring it to your appointment. This simple step allows your doctor to carefully review everything and protect your well-being.

What to expect from health screenings

Safety is the top priority during Spravato treatment, which is why monitoring is a built-in part of every session. After you receive your dose, you’ll relax at the clinic for at least two hours. This isn’t just downtime; it’s an important observation period where your medical team can watch for any side effects, like drowsiness or changes in your blood pressure. A nurse or doctor will check your blood pressure both before and after your treatment. It’s also your time to speak up. If you experience anything that feels off—like chest pain, a severe headache, or vision changes—let your team know right away. This careful monitoring ensures you get the best care possible.

What can you expect during a treatment session?

Knowing what to expect during your Spravato appointment can help you feel more prepared and at ease. Each session is a structured and closely monitored experience designed with your safety as the top priority. Unlike taking a daily medication at home, Spravato is administered in a certified healthcare setting because of its unique effects and potential side effects that require professional observation. This controlled environment ensures that a medical professional is always present to support you, answer your questions, and respond immediately to your needs. From the moment you arrive, your healthcare team guides you through each step: the initial check-in, the self-administration of the nasal spray, the mandatory observation period, and the final assessment before you go home. The entire process is predictable and routine, which helps many people relax and focus on their treatment and well-being. Understanding the flow of the appointment—from how to get ready beforehand to what happens after the treatment is complete—can demystify the experience and empower you to take an active role in your care. Let’s walk through what a typical session looks like so you can feel confident and comfortable from start to finish.

How to prepare for your appointment

A little preparation can make your treatment day go much more smoothly. To help prevent potential nausea, it’s best to avoid eating for at least two hours before your appointment and stop drinking liquids about 30 minutes prior. If you use other nasal sprays for things like allergies, make sure to use them at least one hour before your Spravato dose. Since you won’t be able to drive yourself home, you’ll need to arrange for a ride in advance. It’s also a good idea to wear comfortable clothing and consider bringing headphones to listen to calming music during your session. Thinking through these small details helps you arrive feeling relaxed and ready.

A step-by-step look at a treatment session

When you arrive at the clinic, your healthcare provider will get you settled in a comfortable space. They will check your blood pressure before you begin. The Spravato treatment itself is a nasal spray that you will administer yourself under your provider’s direct supervision. After you use the device, the main part of your session begins: a mandatory two-hour observation period. During this time, your medical team will monitor you to ensure your safety and watch for any immediate Spravato side effects. Most people use this time to relax, listen to music, or rest quietly. Your provider is there to answer any questions and make sure you feel secure throughout the entire process.

What happens after your session ends?

Your safety is the top priority, which is why the two-hour observation period is required. Your doctor will continue to check on you, monitoring for side effects like drowsiness, dissociation, or elevated blood pressure. Once your provider determines you are ready to leave, your pre-arranged ride can take you home. It is crucial that you do not drive, operate machinery, or do anything that requires you to be fully alert until the next day, after a full night of sleep. Plan on taking it easy for the rest of the day. This downtime is an important part of the treatment process, giving your body and mind time to rest and integrate the experience.

How can you manage Spravato’s side effects?

Facing the side effects of any new treatment can feel daunting, but you’re not in it alone. Managing the side effects of Spravato is an active, collaborative process between you and your medical team. The entire treatment protocol is designed with your safety and comfort in mind, from the in-office administration to the post-session monitoring period.

Think of managing side effects as a three-part strategy. First, it involves building a strong, open partnership with your healthcare provider who will be with you every step of the way. Second, it’s about knowing which symptoms are common and which ones require an immediate call to your doctor. Finally, it includes simple self-care practices you can adopt between appointments to make your experience as smooth as possible. By taking a proactive role, you can feel more in control and confident as you move through your treatment plan.

Partner with your healthcare provider

Your relationship with your healthcare provider is the cornerstone of managing Spravato’s side effects. This isn’t a medication you pick up from the pharmacy; it’s a treatment administered in a certified medical facility for a reason. As the Mayo Clinic notes, you must receive this medicine under a doctor’s supervision. This ensures that a professional is present to monitor your response in real-time and can immediately address any reactions you might have.

Be open and honest with your care team. Let them know about everything you’re feeling during and after the session, even if it seems minor. They are there to help you distinguish between a normal, temporary effect and something that needs more attention. This open dialogue allows them to make your treatment as comfortable as possible and adjust care as needed.

Know when to call your doctor

Most of Spravato’s side effects are temporary and resolve within a few hours. However, it’s vital to know the difference between a common side effect and a serious one that requires immediate medical attention. The National Alliance on Mental Illness (NAMI) advises that you should tell your doctor right away if you experience symptoms like chest pain, shortness of breath, a sudden and severe headache, changes in your vision, or seizures.

Pay close attention to mental changes as well. While feelings of dissociation are expected during treatment, you should report any persistent confusion, agitation, or irritability. Most importantly, if you experience any new or worsening suicidal thoughts, contact your doctor or a crisis line immediately. Knowing these warning signs ahead of time empowers you to act quickly and protect your health.

Self-care tips for in-between sessions

You can also take simple, practical steps to manage side effects and improve your comfort between appointments. To help with potential nausea, a common side effect, experts at Good Health Psych suggest not eating for at least two hours before your treatment and avoiding drinking liquids for 30 minutes prior. After your session, focus on staying well-hydrated to help your body recover.

It’s also a great idea to keep a simple journal of your side effects. Note when they start, how long they last, and what they feel like. This record isn’t just for you; it provides valuable, concrete information you can share with your doctor at your next visit. Tracking these details helps both of you see patterns and understand how your body is responding to the treatment over time.

Is Spravato the right choice for you?

Deciding on a new treatment path is a significant step, and it’s one you’ll take hand-in-hand with your healthcare provider. Spravato is a specialized option for those with treatment-resistant depression, and it’s not a fit for everyone. To figure out if it’s right for you, it’s helpful to look at the practical side of treatment, from costs and long-term expectations to how it fits with other therapies you may have tried. This conversation is about finding the most effective and sustainable way forward for your mental health.

Breaking down cost and insurance

The cost of Spravato and what your insurance will cover are major factors in your decision. Because it’s a newer, specialized medication, coverage can vary. Spravato is only available through a restricted program called the Spravato® REMS Program, which ensures it’s administered safely in a certified healthcare setting. This strict protocol often means insurance providers have specific criteria you must meet before they approve coverage. It’s a good idea to speak directly with your insurance company and your doctor’s office to understand your potential out-of-pocket costs. Also, keep in mind that Spravato is generally not recommended during pregnancy, so be sure to discuss this with your doctor if you are pregnant or planning to become pregnant.

What to expect from long-term treatment

Committing to Spravato means preparing for a consistent treatment schedule, especially in the beginning. Most side effects, like dizziness or a feeling of dissociation, are temporary and typically fade within a day. A key part of every session is the two-hour monitoring period at your doctor’s office, where a healthcare professional will keep an eye on you to ensure your safety as the immediate effects wear off. It’s also important to have realistic expectations. While Spravato can be life-changing for many, it is not a cure for depression or a replacement for hospitalization if that level of care is needed. Your treatment plan will be designed to manage your symptoms over the long term.

Considering your other treatment options

Spravato is specifically for adults with treatment-resistant depression or major depressive disorder with suicidal thoughts or actions. It’s not a starting point for treatment; it’s an option considered after other antidepressants haven’t provided enough relief. A critical piece of the puzzle is that Spravato is always used alongside a daily oral antidepressant. You won’t stop your current medication—you’ll add Spravato to it. The best way to determine if you’re a candidate is to have an open conversation with your doctor about your mental health history, what you’ve already tried, and what your goals are for feeling better. Together, you can weigh the pros and cons and decide on the next best step.

Frequently Asked Questions

Why do I have to go to a certified clinic for every Spravato treatment? Think of it as a built-in safety feature. Spravato is a powerful medication that can temporarily affect your blood pressure and cause psychological effects like dissociation. By having you in a comfortable, monitored setting for a couple of hours after your dose, your medical team can keep a close eye on you and respond to any side effects right away. This controlled environment is what makes it possible to use this unique treatment safely and effectively.

Do I have to stop taking my current antidepressant to use Spravato? No, and this is a really important point. Spravato is designed to be an add-on therapy, meaning you take it in addition to your daily oral antidepressant. It works on different pathways in the brain than most common antidepressants, so the two medications work together. Your doctor will make sure your complete treatment plan is working in harmony to give you the best possible results.

How long do the side effects like dizziness and dissociation actually last? The most common side effects are temporary and happen on the day of your treatment. You can expect feelings like dizziness, nausea, or a sense of being disconnected to be strongest in the first hour or two after your dose. For most people, these effects fade significantly before the mandatory two-hour observation period at the clinic is over. The rule of thumb is that you should feel back to your usual self by the next morning after a full night of sleep.

What does “treatment-resistant depression” really mean? It’s a clinical term, not a personal judgment. It generally means you have tried at least two different oral antidepressant medications for an adequate amount of time and at an effective dose, but your depression symptoms haven’t improved enough. It’s simply a way for doctors to identify when it’s time to look at different types of treatments, like Spravato, that work in a completely different way than the medications you’ve already tried.

How quickly can I expect to feel a difference with Spravato? One of the most significant aspects of Spravato is how quickly it can work compared to traditional antidepressants, which often take several weeks. While everyone’s experience is different, some people report feeling an improvement in their depressive symptoms within the first couple of weeks of starting treatment. Your doctor will work with you to track your progress and adjust your treatment schedule as you move forward.