Key Takeaways
- Dissociation, dizziness, and nausea are among the most frequently experienced reactions.
- Some Spravato side effects are serious and carry important safety warnings.
- Spravato is only given in a clinical setting due to a required federal monitoring program.
Every Spravato dose is given at a certified clinic, and staff watch you for at least two hours afterward. Most side effects show up within minutes of your dose and fade well before you leave.
| Side effect | How common | Typical duration | How to manage |
|---|---|---|---|
| Dissociation | Very common | Up to 90 minutes | Stay still in a calm, quiet room |
| Dizziness | Common | 1–2 hours | Remain seated; move slowly |
| Nausea/Vomiting | Common | Under 1 hour | Eat a light meal 2–3 hours before |
| Sedation/Drowsiness | Common (boxed warning) | 1–2 hours | Rest during monitoring; no driving until next day |
| Increased Blood Pressure | Common | Usually under 2 hours | Staff check BP before, during, and after |
| Headache | Common | Hours to a day | Hydrate; OTC pain relief with doctor approval |
| Blurred Vision | Less common | Under 2 hours | Resolves during monitoring period |
| Vertigo | Less common | Under 2 hours | Close eyes or fix gaze on one point |
| Session Anxiety | Less common | Minutes to an hour | Slow breathing; alert your care team |
Dissociation
Dissociation (a feeling of being disconnected from your body, thoughts, or surroundings) is the side effect patients ask about most. During a session, it can feel like you’re floating, watching yourself from a distance, or like the room isn’t quite real.
This sensation typically fades within 90 minutes. Your care team stays nearby the entire time, and the quiet clinic environment is designed to keep the experience manageable.
Dizziness
Lightheadedness or unsteadiness, especially when standing, is common during the monitoring period. It tends to appear shortly after the dose and resolves as the medication clears your system.
Stay seated until staff say it’s safe to move. When you do stand, go slowly. Rushing to your feet is the fastest way to make dizziness worse.
Nausea and Vomiting
Nausea often peaks within the first hour. Some patients also vomit, though this is less frequent. Eating a light meal two to three hours before your appointment (not right before) can reduce the odds.
Your doctor may suggest anti-nausea medication before the session. Greasy or heavy food beforehand tends to make things worse, so stick with something simple like toast or crackers.
Sedation and Drowsiness
Sleepiness ranges from mild grogginess to, in rare cases, brief loss of consciousness. Sedation carries an FDA boxed warning, which is why you’re monitored for at least two hours.
Plan to rest during that window. You can’t drive, operate heavy equipment, or do anything requiring full alertness until the following day. Arrange a ride home before every appointment.
Increased Blood Pressure
Spravato can cause a temporary blood pressure spike that usually returns to your baseline within two hours. Clinic staff check your blood pressure before your dose, during the monitoring period, and again before you leave.
If you already have high blood pressure, tell your psychiatrist before starting treatment. They’ll review your readings at each visit and decide whether it’s safe to proceed with that day’s dose.
Headache
Headache is one of the milder side effects and one of the most common. It can linger after you leave the clinic, but it’s typically manageable.
Drinking water before and after your session helps. Over-the-counter pain relief is usually fine, though check with your doctor first since some medications interact with Spravato.
Blurred Vision
Some patients notice temporary visual changes during or shortly after their dose. Objects may look slightly out of focus, or your peripheral vision may feel off.
This resolves during the monitoring period for most people. Because it affects your ability to see clearly, it’s another reason you don’t drive yourself home.
Vertigo
Vertigo feels like the room is spinning around you, which is different from the lightheadedness of dizziness. It’s less commonly reported but shows up in clinical trial data.
Closing your eyes or fixing your gaze on a single point can ease the sensation. Staying seated until it passes is the safest approach.
Session Anxiety
Some patients feel a brief spike in anxiety, especially when dissociative effects kick in. The unfamiliar sensation of disconnection can trigger a wave of worry, even if you’ve been told to expect it.
Slow, deliberate breathing helps bring the intensity down. Let your care team know what you’re feeling so they can adjust the environment. This anxiety tends to ease as you become more familiar with the medication over multiple sessions.
Serious Risks and Safety Warnings
Spravato carries an FDA boxed warning, the strongest safety alert placed on any medication. The warning covers four risks:
- Sedation
- Dissociation
- Potential for misuse or abuse (Spravato is a Schedule III controlled substance)
- Suicidal thoughts and behaviors
Can Spravato make depression worse?
In some people, yes. Suicidal thoughts can increase, particularly during the first weeks of treatment. This risk exists with many antidepressants, and it’s one reason your care team monitors you closely.
If your mood darkens or new thoughts of self-harm appear between appointments, tell your psychiatrist right away. Don’t wait for your next dose.
Beyond the boxed warning, rare but serious reactions include:
- Severe high blood pressure that doesn’t return to baseline within the monitoring window
- Slowed breathing (more likely if you’re also taking sedating medications or opioids)
- Allergic reactions such as swelling, rash, or difficulty breathing
Long-Term Considerations
Prolonged ketamine use has been linked to bladder damage and cognitive changes in some research. Current studies on esketamine haven’t run long enough to answer whether these risks apply over years of treatment.
Discuss this gap with your psychiatrist, especially if you expect to stay on Spravato long-term. Your doctor can also walk through how Spravato compares to other options like TMS for treatment-resistant depression.
Spravato Clinic Monitoring and the REMS Program
The FDA requires every Spravato dose to be given through a safety program called REMS (Risk Evaluation and Mitigation Strategy). This program exists because of the sedation, dissociation, and abuse risks covered by the boxed warning.
REMS means you can’t take Spravato at home. Each dose is given at a certified clinic, and you stay for at least two hours of monitoring afterward. Staff check your blood pressure, alertness, and overall response before clearing you to leave.
You can’t drive or operate heavy equipment until the day after treatment. On treatment days, avoid alcohol and any sedating medications unless your psychiatrist has specifically approved them. Bring up every substance you use, including over-the-counter sleep aids, so your care team can flag interactions.
Treatment frequency follows a tapering schedule. Most patients start with twice-weekly sessions for the first month. That drops to once a week, then eventually to every one to two weeks.
Short-lived side effects are manageable with proper monitoring
Most Spravato side effects peak within the first hour and clear before you leave the building. Side effects are real, and the serious risks covered earlier shouldn’t be brushed aside.
For many people whose depression hasn’t responded to standard antidepressants, the supervised benefits of Spravato outweigh those risks. Your psychiatrist can walk through your specific medical history and help you decide. Call Pacific Neuropsychiatric Specialists at (714) 545-5550 to schedule an evaluation with a certified Spravato care team.
Frequently Asked Questions
Can you drive after a Spravato treatment session?
No. You can’t drive until the day after treatment. Arrange a ride home before every appointment.
Does Spravato interact with alcohol?
Yes. Avoid alcohol on treatment days. It increases sedation risk. Tell your care team about every substance you use.
How should you prepare for a Spravato session to reduce side effects?
Eat a light meal two to three hours before. Avoid heavy or greasy food. Arrange your ride home in advance.
What does dissociation feel like during a Spravato session?
You may feel like you’re floating or watching yourself from a distance. This typically fades within 90 minutes.
Is the blood pressure increase from Spravato dangerous?
It’s usually temporary, returning to normal within two hours. Staff check your blood pressure before, during, and after every session.
What serious risks does Spravato carry?
The FDA boxed warning covers sedation, dissociation, abuse potential, and suicidal thoughts. Rare risks include slowed breathing and severe allergic reactions.
What is the REMS program and why does it matter for Spravato patients?
REMS is an FDA safety program requiring every dose be given at a certified clinic with at least two hours of monitoring.
Can Spravato make depression or suicidal thoughts worse?
In some people, yes. Suicidal thoughts can increase early in treatment. Tell your psychiatrist right away if your mood darkens.
Are there long-term side effects from Spravato?
Research on long-term esketamine use is still limited. Bladder damage and cognitive changes have appeared in some ketamine studies. Discuss this with your psychiatrist.
How often do Spravato side effects actually occur during sessions?
Most side effects, including dizziness and nausea, peak within the first hour and clear before monitoring ends.