If you have major depressive disorder (often called depression), your doctor might suggest Spravato as a treatment option for you. It’s a prescription drug used to treat the following in adults:

For these conditions, doctors will prescribe Spravato with another antidepressant (one you’ll take by mouth). You and your doctor will determine whether you’ll use Spravato short or long term.

A doctor at a healthcare facility will give you a spray called svarato that will help you with your nose. Esketamine is the active ingredient in Spravato. An active ingredient is what makes a drug work.

For more information about Spravato, including details about its uses, see this in-depth article.

Mild to serious side effects can be caused by the drug. Continue reading to learn more.

Some people may experience side effects during their treatment. Some of the reported side effects of Spravato are listed.

While these were the most common side effects reported in Spravato’s studies, it’s important to note that they won’t happen to everyone who uses this drug. And these are just a few side effects Spravato may cause. Read on for more information about other possible side effects of this drug.

* Spravato has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effects explained” section below.

Mild side effects can be caused by most medications. Some examples have been reported.

“These side effects should be temporary. Some may be easy to manage. If you have any symptoms that bother you, talk to your doctor or pharmacist. Unless your doctor recommends it, don’t stop treatment.”

Spravato may cause mild side effects other than the ones listed above. See Spravato’s prescribing information for details.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Spravato, visit MedWatch.

There are serious side effects with treatment. There have been serious side effects reported.

If you develop serious side effects, you should call your doctor. If the side effects seem life threatening or you think you have a medical emergency, immediately call the emergency number.

* Spravato has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effects explained” section below.
** Spravato has a boxed warning for risk of misuse. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Spravato and misuse” section below.
† To learn more about this side effect, see the “Side effects explained” section below.
‡ An allergic reaction is possible after using Spravato. But this side effect wasn’t reported in studies.

Get answers to questions about the side effects of Spravato.

Can Spravato cause long-term side effects?

It is possible to have long-term side effects from Spravato.

Long-term side effects reported in Spravato’s studies include:

Even if you have used this drug for a long time, each of the side effects can occur at any time.

If you have questions about the long-term effects of Spravato, talk to your doctor or pharmacist.

* Spravato has a boxed warning for risk of misuse. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Spravato and misuse” section below.
** Spravato has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effects explained” section below.
† To learn more about this side effect, see the “Side effects explained” section below.

Does Spravato cause weight gain?

No, weight gain wasn’t a side effect reported in people using Spravato in the drug’s studies.

Other medications used to treat depression may cause weight gain as a side effect. Examples of these include:

You can use other medications for depression. It is possible that other medications may cause weight gain. Your doctor or pharmacist can tell you about the less likely causes of weight gain.

Is Spravato addictive?

Treatment with Spravato may cause dependence, and it’s possible to abuse (misuse) this drug. But addiction wasn’t a side effect reported in the drug’s studies.

It is important to note the differences between dependence, addiction, and abuse.

  • With dependence, your body needs a substance (such as a drug) for you to feel comfortable. Dependence wasn’t reported in Spravato studies, but it’s happened when people have used ketamine frequently and for a long time. (Spravato contains the active drug esketamine, which is very similar to ketamine.)
  • Addiction is the inability to stop using a drug even when it’s causing issues with your work or social life or has other consequences.
  • Drug abuse (now referred to as substance use disorder) is when a person uses a drug compulsively, and it interferes with their day-to-day functioning.

Spravato may also be misused and has a boxed warning for risk of misuse. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Spravato and misuse” section below.

If you want to learn more about drug dependence, addiction, and misuse, speak to your doctor or pharmacist.

Some of the side effects of Spravato may be discussed.

Risk of sedation and disassociation

Spravato has a boxed warning about the risk of sedation and dissociation (feeling disconnected from yourself or your thoughts). This is the most serious warning from the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about the most serious side effects that drugs such as Spravato may cause.

Spravato may cause feelings of sedation (extreme It is too sleepy.), anxiousness, or dissociation (feeling disconnected from yourself or your thoughts). Dissociation was the most common side effect, and sedation was among the most common side effects in Spravato’s studies.

Dissociation can cause symptoms such as feeling disconnected from yourself or your thoughts.

Your risk of dissociation from Spravato is higher if you have or have had psychosis.

What might help

Your doctor will assess your risk of being in a state of dissociation and sedation before you are prescribed Spravato. If you have been diagnosed with psychosis, your doctor may prescribe a different treatment.

“If your doctor prescribes the drug, you will receive it in a healthcare setting, such as a clinic. After each dose, your doctor or other healthcare professional will monitor you for at least 2 hours. If you feel like you can’t stand up or pass out after taking a dose of Spravato, tell your doctor right away.”

“After 2 hours, your doctor will check in with you to see if you are ready to leave the office or clinic. You will need someone else to drive you home after you get your dose of Spravato. You should not operate machinery on the day of your treatment. After waiting at least one day and getting a full night’s sleep, only resume these activities.”

Risk of suicidal thoughts and behaviors

Spravato has a boxed warning about the risk of suicidal thoughts and behaviors. This is the most serious warning from the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about the most serious side effects that medications such as Spravato may cause.

People under the age of 24 years can be at increased risk of suicidal thoughts and behaviors. Spravato is only approved for adults 18 years and older. The risk is highest during the first few months of treatment.

Suicidal thoughts were reported in Spravato’s studies, but this side effect was not common. Self-harm was rare in these studies when the drug was used in adults with depression who were actively having suicidal thoughts or behaviors.

Depression is a risk factor for suicidal thoughts and behaviors.

What might help

Your doctor will keep an eye on you for any worsening of depression or suicidal thoughts. You should let your friends and loved ones know that you are using a medication to treat depression. They can help you watch for changes in your mood.

If you develop suicidal thoughts or behaviors while you are on the drug, your doctor may suggest stopping it.

SUICIDE PREVENTION

If you think someone is at risk of self-injury or hurting another person.

  • You can call your local emergency number.
  • Stay with the person until help arrives.
  • Guns, knives, medications, and other things should be removed.
  • “Don’t judge, argue, threaten, or yell.”

If you or someone you know is considering suicide, you should get help from a hotline. The National Suicide Prevention Hotline is 800-273-8255.

Temporary increase in blood pressure

You may have a temporary increase in blood pressure after receiving a dose of Spravato.

In studies, these increases were highest about 40 minutes after getting a dose. They lasted about 4 hours on average. In some instances, these increases were high enough to cause concern.

Mild increases in blood pressure are not usually a cause of symptoms. If your blood pressure gets too high, it could cause serious symptoms.

“Doctors usually won’t prescribe Spravato for people with certain conditions that could cause a serious increase in blood pressure. These conditions are included.”

If you have other medical conditions that could make a blood pressure increase worse, your doctor can explain the risks and benefits of Spravato. These include:

What might help

Inform your doctor about any medications you take and the conditions you have before starting treatment. Your doctor can help determine if this drug is safe for you.

Before each dose of Spravato, your doctor will check your blood pressure. If your blood pressure reading is high that day, your doctor may delay your dose until it returns to acceptable levels for you.

After each dose of Spravato, your doctor or another healthcare professional will monitor you for at least 2 hours. This includes monitoring your blood pressure. If you have symptoms of dangerously high blood pressure. or a very high reading, they can refer you for emergency care. This may involve treatment in an emergency room or hospital.

Cognitive impairment

Spravato treatment may cause cognitive impairment. But this side effect was temporary in the drug’s studies, peaking about 40 minutes on average after people received a dose. This side effect went away after about 1 to 2 hours. Long-term cognitive impairment wasn’t reported in anyone during Spravato’s studies.

But long-term cognitive impairment has happened in people who have used ketamine frequently and for a long time. (Spravato contains the active drug esketamine, which is very similar to ketamine).

There are symptoms of cognitive impairment.

  • There are problems with memory.
  • Difficulty with carrying out tasks, such as planning your day or doing math.

What might help

“After each dose of Spravato, your doctor or another healthcare professional will keep an eye on you. They will confirm that monitoring your cognitive function is satisfactory before clearing you to leave. You should not operate machinery on the day of a dose. After waiting at least one day and getting a full night’s sleep, only resume these activities. This is to make sure your brain is back to normal.”

Allergic reaction

Like most drugs, Spravato can cause an allergic reaction in some people. But this side effect wasn’t reported in studies.

Mild to serious symptoms can be present.

  • There is a skin rash.
  • It is itchy.
  • flushing (temporary warmth, redness, or deepening of skin color)
  • “It’s usually under your skin, but it can be anywhere.”
  • It can be hard to breathe if you have swelling of your mouth, tongue, or throat.

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest an over-the-counter oral antihistamine, such as Benadryl (diphenhydramine), or a topical product, such as hydrocortisone cream, to manage your symptoms.

If your doctor confirms you have had a mild allergic reaction to Spravato, they will decide if you should continue treatment.

If you have a severe allergic reaction, you should call the emergency number. These symptoms could be life threatening and need immediate medical care.

If your doctor confirms you have had a serious allergic reaction to Spravato, they may have you switch to a different treatment.

Keeping track of side effects

Take notes on any side effects you are having during your treatment. You can share this information with your doctor. This is helpful when you are starting to use a combination of treatments.

Side effect notes can include things.

  • When you had the side effect, what dose of the drug was taking?
  • How soon did you experience the side effect?
  • What are your symptoms?
  • How did it affect your daily activities?
  • What other drugs were you taking?
  • Other information is important to you.

Sharing notes with your doctor will help them learn more about how the disease affects you. If needed, they can use this information to adjust your treatment plan.

Important considerations that may affect whether your doctor prescribes Spravato for you are listed below. There are several boxed warnings.

Boxed warnings

Spravato has the boxed warnings listed below. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

  • Risk of sedation and dissociation. Spravato may cause you to feel extremely sleepy, anxious, or dissociated (disconnected from yourself). Your doctor or another healthcare professional will monitor you for at least 2 hours after each dose of Spravato. Tell your doctor right away if you feel like you can’t stand up or are going to pass out after receiving your dose.
  • Risk of misuse. Spravato can be misused. (With misuse, a person uses a drug in a way other than how a doctor prescribes it.) Due to the risk of misuse, Spravato is only available through a special prescribing program. Your doctor must have special approval to prescribe it. And you can only receive it in a setting such as their office or a clinic. Your doctor will monitor you for signs of misuse throughout your treatment.
  • Risk of suicidal thoughts and behaviors. Like other antidepressants, Spravato can increase the risk of suicidal thoughts and behaviors in people ages 24 years and younger. (Spravato is only approved for use in adults ages 18 years and older.) This risk is highest during the first few months of treatment or any time the dose is changed.

For details on the risk of misuse, see the “Spravato and misuse” section below. For information on the other boxed warnings shown here, see the “Side effects explained” section above.

Other warnings

If you have a medical condition that affects your health, svarato may not be right for you. Before starting Spravato, you should talk to your doctor about your health history. The list has factors to consider.

Brain or heart problems. Treatment with Spravato can cause temporary but large increases in blood pressure. In certain people, elevations in blood pressure can be dangerous. This includes people who have or have had certain brain or heart problems, including a heart attack or bleeding in the brain. Your doctor can help determine whether Spravato is safe for you.

Liver problems. If you have liver problems, you may be at increased risk of side effects from Spravato. And the manufacturer of this drug recommends that people with severe liver problems do not use Spravato. Your doctor can help determine whether this drug is safe for you. They may monitor you more closely if they decide to prescribe it for you.

Mental health condition, including psychosis. Spravato can cause side effects related to mental health, including suicidal thoughts or behaviors. (Spravato has a boxed warning about this side effect, which is discussed in more detail just above.) If you have a mental health condition, such as psychosis, Spravato may not be safe for you. Your doctor can help determine this. And they may monitor you more closely if they decide to prescribe this drug for you.

Allergic reaction. If you’ve had an allergic reaction to Spravato or any of its ingredients, your doctor will likely not prescribe it for you. Ask them what other medications are better options.

Alcohol and Spravato

You should avoid drinking Alcohol. on the day you get a dose of Spravato. This is because both Spravato and Alcohol. can cause sedation (extreme It is too sleepy.). Alcohol can also increase your risk of other side effects from Spravato, such as:

“If you don’t get a Spravato dose, you should talk to your doctor about whether it’s safe to consume Alcohol. on days you don’t.”

Pregnancy, breastfeeding and Spravato

If you are pregnant or breastfeeding, the manufacturer of the drug recommends against using it. Your doctor can suggest other treatment options for you.

If you and your doctor decide you’ll use Spravato during pregnancy, consider joining the National Pregnancy Registry for Antidepressants (NPRAD). Pregnancy registries collect information about the use of certain drugs during pregnancy. To learn more and register, call 866-961-2388 or visit the NPRAD website.

Spravato has a boxed warning about the risk of misuse. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

Spravato can be misused. (With misuse, a person uses a drug in a way other than how a doctor prescribes it.) Due to this risk, Spravato is only available through a special prescribing program called Risk Evaluation and Mitigation Strategy (REMS). This means you can only receive the drug in a setting such as a doctor’s office or clinic. And your doctor must have special approval to prescribe it for you.

It’s also important to note that Spravato is a controlled substance. A controlled substance refers to a drug that has accepted medical uses but also has a risk of dependence, misuse, and abuse. (To learn more about drug dependence, misuse, and abuse, see the question titled “Is Spravato addictive?” in the “FAQs about Spravato’s side effects” section above.)

The U.S. government has laws about how controlled substances can be prescribed. Your doctor or pharmacist can tell you more about the laws.

The risk of misuse is greater if you have or have had a substance use disorder. Be sure to tell your doctor about your entire medical history before starting Spravato, including any history of substance misuse.

Your doctor will watch you for signs of misuse.

Side effects of most drugs range from mild to serious. Talk to your doctor before treatment begins. Ask questions to learn more about the treatment and its side effects.

Some examples can help you start.

  • Is there a lower dose I can try if I have side effects from Spravato?
  • Does my medical history show me an increased risk of side effects from this drug?
  • Is there a way to reduce my risk of side effects from Spravato?

For stories from others who live with depression and advice about managing this condition, sign up for Healthline’s online newsletter.

Q:

Can other drugs increase my risk of side effects?

Anonymous

A:

Taking other medications may increase your risk of side effects. These include:

This is not a comprehensive list of drugs that can cause side effects. Inform your doctor about all your medications before starting. They can check for any interactions with the person. If you take drugs that can increase your risk of side effects, your doctor may be able to tell you if you need to stop taking them.

  • Do you take the other medication?
  • prescribe a medication other than Spravato to treat your depression

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.