Spravato Side Effects: What Patients Should Know Before Starting
July 27, 2026
Starting a new treatment for treatment-resistant depression often comes with questions, especially when it’s different from traditional antidepressants. One of the most common concerns people have before beginning Spravato® (esketamine nasal spray) is simple: What are the side effects, and what should I expect?
The good news is that most people tolerate Spravato well when it’s given under medical supervision. Some side effects are common during or shortly after treatment, but they usually wear off within a few hours. Knowing what to expect ahead of time can make the experience feel much less intimidating.
Here’s a closer look at the most common Spravato side effects, the less common but more serious risks, and what you should know before your first appointment.
How Spravato Works and Why Side Effects Happen
Spravato (esketamine) is a prescription esketamine nasal spray used to treat adults with treatment-resistant depression. Unlike most antidepressants, Spravato treatment targets the brain’s glutamate system rather than serotonin. This different approach is one reason it may help some people who haven’t responded to other treatments.
Because it acts directly on the brain, it’s normal to experience temporary changes after each dose. These effects are expected, which is why every treatment takes place in a certified clinic where healthcare professionals monitor patients for at least two hours.
Most side effects begin soon after the medication is given and gradually fade before patients go home.
Common Spravato Side Effects: What Most Patients Experience
Not everyone experiences the same side effects, and some people notice only mild symptoms. Still, there are a few reactions that are reported more often than others.
Dissociation During Spravato Treatment
One of the most talked-about Spravato side effects is dissociation. Spravato dissociation is usually temporary and occurs while the medication is actively affecting the brain.
People describe it in different ways. Some feel detached from their surroundings, while others say time seems to move differently or that they feel dreamlike for a short period. It can feel unusual, especially during the first session, but these sensations are usually temporary and wear off as the medication leaves the body.
Medical staff stay with you throughout the appointment to make sure you’re comfortable until the effects pass.
Nausea and Dizziness
Some patients feel nauseous or lightheaded after treatment. These symptoms are usually mild and don’t last long.
Your provider may recommend avoiding food for a couple of hours before your appointment, as this can help reduce the chance of nausea. Moving slowly when standing up after treatment can also help if you’re feeling dizzy.
Blood Pressure Changes
Spravato treatment can temporarily increase blood pressure, which is one of the monitored Spravato side effects during every appointment.
For that reason, your blood pressure is checked before treatment and monitored again afterward. In most cases, it returns to normal without any additional treatment, but your care team will make sure it’s safe before you leave the clinic.
Headache and Drowsiness
Headaches, tiredness, or feeling sleepy are also fairly common after a session.
Many people choose to take the rest of the day off from work or other responsibilities. Since you shouldn’t drive after treatment, it’s important to arrange for someone to take you home.
Serious Spravato Side Effects: What to Know and Watch For
Serious complications are uncommon, but they’re still important to understand before starting treatment.
Risk of Misuse and Abuse
Esketamine is a controlled medication because it has the potential for misuse.
To reduce this risk, Spravato is only available through a certified treatment program. It isn’t prescribed for home use, and every dose is given under medical supervision.
Worsening Depression or Suicidal Thoughts
Like many medications used to treat depression, Spravato carries a warning about the possibility of worsening depression or suicidal thoughts in some individuals.
This doesn’t happen to most patients, but it’s something your provider will discuss before treatment. If you notice changes in your mood, thoughts, or behavior between appointments, it’s important to let your healthcare team know as soon as possible.
Rare but Serious Reactions
Although uncommon, some people may experience severe increases in blood pressure or allergic reactions.
Your treatment team is trained to recognize these situations quickly and provide immediate medical care if needed. This is one of the reasons patients remain under observation after every session.
Is Spravato Safe? Understanding the Risk-Benefit Profile
Many people ask, “Is Spravato safe?”
For the right patient, it can be. Spravato has been studied in clinical trials and is an FDA-approved treatment for treatment-resistant depression when used according to established treatment guidelines.
Like any prescription medication, it isn’t completely risk-free. The decision to start treatment depends on balancing the possible benefits against the potential risks.
Your psychiatrist will review your medical history, current medications, and overall health before deciding whether Spravato is an appropriate option.
Who Should NOT Take Spravato?
Spravato isn’t suitable for everyone.
Absolute Contraindications
People with certain blood vessel disorders, a history of bleeding in the brain, or an allergy to esketamine or ketamine generally should not receive Spravato.
Your provider will review these conditions carefully before treatment begins.
Use With Caution — Discuss With Your Provider
Some medical conditions don’t automatically rule out treatment but may require extra monitoring.
These include uncontrolled high blood pressure, certain heart conditions, liver disease, pregnancy, or a history of substance use disorder. Your provider may recommend additional precautions or discuss other treatment options depending on your situation.
How to Prepare for Your First Spravato Session
Knowing what happens during your appointment can help you feel more comfortable.
Before Your Session
Follow any instructions your provider gives about eating, drinking, and taking your regular medications. Wear comfortable clothing, and arrange transportation home since you won’t be able to drive afterward.
During Your Session
You’ll use the nasal spray under your provider’s supervision before relaxing in a comfortable treatment room.
Your care team will check your blood pressure and monitor you throughout the observation period while the medication’s effects gradually wear off.
After Your Session
It’s common to feel tired for the rest of the day.
Plan to rest at home, avoid driving or operating machinery, and wait until the following day before returning to your normal routine unless your provider tells you otherwise.
Have Questions About Spravato Side Effects? We’re Here to Help
Starting a new Spravato treatment can feel overwhelming, especially when you’re unsure what to expect. While Spravato side effects can sound concerning at first, most are temporary and closely monitored by experienced healthcare professionals.
The best way to know whether Spravato is right for you is to have an open conversation with your provider. They can explain what to expect, answer your questions, and help you weigh the benefits and risks based on your medical history and treatment goals.
If you’re considering Spravato treatment and want to learn more, our team is here to guide you through the process and help you make an informed decision.
Learn More About Spravato Treatment at Marpa Minds
Understanding the potential side effects of Spravato is just one part of deciding whether this treatment is right for you.
At Marpa Minds, patients receive a comprehensive psychiatric evaluation to determine if they are appropriate candidates for Spravato therapy and FDA-approved treatment for treatment-resistant depression. The team takes time to review your medical history, current medications, previous depression treatments, and overall mental health before recommending a personalized treatment plan. If Spravato is a suitable option, they also help patients understand the treatment schedule, answer questions about what to expect during each visit, and provide guidance throughout the process. To learn more about Spravato treatment and schedule a consultation, visit https://marpaminds.com/.
Frequently Asked Questions
What does Spravato dissociation feel like?
Dissociation can feel different for everyone. Some people describe feeling detached from their surroundings, experiencing changes in perception, or feeling as though they’re observing themselves from a distance. These effects are usually temporary and monitored during treatment.
Are Spravato side effects permanent?
Most side effects, including dizziness, nausea, drowsiness, and dissociation, wear off within a few hours after treatment. Long-term side effects are uncommon when Spravato is used as directed under medical supervision.
Is esketamine safe for long-term use?
Clinical studies have shown that Spravato can be safe for long-term use when prescribed appropriately and monitored by a healthcare provider. Regular follow-up appointments help ensure ongoing safety and effectiveness.
Can Spravato make depression worse?
Although uncommon, some people may experience worsening depression or suicidal thoughts. It’s important to tell your provider immediately if your symptoms change or become more severe during treatment.
What happens if I have a bad reaction during a session?
Spravato is only administered in certified healthcare settings where trained professionals monitor patients throughout the session. If a concerning reaction occurs, medical staff can provide immediate care.
Does Spravato interact with other medications?
Spravato may interact with certain medications, including central nervous system depressants and stimulants. Be sure to share a complete list of your medications with your healthcare provider before starting treatment.
Will I feel “high” during Spravato treatment?
Some patients experience temporary feelings of detachment or altered perception, but these effects are closely monitored and usually fade before you leave the clinic. Not everyone experiences the same sensations.
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