Spravato (esketamine) is a prescription nasal spray designed to treat certain types of depression in adults, including treatment-resistant depression and major depressive disorder (MDD) with suicidal thoughts or behaviors.
While it can be an effective treatment option for those who haven’t found relief with other antidepressants, it’s important to be aware that Spravato can cause side effects – just like all medications. These can range from mild, like dizziness and nausea, to more serious health concerns.
In this article, we’ll help you understand the possible side effects of Spravato, including common side effects, mild side effects, and more serious side effects. We’ll also answer some frequently asked questions about Spravato side effects and share some information about when this treatment may not be a suitable option for you.
Most common Spravato side effects
When taking Spravato, you may experience certain side effects that can vary depending on the condition you’ve been prescribed Spravato for. For many people, side effects are temporary and last anywhere between a few days to a few weeks. However, if they persist or become more severe, it’s important to consult with your healthcare provider.
Note that Spravato is typically prescribed alongside an oral antidepressant, such as sertraline (Zoloft) or fluoxetine (Prozac). In some cases, the side effects may be caused by the oral antidepressant rather than Spravato itself.
Some common side effects reported during Spravato clinical trials include:
- Dizziness
- Nausea and vomiting
- Sedation (excessive sleepiness)
- Vertigo (a spinning sensation)
- Dissociation (feeling disconnected from reality).
Although these side effects were frequently reported in clinical trials, it doesn’t mean that everyone will experience them. They are also not the only potential side effects of Spravato.
Learn More: The Difference Between Ketamine and Esketamine
Mild side effects of Spravato
Spravato can cause mild side effects – again, these will vary depending on the condition for which it has been prescribed. As with the common side effects listed above, keep in mind that these side effects can stem from an oral antidepressant taken alongside Spravato rather than Spravato itself.
Mild side effects reported with Spravato include:
- Dizziness
- Vertigo (feeling of spinning)
- Anxiety
- Lethargy (feeling sluggish)
- A sensation of being ‘drunk’
- Irritation or discomfort in the nose or throat area
- Headache
- Feeling extreme happiness or excitement
- Insomnia
- Diarrhea
- Nausea and vomiting
- Loss of sensation in parts of the body
- Mild sedation*
- Mild allergic reactions.
Most of these side effects are temporary, lasting anywhere between a few days to a few weeks. They typically resolve on their own, however if they persist or become worse, it’s important to reach out to your healthcare provider.
Note that Spravato may also cause additional mild side effects that aren’t listed here.
If you’re experiencing Spravato side effects and want to report them, the Food and Drug Administration (FDA) tracks these issues through its MedWatch program.
*Sedation is a very common side effect of Spravato, ranging from mild to severe. The FDA has issued a boxed warning for sedation, which is the most serious warning it can provide.
Keep Reading: Do Antidepressants Work and How Effective Are They?
Serious side effects of Spravato
Spravato can be an extremely effective treatment for certain types of depression, however in certain cases it may cause serious side effects. These can vary depending on the condition being treated and the list below may not include all possible side effects.
If you experience any serious side effects, it’s crucial that you contact your doctor immediately. If you believe the situation is life-threatening or an emergency, call 911 or your local emergency number.
Serious Spravato side effects that have been reported include:
- Cognitive impairment, like difficulty making decisions, remembering things, or concentrating
- Increased blood pressure
- Severe bladder or urinary tract issues, such as bladder inflammation
- Severe allergic reactions
- Risk of misuse
- Risk of dissociation
- Risk of sedation
- Risk of respiratory depression
- Risk of suicidal thoughts and behaviours
Although allergic reactions are possible with Spravato, they weren’t reported in clinical trials.
These serious side effects have been highlighted by the FDA as risks with Spravato use. We discuss them in more detail below, including what you can do.
Spravato side effects: FAQ
Below are some answers to frequently asked questions about Spravato’s potential side effects.
Does Spravato cause cardiovascular side effects?
Yes, Spravato can cause cardiovascular side effects, including an increase in blood pressure. This was commonly observed in clinical trials. If your blood pressure becomes too high, it could potentially lead to a stroke. This is when blood vessels leading to the brain bleed or become blocked.
If you’re concerned about how Spravato may affect your cardiovascular health, contact our team for more information.
Does Spravato cause weight gain?
No, weight gain is not a reported side effect of Spravato. Clinical trials haven’t shown any evidence of this drug causing weight gain.
That said, other antidepressants like aripiprazole (Abilify) or fluoxetine/olanzapine (Symbyax) may cause weight gain. If this is a concern for you, discuss your options with your medication management provider and they may provide guidance.
Can Spravato relieve pain like ketamine does?
No, Spravato is not approved to treat pain. While it’s chemically similar to ketamine, which is sometimes used as a painkiller, Spravato is FDA-approved for specific depression-related conditions like MDD and TRD in adults.
If you’re experiencing pain and would like to discuss alternative treatment options, contact us. TMS therapy may be an option for you.
See: The Link Between Depression and Chronic Pain
Does Spravato cause hallucinations?
Yes, some people experience hallucinations after using Spravato. Hallucinations involve seeing, hearing, or feeling things that aren’t real. To minimize this risk, you will be carefully monitored after taking the drug. If you have any concerns about hallucinations, don’t hesitate to contact us for more guidance.
Does Spravato cause long-term side effects?
It’s not fully known whether Spravato causes long-term side effects. Most reported side effects occur on the day of treatment and typically subside by the end of the day. There’s limited information on whether long-term use might increase the risk of specific side effects.
If you’re concerned about long-term effects, discuss this with us prior to treatment.
Is Spravato addictive?
Spravato carries a risk of dependence, and misuse of the drug is possible, but addiction was not reported in the drug’s studies. It’s important to understand that there’s a difference between dependence, misuse, and addiction:
- Dependence: This is when your body relies on the drug to feel normal. While not reported in Spravato studies, dependence can happen with drugs like ketamine (which is similar to esketamine).
- Misuse: This refers to using the drug in ways other than prescribed.
- Addiction: This means you can’t stop using the drug, even if it harms you.
Spravato has a boxed warning from the FDA regarding the risk of misuse. If you have any concerns about addiction, dependence, or misuse, speak with your mental healthcare provider for more information.
Learn More: What to Do When Antidepressants Don’t Work for You (and Why)
Spravato boxed warnings and what you can do
Spravato has several serious risks that come with its use, which are highlighted in its boxed warnings. A boxed warning is the most serious type of warning from the FDA, designed to ensure that the drug is used safely and help prevent harm to patients.
Here’s a closer look at the boxed warnings associated with Spravato and the steps you can take to address them:
Risk of misuse
Spravato has the potential for misuse, which means taking the drug in a way that’s different from how it was prescribed. Although misuse wasn’t common in clinical trials, it’s still a significant concern.
What you can do
Your healthcare provider will monitor you for signs of misuse during treatment. If you have a history of substance misuse, it’s important to discuss this with us beforehand so we can manage your treatment plan accordingly.
Risk of respiratory depression
Respiratory depression refers to slow or shallow breathing, which can be dangerous. While this side effect wasn’t reported in clinical trials, it has occurred since the drug’s approval.
What you can do
After you receive a dose of Spravato, we will monitor your breathing and oxygen levels for at least two hours. If you experience symptoms like shortness of breath, frequent yawning, or confusion, make sure to let us know immediately.
Risk of dissociation
Dissociation can cause you to feel disconnected from your body, time, or space. This might include experiencing hallucinations, such as seeing or hearing things that aren’t real. Dissociation was a commonly reported side effect during Spravato clinical trials.
What you can do
We will be monitoring you for at least two hours after your dose to check your alertness. If you experience changes in perception or any hallucinations, let us know immediately. If you have a history of psychosis, be sure to inform us during your consultation as this could increase your risk of dissociation when taking Spravato.
Risk of sedation
Spravato may cause extreme sleepiness or sedation, which can make it difficult to stay alert. In rare cases, sedation may lead to unconsciousness.
What you can do
After taking Spravato, a member of our team will observe you for at least two hours to ensure you’re safe and alert enough to leave. If you feel excessively sleepy or unable to think clearly, let us know. You’ll need someone to drive you home after your treatment.
Risk of suicidal thoughts and behaviors
Like other antidepressants, Spravato carries a boxed warning for the potential increase in suicidal thoughts and behaviors, especially in children, teens, and young adults under 24.
What you can do
Your medication management provider will closely monitor you for any worsening depression, suicidal thoughts, or behaviors. It’s also important that your friends and family are aware of these symptoms and ready to seek help if needed.
If you or someone around you notice any signs of suicide risk, immediately contact your mental healthcare provider or seek emergency care.
Keep Reading: Persistent Depressive Disorder – Overview, Symptoms and Causes
Who shouldn’t get Spravato?
Before starting Spravato treatment, a consultation and risk evaluation is needed to understand your health history and suitability for the therapy. Spravato may not be suitable for everyone, especially if you have certain medical conditions or other factors that affect your health. Factors to consider include:
- Psychosis: Spravato may cause dissociation. If you have a history of psychosis, you could be at increased risk of a more severe dissociative or psychotic episode with Sprav
- Substance misuse: If you have a history of substance misuse, including drugs or alcohol, Spravato may not be suitable for you. Misusing Spravato can increase the risk of negative health effects and the drug has a boxed warning about its potential for misuse.
- Liver disease: Spravato may pose additional risks for those with liver problems. You may need closer monitoring after your dose.
- High blood pressure: Spravato can increase blood pressure, which can have serious effects on your heart, blood vessels, and brains. If you have high blood pressure, it’s important to discuss it beforehand to evaluate whether Spravato is safe for you.
Certain conditions are contraindicated with Spravato, meaning they could prevent you from being prescribed Spravato because of potential harm. These conditions include:
- Aneurysms or blood vessel disease: Spravato can raise blood pressure, which in extreme cases can cause serious bleeding events such as stroke. If you have or have had an arteriovenous malformation (AVM) or aneurysmal vascular disease (AVD), the risk of bleeding is increased.
- Brain bleed: If you’ve had a brain bleed in the past, Spravato can increase the risk of further bleeding inside the brain due to the rise in blood pressure.
- Allergy to ketamine: Spravato is similar to ketamine (Ketalar). If you’ve had an allergic reaction to ketamine, it’s likely you’ll also be allergic to Spravato.
Explore Spravato today
If you’ve been struggling with depression, Spravato may provide the relief you’ve been looking for. But like any treatment, it comes with benefits and risks, and it’s important to make sure it’s the right fit for you.
At BestMind Behavioral Health, we’re here to provide guidance and the support you need to make an informed decision. We offer this therapy at our comfortable, licensed medical facilities in Colorado, Oregon, and Washington. If you’re thinking about Spravato as part of your treatment or just want to learn more, don’t hesitate to contact us today.
