Common Spravato® Side Effects and How to Deal With Them

Spravato® can provide quick relief for depression symptoms, but like any medication, it can cause side effects in certain people. If you’re considering Spravato® treatment, it helps to know what to expect and how to manage these side effects should they occur. 

In this guide, we explain the most common side effects of Spravato®, including both mild and serious side effects, and how to manage these side effects to keep your treatment comfortable. 

What is Spravato®?

Spravato® (esketamine) is a prescription nasal spray approved by the FDA for adults with treatment-resistant depression (TRD) or major depressive disorder (MDD) with suicidal thoughts or behaviors. It’s usually prescribed alongside an oral antidepressant and is only available in certified healthcare settings. 

The active ingredient in Spravato® is esketamine, a form of ketamine. Ketamine was first developed as a surgical anesthetic, but it has more recently been found to provide quick relief for mood disorders such as depression or post-traumatic stress disorder (PTSD). Unlike traditional antidepressants, which can take weeks to work, Spravato® can begin to relieve depression symptoms within just a few hours. 

Spravato® must be taken under medical supervision. You will be shown how to use the nasal spray and then administer it yourself, remaining under observation for at least two hours afterwards to monitor for potential side effects. 

Common Spravato® side effects

Like any medication, Spravato® can cause side effects. Not everyone will experience them, but it helps to know what to expect. 

Mild Spravato® side effects

Many people notice side effects within the first few hours after Spravato® treatment. These are usually temporary and resolve on their own within the same day. 

Mild side effects include:

• Dizziness or lightheadedness
• Nausea or vomiting
• Sleepiness or grogginess
• Spinning sensation (vertigo)
• Feeling disconnected from your body, thoughts, or surroundings (dissociation)
• Numbness 
• Dry mouth
• Constipation or diarrhea
• Altered sense of taste
• Headache
• Nasal or throat irritation from the spray
• Feeling ‘drunk’, excited, or unusually happy
• Lack of energy or mental alertness 

If these symptoms last longer than expected or feel difficult to manage, your healthcare provider will recommend strategies to make you more comfortable. 

Serious but less common side effects of Spravato®

In rare cases, Spravato® may cause more serious side effects. These include: 

High blood pressure 

One of the more closely monitored side effects of Spravato® is temporarily increased blood pressure. This usually peaks around 40 minutes after a dose and can last up to four hours. Most of the time, it resolves without an issue, but in rare cases blood pressure might rise high enough to cause symptoms like: 

• Chest pain
• Severe headaches 
• Vision changes 
• Shortness of breath 
• Seizures.  

Because of this, Spravato® isn’t recommended for people with certain conditions such as blood vessel disease, history of brain bleeds, or uncontrolled hypertension. Your healthcare provider will review your medical history carefully before starting treatment to make sure it’s safe for you.

Respiratory depression (breathing problems)

In rare cases, Spravato® can slow breathing down to a dangerous level. This is why patients remain under observation for at least two hours after each dose. During this time, your provider will carefully monitor your oxygen levels and watch for signs of slowed or shallow breathing. 

Sedation and dissociation

Spravato® can also cause sedation (feeling very sleepy) and dissociation (feeling detached from your body or surroundings). These sensations are temporary but they can feel intense for some people. You’ll be monitored closely during treatment, and if you ever feel like you might faint or can’t stay awake, your provider will intervene straight away. 

Risk of misuse

Because Spravato® is derived from ketamine, it has the potential for misuse or dependence. To reduce this risk, it’s only available in outpatient healthcare settings certified by the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program, which limits how and where the drug can be administered. If you have a history of substance abuse, be sure to let your provider know beforehand as you may have an increased risk of misuse.

Cognitive effects

High and frequent doses of ketamine (outside of medical use) have been linked to long-term memory and concentration difficulties. This hasn’t yet been observed with Spravato® taken under medical supervision, but some patients might experience short-term cognitive effects for a few hours after treatment. To be safe, it’s best to avoid driving or operating machinery until the day after your dose.

Suicidal thoughts and behaviours

Like other antidepressants, Spravato® carries an FDA boxed warning for the potential of increased suicidal thoughts and behaviours, especially in adults under 25. This risk is highest in the first few months of treatment or if your antidepressant dosage is adjusted. Don’t worry, your provider will carefully monitor your mood throughout the course of treatment, and if you need any extra support, don’t hesitate to reach out to friends or family. 

If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the 988 Suicide & Crisis Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.

Bladder problems

Frequent or long-term ketamine use has been linked to bladder inflammation and urinary issues. While this is rare with Spravato®, some patients have reported symptoms like needing to urinate more often or pain when urinating. If you notice any of these changes, be sure to let your healthcare provider know right away.

Allergic reaction 

In rare situations, some people may experience an allergic reaction to Spravato®. Signs might include a rash, itching, swelling, or trouble breathing. Mild reactions may be managed by your provider, but a severe reaction is a medical emergency and requires immediate care. That said, no allergic reactions have been reported in Spravato® studies thus far.

How long do Spravato® side effects last?

Most Spravato® side effects are short-term and fade within a few hours, usually resolving by the end of the treatment day. Certain factors, like anxiety, hydration levels, or what you’ve eaten before your appointment, can also influence whether side effects feel stronger or last longer. 

If you have concerns about potential side effects of Spravato®, please know that your healthcare team is here to support you. They will provide personalized guidance and care to help minimize any risks.

How to manage Spravato® side effects

Even though most Spravato® side effects are temporary, there are a few things you can do to make your experience more comfortable and reduce the likelihood of symptoms occurring. 

Here are some tips:

Be aware of your diet

If you’re worried about feeling nauseous, it’s best to avoid eating for at least two hours before your Spravato® session and to stop drinking liquids 30 minutes before your dose. This helps reduce the chance of nausea or vomiting. 

If you’re concerned about Spravato® increasing your blood pressure, it may be helpful to watch what you’re eating the day before and the day of your session. For example, certain foods (including beets) can naturally lower blood pressure. 

Stay hydrated

Staying well hydrated might help manage some Spravato® side effects, including nausea. Be sure to drink plenty of water throughout the day, especially after your treatment session – just try to avoid large amounts of liquid right before your dose to prevent nausea. 

Get lots of rest

Rest is also important, especially considering that dizziness, fatigue, and dissociation are common side effects. Make sure to get an early night’s sleep the evening before, arrange for a ride home, and give yourself the rest of the day off to relax and recover.

Medical and natural supports

Some remedies (both medical and holistic) can help ease Spravato® symptoms. These include:

• Anti-nausea or anti-diarrheal medications 
• Peppermint tea for nausea
• Ginger tea for nausea and dizziness
• Lavender tea for headaches and anxiety
• Turmeric tea, supplements, or in foods to reduce inflammation and help with headaches 

Always check with your healthcare provider before you take any herbal or nutritional supplements as some may interact with medications or treatment.  

Journal your symptoms

Keeping a journal can be a good way to track your symptoms and better understand your body’s response to Spravato®. You might want to track:

• When symptoms start after each dose
• How long they last
• How they affect your daily activities
• Any remedies or strategies you used to manage them 

Journaling can make it easier to spot patterns and adjust your treatment plan/prepare for sessions so that you’re more comfortable. 

Summary: Spravato® side effects and how to deal with them

If you’re concerned about Spravato® side effects, remember that this treatment is only ever given in a clinical setting, and you will be monitored for at least two hours after each dose to ensure your safety and comfort. Most side effects are mild and will fade within the same day, and your healthcare team will be there to guide you should you experience any discomfort. 

If you have any questions about Spravato®, or would like to see if this treatment might be right for you, don’t hesitate to reach out to our team at Psychiatry Treatment Centers. We offer this treatment at our clinics in Los Angeles and throughout Georgia, and our team is here to address any concerns and provide support every step of the way. Contact us today.