Spravato Side Effects and How to Minimize Them [2025]
August 29, 2025
For individuals navigating treatment-resistant depression or Major Depressive Disorder, the path forward can feel unclear after multiple antidepressants have failed to provide relief.
This clinical reality requires a different approach, one that moves beyond traditional oral antidepressants and methods to offer new hope. Understanding innovative and structured treatments is the first step toward finding a therapy that finally works.
Spravato (esketamine nasal spray) is an FDA-approved intranasal spray that offers a promising option by working through different brain pathways.
Because it is a powerful and unique medication, feeling prepared involves learning about the entire experience, including the temporary and manageable Spravato adverse effects. A supportive and serene clinical environment is essential to making this journey feel safe and empowering.
This guide walks through what to expect from Spravato therapy, from the first session to long-term care. We will cover the most common adverse effects, explain how long they last, and provide practical strategies to make your treatment as comfortable as possible. Our goal is to give you the clarity and confidence needed to take the next step in your healing journey.
Key takeaways
- Spravato is an intranasal spray that is FDA-approved for treatment-resistant depression/ Major Depression Disorder. It works faster than traditional antidepressants and targets different brain pathways.
- Common adverse effects (dissociation, dizziness, nausea, blood pressure changes) typically resolve within 2-4 hours and decrease with subsequent treatments.
- Insurance typically covers Spravato (unlike other Ketamine treatments) when you meet criteria, and treatment occurs only in certified clinics with mandatory 2-hour monitoring.
- Minimize adverse effects by fasting for 2 hours pre-treatment, using relaxation techniques, and arranging transportation since driving afterward is prohibited.
- Marpa Minds offers a spa-like environment with specialized staff who reduce anxiety-related side effects while managing insurance coordination and comprehensive care.
What is Spravato (esketamine) and why consider it?
Spravato is a Food and Drug Administration-approved intranasal spray containing esketamine, designed specifically for adults with treatment-resistant depression. This means it’s for people who’ve tried at least two different antidepressants without finding relief. The most common adverse effects include feeling disconnected from reality, dizziness, nausea, and temporary blood pressure increases — most of which fade within 2-4 hours after treatment.
Unlike regular Ketamine therapy, Spravato follows strict FDA protocols and is covered by most insurance plans when you meet medical criteria. The medication works through different brain pathways than traditional antidepressants, often providing relief within days rather than weeks.
Basically, Spravato helps brain chemicals adjust to healthier doses by stimulating glutamate production and creating new neural pathways for your brain. As a result, patients have a different outlook on things, and their depression symptoms are alleviated.
How it differs from other Ketamine therapy options
You might wonder why Spravato gets insurance coverage while other types of Ketamine therapy, like IV Ketamine infusions, don’t. The key differences affect everything from your out-of-pocket costs to how safe and standardized your treatment will be:
- FDA-approved therapy: Only Spravato, the intranasal solution, has FDA approval specifically for depression treatment
- Insurance coverage: Your insurance likely covers Spravato but not Ketamine infusions
- Treatment setting: You receive Spravato only in certified clinics with proper monitoring
- Consistent dosing: Every Spravato treatment follows the same FDA-approved guidelines and is administered only in a clinical setting
Understanding the Spravato dose and monitoring
Your treatment starts with an induction phase. Most often, patients start getting the nasal spray formulation twice weekly, for 4 weeks, in a safe and controlled environment. As mentioned, unlike other antidepressant drugs, Spravato’s intranasal spray can only be administered under the trained supervision of a trrained healthcare professional.
After that, you’ll move to maintenance treatments, based on how you respond. Each dosing schedule is personalized, starting at either 56 mg or 84 mg, depending on your needs.
Every session requires you to stay for 2 hours of monitoring. This isn’t just a formality — it’s when healthcare providers track your blood pressure and ensure any side effects are manageable before you leave.
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?
- How old do you have to be for ketamine therapy?
- Does ketamine therapy work for people with ADHD?
7 common side effects of Spravato treatment
Most people experience some side effects during Spravato treatment, but they’re temporary and manageable. Understanding what to expect helps you prepare mentally and practically for each session. Here’s what you might experience:
| Symptom | Duration | Notes / Management | How Common |
|---|---|---|---|
| Dissociation | Peaks 40 mins, resolves in 2–4 hrs | Normal effect, calming environment helps | ~40% |
| Dizziness | ~90 mins | Stay seated, monitored for safety | ~30% |
| Nausea | 1–2 hrs | Avoid food 2 hrs before, anti-nausea meds if needed | ~28% |
| ↑ Blood Pressure | Peaks ~40 mins, normalizes in 2–4 hrs | Vitals checked regularly | Very common |
| Drowsiness | Up to 2–4 hrs | No driving after session, rest required | Common |
| Headache / Nasal Irritation | Brief | Spray-related, comfort measures available | Common |
| Altered Perception / Euphoria | 1–2 hrs | Therapeutic, monitored setting ensures safety | Some patients |
1. Dissociation and feeling disconnected
Dissociation is feeling detached from yourself or your surroundings — like you’re watching a movie of your life rather than living it. About 40% of patients experience this, but it’s actually a sign the medication is working on your brain’s NMDA receptors.
You might notice time moving strangely or feel like you’re floating. These sensations peak within the first hour and fade during your monitoring period. Marpa Minds’ comfortable treatment rooms help you feel secure during these experiences.
2. Dizziness and lightheadedness
Dizziness affects about 30% of patients and usually feels like mild unsteadiness rather than severe spinning. This happens because Spravato temporarily affects your blood pressure and nervous system.
You’ll remain seated in a comfortable chair during monitoring to prevent falls. Most people find the dizziness completely manageable and say it fades significantly within 90 minutes.
3. Nausea or vomiting
About 28% of patients experience nausea, which is why you shouldn’t eat for 2 hours before treatment. Small sips of water are fine up to 30 minutes before your appointment.
If nausea becomes bothersome, your treatment team can provide anti-nausea medication. The feeling typically passes within the first hour as your body adjusts to the medication.
4. Increased blood pressure
Your blood pressure will likely increase temporarily, peaking around 40 minutes after taking Spravato. This is completely expected, and why your vital signs are checked multiple times during each visit.
People with uncontrolled high blood pressure or certain heart conditions may not be candidates for Spravato. Your healthcare provider will screen for these issues before starting treatment.
5. Sedation and drowsiness
Feeling very sleepy affects some ,patients. You might feel like you need a nap or find it hard to keep your eyes open. This is why you absolutely cannot drive after treatment — you must arrange a ride home.
The drowsiness is one reason for the 2-hour monitoring period. You’ll rest in a quiet, comfortable space while the sedation wears off and your brain chemicals adjust to the treatment.
6. Headaches and nasal discomfort
The nasal spray can cause temporary irritation in your nose and throat. Some people also develop mild headaches. These effects are usually brief and relate to the spray delivery method rather than the medication itself.
You might notice a metallic taste or nasal congestion that clears up quickly. Let your treatment team know if these effects bother you — they can suggest comfort measures.
7. Feeling “high” or altered perception
Some patients wonder, “does Spravato make you high?” You might experience euphoria or altered perception, but this happens in a controlled medical setting with supervision from healthcare professionals. It’s completely different from recreational drug use.
These sensations are temporary and part of how the medication helps reset depression-related brain patterns. Your healthcare team will help you understand these feelings as therapeutic rather than recreational.
What about serious or long-term Esketamine side effects
While most side effects are mild, you should know about potential serious effects. Proper screening and monitoring minimize these risks while maximizing your chance of finding relief from depression. Here are the more serious considerations:
- Breathing problems: Very rare but monitored carefully during treatment
- Dependency risk: Controlled through clinic-only administration and tracking
- Bladder issues: Extremely rare with proper medical dosing
- Thinking changes: Temporary effects that clear after treatment
Potential impact on depression and mood
“Can Spravato make Major Depressive Disorder worse?” is a common concern.
Unlike oral antidepressants that might temporarily increase suicidal thoughts, Spravato typically improves mood within days to weeks. Some mood fluctuations are normal as your brain chemistry adjusts.
The key difference is speed — while other antidepressants take 6-8 weeks to work, Spravato often provides noticeable relief much faster. This rapid improvement can actually boost hope and motivation.
Risks of misuse and dependency
Spravato is a Schedule III controlled substance, but multiple safeguards prevent misuse. You can only receive it at certified clinics under direct medical supervision. Every dose is tracked and documented according to the dosing schedule created by your healthcare professional.
You’ll never take Spravato home or self-administer it. Although it is “just” a nasal spray, the clinical control of how this treatment is administered significantly reduces any risk of dependency compared to other controlled substances.
Monitoring blood pressure and health over time
Long-term Spravato patients receive regular health check-ups beyond just treatment sessions. Your provider tracks blood pressure patterns, overall health markers, and how well the treatment continues working.
Marpa Minds maintains comprehensive health records and adjusts treatment plans based on your ongoing response. This careful monitoring ensures both safety and effectiveness over time.
How long do Spravato side effects last
Spravato, the esKetamine nasal spray, has been approved by the FDA, and clinical trials have shown it to be safe for the treatment of depressive symptoms. Most side effects follow a predictable timeline, helping you plan your treatment days. Here’s what typically happens:
- First 40 minutes: Side effects peak, especially dissociation and dizziness
- 1-2 hours: Effects start fading as medication levels drop
- 2-4 hours: Most people feel back to normal
- Next day: You can drive and resume all regular activities
Typical timeline after each session
Dissociation and dizziness usually hit first and strongest. Blood pressure changes peak around 40 minutes, while nausea might come and go during the first hour. By the end of your 2-hour monitoring period, you’ll likely feel much more like yourself.
Some people recover faster than others. Your individual timeline depends on factors like your dose, overall health, and how your body processes the medication.
Factors that may extend or shorten recovery
Several factors influence your recovery time:
- Age: Older adults may need slightly longer to recover
- Other medications: Some drugs interact and extend effects
- Overall health: Better health often means faster recovery
- Individual sensitivity: Everyone’s brain chemistry is unique
Your treatment team will learn your patterns and adjust monitoring accordingly. Some patients feel fine after an hour, while others benefit from the full monitoring period.
Can Spravato make depressive symptoms worse or cause other concerns
The fear of worsening depression is understandable, especially after trying multiple treatments without success. However, Spravato works through completely different brain pathways than traditional antidepressants. Most patients see improvement, not deterioration.
Temporary mood changes during early treatment are normal. Your brain is literally rewiring its depression patterns, which can feel unsettling at first. Do discuss any concerns you may have with your healthcare professionals, though (both your therapist/ psychiatrist and the in-clinic healthcare professionals assisting you throughout the treatment).
Addressing the fear of worsening depressive symptoms
It’s natural to worry about new treatments, especially after past disappointments. Spravato’s rapid action often provides relief and hope within the first few sessions. This quick response can actually improve your overall outlook faster than waiting months for traditional antidepressants to work.
Open communication with your treatment team helps distinguish between normal adjustment and concerning changes. Marpa Minds encourages patients to share any mood shifts or concerns immediately.
Early warning signs and professional guidance
Know when to reach out versus when to seek emergency care. Contact your treatment team for:
- Persistent nausea lasting more than a day
- Ongoing headaches that don’t respond to over-the-counter relief
- Mood changes that worry you between sessions
Seek immediate emergency care for:
- Chest pain or pressure
- Severe breathing problems
- Signs of allergic reaction like swelling or rash
5 ways to minimize Spravato nasal spray side effects
You have more control over your treatment experience than you might think. These practical strategies can significantly reduce side effect intensity and help you feel more comfortable during sessions:
1. Proper preparation and hydration
Arrive at your appointment properly prepared. Don’t eat for 2 hours before treatment to minimize nausea. Wear comfortable, loose-fitting clothing, as you’ll be resting for a while.
Stay hydrated in the days before treatment, but limit fluids 30 minutes before your appointment. Bring comfort items like a soft blanket or calming music to help you relax during monitoring.
2. Relaxation techniques and breathing exercises
Learning relaxation techniques before starting treatment gives you tools to manage dissociation and anxiety. Practice these at home so they’re second nature during sessions:
- Deep breathing: Slow, controlled breaths help ground you
- Progressive muscle relaxation: Tense and release muscle groups
- Visualization: Picture calming scenes or safe spaces
3. Coordinating support and transportation
Having reliable transportation removes one source of stress. Ask a trusted friend or family member to drive you home and possibly stay with you for a few hours.
Plan calm activities for after treatment — rest at home, listen to soothing music, or engage in gentle hobbies. Avoid stressful tasks or important decisions on treatment days.
4. Monitoring Spravato dose adjustments
Work closely with your provider to find your optimal dose. Some people do better starting low and gradually increasing. Others need the full dose from the beginning for effectiveness.
Share detailed feedback about your side effects. Your treatment team can adjust timing, dose, or provide additional support medications based on your experiences.
5. Working with a trusted clinic like Marpa Minds
Your choice of treatment center significantly impacts your experience. Marpa Minds creates a spa-like environment that reduces anxiety and promotes healing. Their specialized staff understand Spravato treatment intimately and provide personalized support throughout your journey.
The serene atmosphere, comfortable monitoring spaces, and comprehensive care coordination at Marpa Minds help minimize stress-related side effects. When you feel safe and supported, your body often responds with fewer intense side effects.
When to seek professional support
Clear guidelines help you respond appropriately to different situations without unnecessary worry. Most side effects are expected and manageable, but certain symptoms need prompt attention.
Identifying urgent symptoms and red flags
Emergency symptoms requiring an immediate 911 call or emergency room visit include:
- Difficulty breathing or feeling like your throat is closing
- Chest pain or pressure
- Severe allergic reactions with swelling, rash, or hives
- Loss of consciousness outside the treatment setting
These reactions are extremely rare but require immediate medical evaluation. Your treatment team will review these warning signs before starting therapy.
Next steps for your healing journey with Marpa Minds
You’ve tried multiple antidepressants without success, and you deserve a treatment that works differently. Spravato offers hope through its unique mechanism and rapid results. The side effects, while real, are temporary and manageable with proper support.
Marpa Minds specializes in making Spravato treatment as comfortable and effective as possible. They handle insurance coordination, create a calming treatment environment, and provide expert monitoring throughout your journey. Their team understands both the clinical aspects and the emotional weight of seeking help for treatment-resistant depression.
Ready to explore whether Spravato is right for you? Take the first step toward relief by completing a confidential assessment to determine your eligibility and insurance coverage options.
FAQs
Can I drive after a ketamine therapy session?
No, you cannot drive after ketamine therapy. The medication causes drowsiness and affects your coordination for several hours, making driving unsafe.
What happens if I have a bad reaction to ketamine therapy?
If you have a bad reaction during ketamine therapy, trained medical staff are there to help immediately. Serious reactions are rare in supervised settings, and staff know exactly how to respond.
Is ketamine therapy safe for people with heart conditions?
Ketamine therapy may not be safe for people with certain heart conditions because it can affect blood pressure. Your doctor will evaluate your specific situation to determine if treatment is appropriate.
How do I know if a ketamine clinic is safe and legitimate?
A safe ketamine clinic uses FDA-approved medications, employs licensed medical staff, and follows proper monitoring protocols. Legitimate clinics are transparent about their credentials and safety procedures.
Are there any medications that interact dangerously with ketamine?
Yes, certain medications can interact with ketamine, which is why thorough medical screening is essential. Tell your provider about all medications and supplements you take.
What should I do if I experience side effects after leaving the clinic?
If you experience concerning side effects after leaving the clinic, call them immediately. Reputable clinics provide emergency contact information and clear instructions for post-treatment care.
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