Spravato, also known as esketamine nasal spray, can be an option for adults with treatment-resistant depression, but it has specific safety requirements that patients should understand before beginning treatment. Unlike many antidepressants that can be taken independently at home, Spravato is administered under medical supervision because it can temporarily affect alertness, perception, blood pressure, and breathing.
Knowing what to expect can make treatment feel more manageable and help you prepare for each appointment.
Spravato can cause temporary side effects such as sedation, dissociation, dizziness, nausea, and increased blood pressure. In rare cases, respiratory depression can occur. Because these effects may happen after administration, patients cannot simply use the nasal spray at home and continue their normal routine.
The FDA requires Spravato to be administered under the supervision of a healthcare provider in a certified healthcare setting. Patients are monitored after each treatment to help identify and address potential problems.
At Scottsdale TMS & Spravato, patients self-administer the nasal spray while supervised by the clinical team, followed by a required observation period.
Before receiving Spravato, your provider reviews your medical history, current medications, symptoms, and previous depression treatments. Blood pressure is also assessed before administration because esketamine can temporarily increase blood pressure.
This evaluation helps determine whether treatment is appropriate and whether there are health considerations that need to be addressed before administration.
Patients should provide complete and accurate information about their medical history. Tell your provider about medications, supplements, recreational substances, previous reactions to medications, and any relevant medical conditions. Being open with your treatment team allows them to make better-informed safety decisions.
Not everyone experiences the same effects from Spravato. Some patients may notice only mild temporary sensations, while others experience more noticeable changes during the observation period.
Commonly reported effects include:
These effects are among the known adverse reactions associated with Spravato.
Experiencing a temporary side effect does not necessarily mean treatment needs to be stopped. Your healthcare team can monitor your response and determine how to proceed based on your individual situation.
After you administer Spravato, you remain at the treatment center while the clinical team observes your response. The FDA requires monitoring for at least two hours after administration, including observation for changes in respiratory status.
Blood pressure and your overall condition are monitored during recovery. The team also watches for sedation, dissociation, and other potential reactions.
At Scottsdale TMS & Spravato, patients can rest in a private treatment suite during this period. You may listen to music, read, or simply relax while the medical team continues monitoring you.
The observation period is not an unnecessary delay. It is an important safety component of Spravato treatment.
No. Patients should arrange transportation home before their appointment.
Spravato can temporarily affect attention, judgment, alertness, and coordination. The FDA prescribing information states that patients should not drive or operate machinery until the next day after a restful sleep.
Planning your transportation ahead of time helps you avoid trying to drive when the medication’s effects have not fully resolved. You should also avoid planning activities that require full concentration immediately after treatment.
Spravato is available through a restricted Risk Evaluation and Mitigation Strategy, known as REMS. This program exists because of important risks associated with sedation, dissociation, respiratory depression, and abuse or misuse.
Under the REMS requirements, Spravato must be administered in certified healthcare settings and patients must be appropriately monitored following treatment.
The program provides a structured framework for safe administration. It also means patients should be cautious about any setting offering Spravato for unsupervised use outside the approved healthcare environment.
Spravato is not appropriate for everyone. Your provider considers your medical and psychiatric history before recommending treatment. Certain conditions can increase the risks associated with esketamine, particularly situations where an increase in blood pressure or intracranial pressure could create a serious health concern.
Spravato also carries warnings related to abuse and misuse. Healthcare providers are expected to consider a patient’s risk before treatment and monitor for signs of problematic use.
This is why a comprehensive evaluation should take place before your first session rather than treating Spravato as a routine nasal medication.
Following your provider’s instructions can help make each appointment smoother. Arrange transportation in advance, provide accurate medical information, follow any food and drink instructions you receive, and allow enough time for the complete treatment and monitoring process.
Do not change your dose, medication schedule, or other aspects of your treatment without discussing them with your provider. If you experience unusual or concerning symptoms during or after treatment, contact your healthcare team for guidance.
Dr. Michael Vines and Our Team at Scottsdale TMS & Spravato can explain the safety requirements, monitoring process, potential side effects, and precautions involved with Spravato treatment.
Spravato safety depends on proper patient selection, supervised administration, and careful monitoring. The medication can cause temporary effects including dissociation, sedation, dizziness, nausea, and increased blood pressure, while serious reactions such as respiratory depression are possible but uncommon.
Because of these risks, Spravato must be administered in a certified healthcare setting and followed by an appropriate observation period. Patients should also arrange transportation home and follow their provider’s instructions after treatment. Scottsdale TMS & Spravato provides supervised esketamine treatment with safety procedures built into each session.
Dr. Vines has practiced psychiatry in Arizona for for over 25 years and has experience working with diverse populations that include children, adolescents, adults, geriatrics, SMI patients, and the chemically dependent.
September 4, 2026
