Does Spravato cause hallucinations? What patients should know [2025]
September 15, 2025
When traditional antidepressants don’t work, Spravato (esketamine) offers hope for treatment-resistant depression. Proven in clinical studies to be both safe and effective, this nasal spray works in a completely different way from traditional oral antidepressants.
Despite its promising outcome, many patients wonder if Spravato causes hallucinations or other side effects–and that’s natural; you want, after all, to know as much as possible about a treatment before you jump into it.
This guide provides clear answers about what to expect during your Spravato therapy, including potential side effects, the difference between dissociation and hallucinations, and practical management strategies in the supportive environment of Marpa Minds.
Key takeaways
- Spravato isn’t addictive when used clinically, and most patients experience gradual symptom improvement rather than worsening.
- This nasal spray is FDA-approved for treatment-resistant depression, helping adults whose depression persists after trying two other medications.. It targets NMDA receptors instead of serotonin (which is what traditional oral antidepressants do).
- Hallucinations affect fewer than 1 in 20 patients, are temporary, and fade within 2 hours under medical supervision.
- Side effects like dissociation, dizziness, and nausea are typically mild, peak within 40 minutes, and resolve during the 2-hour monitoring period.
- Marpa Minds offers treatment in comfortable, spa-like settings with staff who remain present throughout your session and handle insurance coordination.
What is Spravato (esketamine) and why does it matter?
Spravato can cause hallucinations in some patients, but this happens rarely and the effects are temporary. Most people who take Spravato don’t experience hallucinations at all.
Spravato is a nasal spray medication that contains esketamine, and which has been proven safe in clinical trials. This means you spray it into your nose during supervised medical visits. The Food and Drug Administration approved Spravato specifically for adults whose depression hasn’t improved after trying at least two different antidepressants.
Esketamine works on different brain chemicals than regular antidepressants. While most depression medications target serotonin, Spravato affects something called NMDA receptors, which generate new neural pathways in the brain. This different approach can help when other oral antidepressant treatments haven’t worked.
Do note that, unlike most oral antidepressants, Spravato is only administered in a special, approved clinic, under the supervision of healthcare professionals.
Plus, this esketamine nasal spray is only administered according to the Spravato REMS program (Risk Evaluation and Mitigation Strategies program) of the Food and Drug Administration. This minimizes the risk of any major adverse effects and helps you make sure you take the right Spravato dose to reap all the benefits against depressive symptoms.
Basically, you take Spravato in a medical office or clinic where healthcare providers watch you for about two hours. This monitoring period ensures your safety if you experience any side effects. Marpa Minds provides this treatment in comfortable, spa-like rooms designed to help you feel calm and secure.
Does Spravato cause hallucinations or dissociation?
Spravato can cause both hallucinations and dissociation, but they’re different experiences from what one would experience with other controlled substances. Moreover, hallucinations and dissociation are different among themselves, and understanding this difference helps you know what to expect during treatment.
Dissociative effects mean feeling disconnected from yourself or your surroundings. You might feel like you’re floating or watching yourself from outside your body. These dissociative episodes happen much more often than hallucinations.
On the other hand, the hallucinogenic effects involve sensing things that aren’t there. You might see colors or patterns, hear sounds, or feel sensations that aren’t real. These experiences are less common than dissociation.
Here’s what you should know about how often these effects occur:
- Dissociation frequency: About 1 in 4 patients experience some form of dissociation
- Hallucination frequency: Fewer than 1 in 20 patients report hallucinations
- When they start: Both effects usually begin within 30 minutes of taking Spravato
- How long they last: Most effects fade within 2 hours
These effects happen because the esketamine nasal spray temporarily changes how certain parts of your brain work. The changes affect areas that control perception and awareness (and eventually help your brain build better thinking patterns against depression symptoms).
At Marpa Minds, trained staff will stay with you during this time to ensure you feel safe and supported.
Wondering if Spravato can work for you? Read more on our blog:
- Does Spravato help with depression?
- Does Spravato help with anxiety?
- How long does Spravato last?
- What do you do during Spravato treatment?
- Can Spravato be taken at home?
- How does Spravato make you feel?
Common side effects of Spravato
Spravato causes various side effects that range from mild and common to serious but rare. Knowing what to expect helps you prepare for treatment and recognize when to ask for help.
Mild side effects
Most patients experience only mild side effects that go away quickly. These common effects are manageable and don’t last long after your treatment session ends.
The most frequent mild side effects include:
- Dissociation: Feeling detached or “spacey” during treatment
- Dizziness: Feeling unsteady or lightheaded, especially when standing
- Nausea: Stomach discomfort that usually passes within an hour
- Drowsiness: Feeling very sleepy during and after treatment
- Altered taste: A metallic or strange taste in your mouth
- Increased blood pressure: Temporary rise that returns to normal after treatment
Your healthcare team expects these effects and knows how to help you manage them. The comfortable environment at treatment centers helps you rest while these feelings pass.
Serious side effects
Serious side effects are rare but require immediate attention from your healthcare team. Your providers monitor you closely to catch and address any serious reactions right away.
Watch for these serious side effects:
- Severe hallucinations: Intense or frightening visions or sounds
- Breathing problems: Difficulty breathing, respiratory depression, or feeling like you can’t get enough air
- Very high blood pressure: A hypertensive crisis can cause headaches or chest discomfort
- Extreme dissociative effects: Feeling completely disconnected from reality
- Thoughts of self-harm: New or worsening suicidal thoughts
Your treatment team checks your vital signs and mental state throughout your visit. They’re trained to respond quickly if you experience any serious effects.
Understanding short-term and long-term side effects
Spravato’s side effects follow predictable patterns. Most effects are short-term and go away completely after each treatment session.
Short-term side effects and how long they last
Short-term effects follow a timeline that helps you plan your treatment day. Knowing when effects peak and fade helps you arrange transportation and schedule activities.
Here’s the typical timeline for Spravato side effects:
- First 15 minutes: You might taste the medicine and feel slightly dizzy
- 15-40 minutes: Effects reach their strongest point
- 40-90 minutes: Symptoms start to fade gradually
- 90-120 minutes: Most effects are gone, though you might still feel tired
- Rest of the day: Mild drowsiness may continue
Marpa Minds will provide you with quiet, comfortable spaces where you can relax during this recovery time. Staff members check on you regularly to ensure you’re comfortable.
Long-term side effects to keep in mind
Research shows Spravato doesn’t cause permanent side effects when used properly. Some patients worry about long-term brain changes, but clinical trials haven’t found evidence of lasting problems.
Regular use of Spravato under the medical supervision of healthcare professionals appears safe for extended periods. Your doctor will monitor your progress and adjust treatment if needed. The goal is to find the right balance between managing depressive symptoms and minimizing side effects.
Many patients find that side effects become more predictable and manageable over time. Your body often adjusts to the medication, making each session easier than the last. Plus, combined with integration therapy with a mental health professional, the temporary relief provided by the esketamine nasal spray can be turned into long-term healing and winning the battle against major depressive disorder.
7 ways to manage Spravato treatment side effects
You can take steps to make your Spravato sessions more comfortable. These strategies help you feel more in control and reduce anxiety about side effects.
1. Practice relaxation techniques
Deep breathing and meditation help you stay calm during treatment. Practice these techniques at home so they feel natural during your session. Simple breathing exercises can reduce anxiety when you feel disconnected or uncomfortable.
2. Prepare for your session
Wear comfortable clothes and bring items that help you feel secure. A soft blanket, eye mask, or calming music can make the experience more pleasant. Avoid caffeine on treatment days as it might increase anxiety.
3. Stay hydrated and nourished
Drink water before your appointment and eat a light meal a few hours before treatment. Being hungry or dehydrated can make side effects feel worse. Follow your doctor’s specific instructions about eating and drinking.
4. Engage with support staff
Tell your treatment team how you’re feeling throughout the session. They can adjust the room temperature, lighting, or provide reassurance when needed. Open communication helps them support you effectively.
5. Plan a calm post-treatment schedule
Clear your calendar for the rest of the day after treatment. Arrange for someone to drive you home and stay nearby if possible. Having a quiet evening planned reduces stress about post-treatment activities.
6. Track symptom patterns
Keep notes about which side effects you experience and when they occur. This information helps your doctor optimize your treatment plan. You might notice patterns that help you prepare for future sessions.
7. Consider therapy or counseling
Working with a therapist alongside Spravato treatment can enhance results. Therapy provides tools for managing both depression and treatment side effects. Many patients at Marpa Minds combine Spravato with ongoing counseling.
Is Spravato addictive or does it make you high?
Many people worry about addiction because Spravato is related to ketamine. However, medical use of Spravato is very different from recreational drug use. When administered in a clinical setting under proper supervision, Spravato is not addictive.
While you may experience temporarily altered perceptions during treatment, this is not the same as getting “high” in the recreational sense—it’s a controlled therapeutic experience that happens under medical supervision, designed to help heal depression symptoms. Over time, this treatment can be much more effective than traditional oral antidepressants.
Why Spravato is different from recreational ketamine
Medical Spravato treatment includes safeguards that prevent addiction and misuse. The controlled environment and professional oversight make it a safe therapeutic option.
Key differences include:
- Precise dosing: You receive exact amounts determined by your doctor
- Medical supervision: Healthcare providers monitor every dose
- Limited access: You can’t take the medication home
- Treatment focus: The goal is depression relief, not recreational effects
- Regular assessment: Your doctor evaluates your response and adjusts as needed
Controlled clinical use and safety
The FDA requires special safety measures for Spravato through a program called REMS. This program ensures only certified providers in appropriate settings can administer the medication.
Marpa Minds follows all safety protocols and adds extra support measures. Staff members stay with you throughout treatment and recovery. The risk of developing addiction is very low when following medical guidelines.
Can Spravato make depression worse?
Some patients worry that Spravato might worsen their depression. The FDA requires a warning about increased suicidal thoughts, especially in younger adults under 25.
However, most patients see improvement in their depression symptoms. Your doctor screens you carefully before starting treatment to ensure Spravato is appropriate for your situation.
Close monitoring during early treatment helps catch any mood changes quickly. Your treatment team asks about your mood and thoughts at each visit. Most people experience gradual improvement rather than worsening symptoms.
Tell your doctor immediately if you notice increased depression or new suicidal thoughts. Quick communication allows for prompt adjustments to your treatment plan.
How does Spravato make you feel and what to expect
Spravato creates temporary changes in how you perceive the world around you. These sensations vary between people but follow general patterns.
Physical sensations often include feeling light or heavy, as if gravity has changed. Your body might feel warm or tingly. Some people describe feeling like they’re floating or sinking into their chair.
Visual changes can make colors seem brighter or different. Objects might appear to shift or move slightly. Sounds may seem louder, softer, or have an echo-like quality.
Your sense of time often changes during treatment. Minutes might feel like hours, or time might seem to speed up. These effects are temporary and fade as the medication wears off.
Emotional responses vary widely. Some patients feel very calm and peaceful. Others might feel anxious at first but find the feeling passes quickly. Marpa Minds creates a soothing environment with soft lighting and comfortable seating to help you feel secure during these experiences.
Moving forward with hope in a supportive environment
Hallucinations from Spravato are uncommon and manageable when they occur. Professional monitoring ensures your safety throughout treatment.
Many people with treatment-resistant depression find relief through Spravato when other medications haven’t helped. The temporary side effects are often worth the potential for lasting improvement in depression symptoms.
Marpa Minds specializes in making Spravato treatment as comfortable as possible. The team handles insurance coordination and creates a peaceful space for your healing journey. Their expertise in this specific treatment helps patients feel confident and supported.
Taking the first step toward Spravato treatment might feel overwhelming. Remember that you’ll have professional support every step of the way. The possibility of finding relief from depression makes exploring this option worthwhile for many patients.
Frequently asked questions
Do Spravato hallucinations happen to everyone who takes the medication?
No, Spravato hallucinations don’t happen to everyone who takes the medication. Most patients don’t experience hallucinations at all, with fewer than 1 in 20 people reporting this side effect during clinical trials.
How long do Spravato hallucinations last when they occur?
When hallucinations do occur after being administered the Spravato nasal spray, they typically last less than 2 hours. The effects peak within the first hour and fade completely by the end of the monitoring period at your treatment facility.
Can you prevent hallucinations while taking Spravato?
You can’t completely prevent hallucinations while taking Spravato, but staying calm and using relaxation techniques can help. Your healthcare team monitors you closely and provides support if hallucinations occur during treatment.
Is Spravato safe for people with a history of psychosis or schizophrenia?
Spravato isn’t recommended for people with psychotic disorders like schizophrenia. Your doctor will review your mental health history carefully to determine if Spravato is safe for your specific situation.
What should you do if you experience hallucinations during Spravato treatment?
If you experience hallucinations during Spravato treatment, tell your healthcare provider right away. They’ll stay with you, provide reassurance, and help you through the experience in a safe clinical environment.
Will Spravato side effects prevent you from driving after treatment?
Yes, Spravato side effects will prevent you from driving after treatment. You must arrange for someone else to drive you home and avoid operating vehicles or machinery for the rest of the day.
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