Concerns about memory, concentration, and mental clarity are common among people considering Spravato treatment. Spravato, or esketamine nasal spray, is used for certain adults with treatment-resistant depression. Because depression itself can affect attention, memory, and executive functioning, patients may wonder whether treatment could improve or temporarily affect cognitive function.
Research provides useful information, although individual experiences can vary.
Spravato can temporarily affect cognitive abilities after administration. The FDA prescribing information reports that a single dose caused measurable declines in cognitive performance approximately 40 minutes after treatment in healthy volunteers. By two hours after dosing, cognitive performance was comparable to placebo.
Patients may therefore notice temporary changes in attention, thinking, alertness, or coordination during the observation period. These effects are one reason Spravato must be administered under supervision rather than taken independently at home.
Available research has not shown evidence that Spravato causes progressive cognitive decline when used as prescribed. An analysis of four Phase 3 studies involving adults with treatment-resistant depression found that cognitive performance remained similar or slightly improved during short-term treatment and long-term maintenance. The researchers did not identify negative effects on cognition associated with esketamine treatment.
The current FDA labeling similarly reports that cognitive functioning remained stable in one-year and three-year open-label studies. However, continued research is important because individual responses and long-term outcomes can differ.
Depression itself can contribute to difficulties with concentration, memory, processing speed, and other cognitive functions. When depressive symptoms improve, some patients may also experience improvements in these areas.
Research involving esketamine has reported stable or improved cognitive performance in several areas. A recent systematic review found that available studies did not show cognitive deterioration and that improvements in attention and processing speed were among the more consistent findings. However, researchers also emphasized that the evidence remains limited and additional studies are needed.
This means patients should not assume that every cognitive change is caused by Spravato. Depression, medications, sleep, anxiety, and other factors can all influence mental performance.
Spravato can cause temporary sedation and dissociation, which may make it harder to concentrate or think clearly immediately after administration. The FDA recommends monitoring patients for at least two hours following treatment because of these and other potential effects.
Patients should also avoid driving or operating machinery until the following day after a restful sleep. Transportation arrangements are therefore an important part of spravato treatment planning.
Spravato treatment is conducted in a controlled clinical setting. Before treatment, providers review relevant medical information and assess whether treatment is appropriate. During the visit, patients remain under observation while the effects of the medication gradually wear off.
Our Team can monitor patients during treatment and discuss any changes in alertness, attention, or other symptoms. Communicating openly about previous medication reactions, current medications, and concerns about cognition can help support appropriate treatment decisions.
Dr. Michael Vines and the clinical team can also consider a patient’s broader mental health needs when developing an individualized treatment approach.
Current research does not indicate that prescribed Spravato causes progressive cognitive decline. Temporary changes in attention, thinking, or alertness can occur shortly after treatment, while longer-term studies have generally shown stable cognitive performance.
Scottsdale TMS & Spravato provides supervised Spravato treatment with monitoring designed around patient safety and individual needs. Understanding both the temporary cognitive effects and the available research can help patients approach treatment with realistic expectations and informed questions.
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 9, 2026
