If you’re considering Spravato (esketamine) for treatment-resistant depression, it’s essential to have a clear understanding of its side effects. Spravato is an effective esketamine nasal spray that has brought hope to many adults with treatment-resistant major depression. However, like all prescription medicines, it comes with potential side effects. Knowing what to expect during and after a treatment session can help you feel more prepared and confident in your decision.
One common question patients considering ketamine therapy ask is, “How long do Spravato side effects last?” The good news is that for most people, the immediate effects occur and resolve quickly within a controlled clinical setting. This article will provide a detailed overview of the most common side effects, how they are managed, and their typical duration.
Quick Takeaways
- Immediate but Temporary: Most Spravato side effects, such as dissociation (feeling disconnected) and dizziness, begin shortly after the first dose and typically are observed at least two hours post-treatment.
- Monitored for Safety: Because of the risk of sedation and increased blood pressure, Spravato is only administered in a healthcare settings certified to monitor patients under a risk evaluation and mitigation strategy (REMS).
- Common Side Effects: The most common side effects include feeling disconnected, dizziness, nausea, drowsiness, anxiety, and a temporary increase in blood pressure.
- Serious Risks are Uncommon: While rare, serious risks like respiratory depression and high blood pressure (hypertensive encephalopathy) are why close monitoring by a healthcare provider is mandatory.
- Duration: The acute side effects are short-lived, lasting only a couple of hours. Long-term risks, like bladder problems, are monitored over time by your healthcare professional.
Common Spravato Side Effects and How Long They Last
When you begin treatment, it’s important to know what to expect. The effects occur quickly after administration. For patients treated with Spravato, the most frequently reported side effects are temporary and resolve before they leave the clinic. Below are some example timelines for these side effects, though the actual time can be variable.
| Common Side Effect | What It Feels Like | Possible Duration |
|---|---|---|
| Feeling Disconnected | A sense of dissociation from your thoughts or body. | 30-90 minutes, fades during the monitoring period. |
| Dizziness/Vertigo | Feeling lightheaded or as if the room is spinning. | 45-90 minutes, resolves while resting at the clinic. |
| Nausea/Vomiting | Feeling sick to your stomach. | Can occur during the first hour; medication can help. |
| Drowsiness/Sedation | Feeling sleepy or tired. | Peaks in the first hour and improves before discharge. |
| Increased Blood Pressure | You likely won’t feel it, but it’s monitored. | Peaks around 40 minutes post-dose and returns to normal. |
These side effects are often strongest after the first dose and may become less noticeable during later sessions as treatment is adjusted and patients become more accustomed to the experience.
Understanding Serious but Rarer Side Effects
While less common, Spravato carries a risk of more serious side effects, which is why the REMS program is so important. Your healthcare provider is trained to watch for these issues.
- Increased Blood Pressure: Spravato can cause a temporary but significant spike in blood pressure. In rare cases, this can lead to hypertensive encephalopathy, a sudden, severe headache, or chest pain. This is a primary reason for the two-hour monitoring that clinics will observe patients.
- Respiratory Depression: The medication can cause slow or shallow breathing or even respiratory arrest. This increased risk is higher if you take other medications that cause drowsiness, like benzodiazepines, opioids, or monoamine oxidase inhibitors. If you are having trouble breathing, you should treat that as an emergency.
- Bladder Problems: Long-term use of ketamine (the drug class Spravato belongs to) has been linked to ulcerative or interstitial cystitis. You should report any pain or urinating to your doctor promptly.
- Risk of Suicidal Thoughts: Like other antidepressants, Spravato has a warning for an increased risk of suicidal thoughts and behaviors, particularly in young adults. It’s vital to report any new or sudden changes in mood.
| Risk Category | Potential Issue | Who Is at Higher Risk? |
|---|---|---|
| Cardiovascular | Hypertensive Encephalopathy, Aneurysmal Vascular Disease | Patients with a history of high blood pressure or blood vessel disease. |
| Respiratory | Respiratory Depression / Breathing Problems | Patients using other sedating prescription medicines or street drugs. |
| Urological | Ulcerative or Interstitial Cystitis | Long-term, high-dose users (monitored in all patients). |
| Psychological | Worsening Depressive Symptoms, Suicidal Ideation | Young adults at the start of treatment. |
The Spravato Risk Evaluation and Mitigation Strategy (REMS)
Spravato is not a medication you can pick up at a pharmacy and take at home. Due to its potential for serious adverse outcomes, it is only available through a restricted program called the Spravato REMS (Risk Evaluation and Mitigation Strategy). This program is a safety requirement from the FDA to ensure the benefits of the drug outweigh its risks.
The evaluation and mitigation strategy has two key parts:
- Certified Centers: Only healthcare settings certified in the REMS program, such as specialized medical offices and outpatient healthcare settings, can prescribe and dispense Spravato.
- Patient Monitoring: Your healthcare provider must closely monitor you for at least two hours after you use the nasal spray. This is to manage any immediate side effects, such as sedation or a spike in blood pressure. You also cannot drive until the day after your session, following a restful sleep.
This strict risk evaluation protocol is designed to protect patients and ensure the medicine is used safely to treat depressive symptoms.
Frequently Asked Questions About Spravato Side Effects
Can I use a nasal decongestant before my Spravato treatment?
You should avoid using a nasal decongestant medicine in the hour before your Spravato session. If a decongestant is medically necessary, your healthcare provider determines the best course of action to ensure the esketamine nasal spray is absorbed properly.
What if I am pregnant or become pregnant?
Spravato may harm an unborn baby. It is not recommended for use during pregnancy, and women who could become pregnant should use effective contraception. There is a national pregnancy registry for women exposed to Spravato to monitor outcomes.
Is Spravato the same as the ketamine used for drug abuse?
No. Spravato is a specific form of ketamine (esketamine) administered in a controlled, low dose. It is an anesthetic medicine used to relieve pain and treat adults with depression under strict medical supervision, which is entirely different from the high-dose, uncontrolled, and dangerous nature of illicit drug abuse.
A Safe Path Forward with Azona Health
Understanding the side effects of Spravato is a key part of informed consent and successful treatment. While the list of potential issues can seem daunting, the vast majority are temporary and well-managed within the structured, safe environment of a certified clinic. At Azona Health, our priority is your safety and well-being. We are here to guide you through every step of your mental health treatment, ensuring you are monitored and cared for throughout your mental health journey and finding relief from major depressive disorder (MDD). Contact us to learn more.
