Spravato is a revolutionary new nasal spray that is derived from ketamine. It has been approved for treatment in major depressive disorders and treatment-resistant depression cases. If you are considering Spravato, it is important to understand the potential side effects. Most of the known side effects are mild, things that go away on their own within one day or less. There are, however, things you can do at home and before each dose to help manage and mitigate your symptoms.
What is Spravato?
Spravato is a nasal spray, which is the brand name for the drug esketamine. It is a prescription version of ketamine. Ketamine is a derivative of PCP, called angel dust. Originally, it was used as an anesthetic during surgery, but since the 1990s, it has been researched as a form of depression treatment.
Esketamine is a water-soluble powder that gets mixed into the liquid used for the nasal spray. It provides rapid improvement of symptoms for those with treatment-resistant depression or suicidal ideations associated with major depressive disorder by regrowing the glutamate receptors on the ends of neurotransmitters. This improves communication in the brain and relieves symptoms in a way that other antidepressants cannot.
Given the main ingredients, it is only approved by the FDA for these treatments, though it can be used for other treatment programs when administered by designated facilities.
When used as an anesthetic, it provides quick relief for depression and anxiety symptoms, which prompted Yale researchers to investigate it in the 1990s as a form of depression treatment.
How it works
Spravato is a nasal spray that you take yourself after a healthcare provider shows you how. They monitor you as you self-administer and subsequently monitor you for around two hours after each dose to check for severe side effects.
Common Side Effects of Spravato
The most common side effects people experience when taking Spravato with an antidepressant or the following:
- Dizziness
- Nausea
- Sleepy sensations
- Spinning sensations
- Disconnectedness
- Numbness
- Anxiety
- Vomiting
- Lack of energy
- Increased blood pressure
- Feeling drunk
- Feeling excited or happy
- Constipation
- Altered sense of taste
- Discomfort in the nose or throat from the spray administration
- Diarrhea
- Dry mouth
How long do Spravato side effects last?
The most common Spravato side effects, including short-term dizziness, spinning sensations, lack of energy, or increased blood pressure, are all things that will resolve themselves in almost all cases within one day of treatment.
Dizziness and Nausea
The dizziness and nausea are related to the disconnection you might feel, as well as the increased blood pressure.
Increased Blood Pressure
Increased blood pressure is one of the more common temporary Spravato side effects, which, according to studies, reach their peak around 40 minutes after a dose and last around 4 hours. There were recorded instances of blood pressure reaching levels high enough to be of concern because of the potential for complications like:
- Chest pain
- Seizure
- Sudden headaches
- Vision impairment
- Shortness of breath
For this reason it is specified that Spravato should not be taken by anyone who has any type of blood vessel disease, history of bleeding in the brain, or abnormal connections between the arteries and veins.
Anyone with pre-existing medical conditions, including heart or brain problems, needs to disclose this information to their healthcare provider, after which it will be determined whether or not this prescription is appropriate. This includes a history of:
- Hypertension
- Heart attack
- Shortness of breath or fainting caused by an abnormally slow or fast heartbeat
- Heart valve disease
- Heart failure
- Stroke
- Brain injury
Sedation and Dissociation
Spravato side effects center on sedation and dissociation. When you use this treatment, you might experience sleepiness or sedation as well as:
- Fainting
- Dizziness
- The feeling as though you are spinning
- Anxiety
- The feeling of being disconnected from your body, feelings, thoughts, or space and time (dissociation)
If, however, you feel like you are about to pass out or you cannot keep yourself awake immediately after a dose of Spravato, let your healthcare provider know.
Due to the aforementioned short and long-term side effects of Spravato, you are required to remain under observation for at least two hours after taking Spravato. During this time, you will remain at the treatment center. The doctor responsible for administering your Spravato will let you know when you are safe to leave.
Long-Term Side Effects of Spravato
The feelings of dissociation and sedation are normal side effects that many people experience. However, they can lead to significantly more dangerous side effects, including respiratory depression and misuse.
Respiratory Depression
Rare cases have been reported where patients who used Spravato experienced respiratory depression. This is sometimes called hypoventilation, which means your breathing has slowed down to the point where your respiratory system is not effectively breathing. This can cause excess carbon dioxide in your blood and result in complications like:
- Respiratory failure
- Cardiac arrest
To ensure you are safe against these potential side effects, you will remain under observation for two hours after each dose. During this time, your physician will monitor your respiration with pulse oximetry, a test that measures how much oxygen is in your blood. Results from this non-invasive check will determine if there are unusually high levels of carbon dioxide building up in your system.
Abuse
Abuse is one of the other long-term side effects of Spravato. Because the main ingredient in Spravato is a ketamine derivative, there is a risk that patients will develop a substance abuse disorder.
To help address these long term side effects of Spravato, it is adminstered under by qualifying facilities who are overseen by the FDA. The Risk Evaluation and Mitigation Strategy (REMS) program restricts access to Spravato in terms of frequency and dose.
If you have ever been addicted to any form of drug, you must let your healthcare provider know. This will not disqualify you, but it will help them monitor and have you monitor for specific signs of dependence versus addiction.
Suicidal Thoughts and Actions
A third category of long-term side effects of Spravato includes increased risks of suicidal thoughts or actions. This is not a direct result of the Spravato but rather the antidepressant medications that are required by the FDA to be taken in conjunction with your Spravato treatment.
There is a higher risk of increased suicidal thoughts and actions in those who are 24 or younger, especially during the first few months of taking an antidepressant or if the dosage for the respective antidepressants is changed.
Those who have a history of serious mental health problems with suicidal ideations need to pay close attention to sudden changes in feelings, thoughts, mood, or behavior and inform their doctor right away if there are changes to symptoms like:
- Worsening depression
- Unusual mood or behavior changes
- Thoughts of suicide
- Suicidal attempts
Limitations of Use
Spravato is a prescription. Moreover, it must be legally taken alongside an antidepressant medication or, in some cases, an antipsychotic. It is only FDA-approved for:
- Treatment-resistant depression
- Major depressive disorder in adults presenting with suicidal thoughts or actions
As of right now, it is not known whether Spravato is safe and effective at preventing or reducing suicide/suicidal thoughts.
If hospitalization is recommended, Spravato is not an alternative even if it provides improvement in symptoms after a first dose.
Cognitive Impairment
There are potential risks for cognitive impairment. Long-term cognitive impairment has occurred in individuals who use ketamine for a long amount of time and frequently. This is often associated with frequency and doses well beyond what would be legally prescribed, but it can result in memory issues and problems with concentration.
This long-term cognitive impairment has not been demonstrated in anyone using Spravato but rather in those who rely on ketamine long-term. Nonetheless, your cognition gets monitored during your sessions, and certain activities are limited on the day you receive your doses, including driving and operating machinery.
How Long Do Spravato Side Effects Last?
Not everyone experiences side effects.
And of those who do, not everyone is limited to the short or long-term Spravato side effects. There can be more or different side effects based on individual cases, according to their respective studies.
That said, there are several factors that affect the duration of side effects. If you, for example, come to your appointments with a high level of anxiety, you might be more likely to experience anxiety as a side effect, but if you show up having eaten a lot of sugar beforehand without a lot of water, you might get dizziness and anxiety.
As mentioned, however, the majority of short-term, common side effects only last one day.
Managing and Mitigating Side Effects
There are several things you can do to manage and mitigate the side effects of Spravato.
Diet and Nutrition
For those who struggle with nausea or who are concerned about the risk of nausea as a side effect, the best way to manage and mitigate this side effect is to avoid eating at least 2 hours prior to your treatment session. If you have severe nausea, you can also consider medications.
If you are worried about the Spravato side effects relating to high blood pressure, be aware of the foods you are eating, particularly the day before and the day you receive your dose. There are certain foods, including natural holistic medications and vitamins or supplements, that can have a direct impact on your blood pressure.
For example, things like beets might be good for blood pressure but when combined with the side effects you experience from your dose might be something to avoid around the time you have your sessions.
Hydration and Rest
Hydration is an equally important factor in managing some of your side effects. Nausea can be managed by avoiding drinking anything at least 30 minutes before your dose and making sure that you stay hydrated long after receiving your dose.
Medical Interventions
As mentioned, some medical interventions can be used to mitigate certain symptoms, such as anti-nausea medications or anti-diarrheal medications if that is one of the main symptoms you experience. If you prefer, there are nutritional and herbal options here, too, such as:
- Peppermint tea is known for its anti-nausea effects
- Ginger tea or ginger supplements to help with vertigo and dizziness
- Lavender tea to help with headaches or anxiety
- Turmeric tea, supplements, or foods to help with headaches
It is important to keep track of all your side effects to consider what over-the-counter remedies can be used when you first experience symptoms, and then to speak with your healthcare provider about other medical interventions where appropriate.
Journaling
Journaling or otherwise tracking your symptoms is important, too. You want to note things like:
- When they started after your Spravato dose
- How long they lasted
- How they impacted your daily activities
- Whether you took anything for the symptoms
- Any other relevant information
With this information journaled appropriately, you can monitor whether things like hydration or rest help with the high blood pressure you feel or whether changing your diet to exclude things a few hours before a dose helps with nausea.
Conclusion
Spravato side effects are often short-lived, things that manifest to some degree over the first few hours after each dose but then go away several hours after that. The most common Spravato side effects are short-term, things like dizziness, dissociation, low energy, and nausea all of which can be managed with things like diet, hydration, rest, or other Medical interventions.
There are opportunities for long-term side effects of Spravato as well, so it’s important that you seek help and stay informed. Your doctor will let you know what conditions require extra monitoring, how you can manage your side effects for a better treatment experience, and what symptoms might pose a red flag. The more you communicate your experiences, the more effective your treatment can be.