Spravato Side Effects: What to Expect During Esketamine Nasal Spray Treatment

If your doctor has brought up Spravato, you probably have questions. What will you actually feel during a session? How long do the effects last? Are the possible side effects of Spravato worth it after everything you’ve already tried?

Those are fair questions. When you’ve already been through rounds of antidepressants that didn’t work, the last thing you need is more uncertainty.

Spravato (esketamine) is a nasal spray approved by the FDA for adults with treatment-resistant depression, meaning depression that has not improved with at least two different oral antidepressants. Esketamine works differently from a standard antidepressant. Rather than adjusting serotonin levels over weeks, it targets the brain’s NMDA receptors to produce a faster change in symptoms of depression for many patients.

But what does that mean for your body on treatment day?

This guide walks you through the potential side effects of Spravato, what each one feels like, which adverse effects to be aware of, and what the supervised treatment experience actually looks like. At Mind Garden Mental Health Services, Carolyne Mburu-Gerena, PMHNP-BC supervises Spravato treatment in a certified healthcare setting at our Mesa, AZ office. Understanding what to expect can make a real difference in how you experience your sessions.

In this guide, you will learn:

• How Spravato works and who it’s designed for
• The common side effects most patients notice during sessions
• Serious adverse effects that require immediate attention
• What the Risk Evaluation and Mitigation Strategy (REMS) program means for your safety
• How long Spravato side effects typically last
• What dissociation actually feels like
• How to prepare for and recover from a session
• What Spravato care at Mind Garden MHS looks like

What Is Spravato and How Does It Work?

Spravato is the brand-name form of esketamine, a medication specifically approved for adults with treatment-resistant depression and for adults with major depressive disorder experiencing active suicidal ideation.

Unlike a standard antidepressant taken by mouth each day at home, Spravato is an esketamine nasal spray administered at healthcare settings certified under the REMS program. You do not fill a prescription at a pharmacy and take it home.

Esketamine works on the brain’s NMDA receptor system, which involves a chemical messenger called glutamate. This is a different pathway from most oral antidepressants, which primarily target serotonin or norepinephrine. The antidepressant effect of esketamine may appear quickly, sometimes within hours or days of a first session, which is rare with traditional medications.

For patients who have tried standard treatments without lasting relief, this difference in how Spravato works is often why it may succeed where other approaches have not.

Why Spravato Is Different From a Standard Antidepressant

Most people have already tried an antidepressant before they arrive at Spravato. The effects of esketamine feel different in ways that can be surprising if you are not prepared.

Standard oral antidepressants are taken daily at home over weeks or months. The effects are gradual and mostly internal, most people don’t notice anything unusual on the days they take them. Spravato is the opposite. You will notice it working.

An antidepressant taken by mouth adjusts brain chemistry slowly. Esketamine produces noticeable effects within minutes of nasal spray administration. Those effects are temporary, they peak during the session and fade during the monitoring period, but they are present and expected.

This is also why Spravato cannot be dispensed as a take-home medication. The supervision and monitoring requirements exist because of these acute effects. Understanding this before your first session removes a great deal of the anxiety around what you will feel.

Who Qualifies for Spravato? Adults With Major Depressive Disorder and Treatment-Resistant Depression

Spravato is FDA-approved for two specific groups:

1.  Adults with treatment-resistant depression, meaning their symptoms of depression have not improved after at least two different antidepressants at adequate doses and durations.

2.  Adults with major depressive disorder who have active suicidal thoughts or behaviors at the time of evaluation.

If you’ve been told your depression is treatment-resistant, or if you feel like nothing has worked despite trying everything your previous providers suggested, you may be a candidate. A thorough evaluation comes first.

At Mind Garden MHS, Carolyne completes a full psychiatric evaluation before any Spravato treatment begins. This includes reviewing your history, previous medications, current mental health status, and medical background to confirm that the potential side effects and requirements of Spravato fit your situation.

How the Spravato Nasal Spray Is Administered

On treatment day, here is what actually happens.

Your provider checks your blood pressure before taking Spravato. Blood pressure monitoring is required at the start, during, and after every session because Spravato can raise it temporarily.

You then use the nasal spray device yourself under direct supervision. Your provider walks you through it, you are not alone. Each device delivers a precise dose into one or both nostrils depending on your prescribed amount.

After the administration of esketamine, you remain in the office for monitoring. Per REMS requirements, your provider will monitor you for serious side effects for at least 2 hours after each dose. Side effects monitoring for at least the full two-hour window is a mandatory safety protocol, it cannot be shortened or skipped.

You cannot drive afterward. Arrange your ride home before your appointment. Most patients use the first 30 to 60 minutes to rest quietly. The monitoring window is built into the session itself.

Common Side Effects of Spravato During Treatment

If you’re wondering about the possible side effects before your first session, this section gives you the clearest picture. Most patients experience some side effects of Spravato® during or shortly after their session. The side effects of Spravato are typically mild, temporary, and resolve within the monitoring window.

Here are the common side effects patients most often report:

• Dissociation, A feeling of being detached from your body, thoughts, or surroundings. This is the most frequently reported effect and is covered in detail below.
• Dizziness, Lightheadedness or unsteadiness that typically fades as the medication clears.
• Nausea, Some people feel queasy during or shortly after the session. Eating lightly before your appointment can help.
• Sleepiness or sedation, Drowsiness is expected. You will rest during the monitoring period.
• Increased blood pressure, Your blood pressure is checked regularly throughout the session.
• Nasal irritation, Some patients notice mild burning, congestion, or a metallic taste after using the nasal spray.

None of these are signs that something has gone wrong. They are anticipated effects of esketamine and are part of the supervised treatment experience.

Serious Adverse Effects and Spravato’s Boxed Warning: What to Watch For

Alongside the common effects, there are serious adverse effects that your care team monitors closely during every session.

Respiratory depression, Spravato can slow breathing. This is one of the primary reasons in-person medical supervision is required. Respiratory depression is uncommon but taken seriously, and your provider monitors your breathing throughout each session.

Sudden changes in mood, Tell your provider right away if you feel sudden shifts in mood, agitation, or emotional instability during or after treatment.

Problems with thinking clearly, Some patients experience trouble concentrating, unusual changes in judgment, or difficulty remembering things. These effects are usually brief.

Suicidal thoughts and behaviors, Like all antidepressants and psychiatric medications, Spravato carries a boxed warning because these drugs may increase suicidal thoughts in some patients, particularly during the early weeks of treatment. The increased risk of suicidal thoughts is closely monitored at every session. The risk of suicidal ideation is discussed openly during your evaluation, especially if you have a history of this. Tell your provider immediately if you notice worsening thoughts or mood.

You may report side effects directly to the FDA at MedWatch: 1-800-FDA-1088. If you experience very high blood pressure, difficulty breathing, or feel like you cannot stay awake, let your provider know immediately.

The Risk Evaluation and Mitigation Strategy (REMS) Program Explained

The Risk Evaluation and Mitigation Strategy, or REMS, is a formal FDA safety program for medications that require special management because of serious risks. Spravato is administered at healthcare settings certified under this program specifically because of its potential for abuse and misuse, respiratory depression, and dissociation.

What does REMS certification mean for you as a patient? It means that every clinic providing Spravato, including Mind Garden MHS, has completed required training and meets strict safety and monitoring standards. Every dose of Spravato is given in certified medical offices and clinics. There are no take-home doses.

The REMS program also addresses the potential for physical and psychological dependence. Because Spravato is a Schedule III controlled substance, the supervised clinical setting is a key safeguard against misuse. Patients cannot receive a Spravato prescription to fill at a pharmacy and take at home. That restriction is intentional and protective.

How Long Do Spravato Side Effects Last?

This is one of the most common questions patients ask before their first session.

Most Spravato side effects peak during the session and begin to fade within one to two hours. By the time your mandatory monitoring period ends, the majority of patients feel significantly more like themselves. Some report mild grogginess or mental fog for the rest of the day, which is why resting at home is recommended after each session.

Most people feel back to normal by the following morning.

Individual responses vary. In clinical studies, patients in the esketamine group sometimes reported that effects including dizziness persisted beyond the session on treatment days, particularly in earlier sessions. This tends to decrease as the body adjusts over the course of treatment.

If side effects feel more intense than expected, or seem to be lasting longer than described here, let your provider know. Dosing can be adjusted based on how your body responds.

Dissociation During Spravato: What Patients Actually Experience

Dissociation is the side effect people ask about most, and the word alone is enough to make some patients hesitate. Here is what it actually tends to feel like.

Most patients describe it as a gentle sense of detachment. Things in the room may look slightly softer or more distant. Thoughts can feel like they’re moving more slowly, or like you are watching them from a slight remove. Some people describe it as dreamlike. A few find it disorienting at first.

What it does not feel like: losing control of your actions, blacking out, or not knowing where you are. You remain awake and aware throughout. Your provider is present the entire time.

The dissociative effect typically begins within 20 to 30 minutes of the nasal spray administration and starts to fade during the monitoring window. Long-term use data on the safety of intranasal esketamine shows that dissociative effects did not worsen over time for most patients in clinical trials. Rest, a quiet room, and a trusted provider make the experience manageable. It becomes less unfamiliar with each session.

Managing Side Effects: Tips for Before and After Your Treatment Session

These practical steps can make your Spravato sessions more comfortable.

Before your session:

• Do not eat for at least two hours before your appointment. Food can increase nausea during treatment.
• Avoid alcohol for 24 hours before treatment.
• If you regularly take a nasal corticosteroid or nasal decongestant, tell your provider before starting Spravato. Some nasal medications may reduce how well the esketamine nasal spray is absorbed. Your provider may ask you to take a nasal corticosteroid at a specific time relative to your Spravato session.
• Arrange your ride home before your appointment. You cannot drive after treatment.
• Plan for a quiet afternoon. Avoid major decisions or stressful tasks on treatment days.

After your session:

• Rest at home. Light walking is fine; strenuous exercise should wait until the next day.
• Avoid alcohol for the remainder of the day.
• Contact your provider if anything feels unusual or if side effects persist longer than expected.

Is Spravato Safe for Treatment-Resistant Depression Long-Term?

Long-term safety is a fair concern when exploring a newer treatment, especially when you’ve already been through a great deal.

According to the FDA prescribing information for Spravato, data from patients in treatment for over a year shows that side effects like dizziness and dissociation remained short-lived and did not worsen with continued use. The efficacy and safety of esketamine in long-term maintenance therapy has been studied in adults with treatment-resistant depression who responded well to initial treatment. You can read more about treatment-resistant depression on the NIMH website.

Blood pressure increases during sessions typically returned to normal within a few hours for most patients.

Because of the potential for physical and psychological dependence and the classification of Spravato as a Schedule III substance, long-term safety monitoring includes watching for signs of abuse and misuse, cognitive changes, and mood stability. Patients with a history of suicidal thoughts, substance misuse, or unstable cardiovascular conditions are evaluated carefully before and throughout treatment.

The ketamine and esketamine family of medications continues to be studied. What current data shows is that for appropriately screened patients, the oral antidepressant in treatment-resistant depression often falls short where Spravato can succeed, and that long-term supervised use appears manageable for most patients.

What to Expect at Mind Garden MHS When You Start Spravato

At Mind Garden Mental Health Services in Mesa, AZ, Carolyne Mburu-Gerena, PMHNP-BC supervises every Spravato session in a certified healthcare setting with the kind of attentiveness most patients say they have never received before. To learn more, visit the Spravato service page on our website.

Before your first session, Carolyne reviews your complete psychiatric history, previous medication trials, and depression rating scale results to confirm that Spravato is the right fit. This is a thorough evaluation, not a ten-minute intake.

On treatment days, you have a private, comfortable space to rest. Blood pressure and breathing are monitored before, during, and after each session. You will not be left alone in a waiting room and told to come back in two hours.

Most appointments are available within 24 to 48 hours. Spravato is often covered by insurance, including Aetna, BCBS, Cigna, United Health, Tufts, and Oscar, unlike ketamine IV infusions, which are not FDA-approved for depression and are typically not covered.

To schedule a consultation, call (781) 430-4309 or book your appointment online. Appointments are typically available within 24 to 48 hours.

Frequently Asked Questions About Spravato Side Effects

Can I drive myself home after a Spravato session?

No. You cannot drive or operate heavy machinery on the day of your treatment. This is a firm REMS safety requirement. Arrange a ride in advance before your appointment.

What does dissociation from Spravato actually feel like?

Most patients describe it as feeling detached, floaty, or dreamlike, like watching your thoughts from a slight distance. It is temporary and usually resolves within one to two hours.

What are the serious side effects of Spravato I should know before starting?

Serious side effects include respiratory depression, significant blood pressure increases, severe dissociation, and suicidal thoughts or behaviors. These are monitored closely during every session. Your care team is trained to respond to all of them.

Does the ketamine and esketamine experience feel like recreational drug use?

Not quite. While both come from the same chemical family, the controlled clinical setting, supervised dosing, and specific medical purpose make this a very different experience. Some perceptual changes are expected. You are supervised throughout.

What if I need to take a nasal corticosteroid on a treatment day?

Tell your provider in advance. Depending on timing, they may ask you to adjust when you take a nasal corticosteroid or nasal decongestant to avoid interfering with Spravato absorption.

Is Spravato covered by insurance for adults with major depressive disorder and treatment-resistant depression?

Spravato is often covered for qualifying diagnoses, including treatment-resistant depression. Coverage varies by plan. Contact Mind Garden MHS to verify your benefits before your first appointment.

Can I report concerns about Spravato side effects to the FDA?

Yes. Patients may report side effects or concerns to the FDA at MedWatch: 1-800-FDA-1088.

Next Steps for Adults With Treatment-Resistant Depression Considering Spravato

Understanding the possible side effects of Spravato before you begin can reduce anxiety and set realistic expectations for what you will feel.

The most common side effects, dissociation, dizziness, nausea, and sedation, are temporary and typically resolve within two hours. Serious adverse effects are rare and are actively monitored by your care team at every session. The Risk Evaluation and Mitigation Strategy program exists specifically to keep those sessions safe.

Spravato is not the right fit for everyone. But for adults with treatment-resistant depression who have already tried multiple antidepressants without lasting relief, it may open a path that felt closed.

At Mind Garden Mental Health Services, Carolyne Mburu-Gerena, PMHNP-BC takes the time to evaluate whether Spravato is appropriate for your specific situation, and to walk with you through the process if it is. Appointments are often available within 24 to 48 hours. Telehealth consultations are available for residents of Arizona, Colorado, Massachusetts, New Mexico, Rhode Island, Vermont, and Washington. Most major insurances are accepted.

Visit mindgardenmhs.com/spravato-treatment-resistant-depression to learn more, or call (781) 430-4309 to speak with our team. Ready to schedule? Book your consultation online here.