Spravato(esketamine) is an N-methyl D-aspartate (NMDA) receptor antagonist for the medication of treatment-resistant depression (TRD) in adults. TRD is a common term used in psychiatry, characterizing a condition in people with primary depressive disorders, not reacting to first-line drugs against depression.

The observed adverse reactions in TRD patients treated with Spravato are dizziness, vertigo, anxiety, nausea, lethargy, vomiting, feeling drunk, and so on.


Common side effects of Spravato include:

  • Sedation.
  • Impaired ability to operate machinery and drive.
  • Dissociation.
  • Cognitive Impairment.
  • Ulcerative or Interstitial Cystitis.
  • Embryo-fetal Toxicity.
  • Rise in blood pressure.

Also, call the doctor at once if experiencing:

  • extreme drowsiness
  • severe behavioral change
  • worsening depression
  • urinating difficulties


Depressive thoughts and suicidal tendencies:

In a pooled analysis of the medical trials considering almost 77000 adults and 4500 pediatric patients, the incidence of suicidal thoughts existed more in people aged 24 years and younger than in placebo-treated patients. Though there prevails a risk of suicidal tendencies in the over-dosage of various drugs, the risk tends to exist more in young patients. Adults with Major Depressive Disorder (MDD), possibly should discontinue spravato to avoid clinical worsening and to avert experiencing suicidal thoughts.



According to trials, 49-61% of the patients had developed sedation based on the sedation scale, and 0.3% had experienced the loss of consciousness. A possibility of prolonged sedation must be monitored closely in the healthcare units, followed by an assessment to infer if the patient is entirely stable for discharge.



Another broad psychological effect of spravato was dissociation or depersonalization or derealization. Based on the Clinician-Administered Dissociative Symptom Scale, 61-75% of the patients have developed these endless changes in them. Since there includes a high chance of the patients experiencing dissociation, the patients must be scrutinized for at least two hours, followed by the assessment to deduce their stability.


Increase in blood pressure:

This drug induces a rise in systolic and diastolic blood pressure at the recommended doses. This increase in blood pressure lasts for almost four hours. The patients with cardiovascular conditions like aneurysmal vascular disease, intracerebral hemorrhage, and so on should be carefully examined. It is necessary to examine them before prescribing the drug to offset the benefits with the underlying risks. If spravato does not outweigh the risks involved, then it should not be administered.

Assessing the blood pressure before prescribing the drug helps in the observation of BP. If the BP is already high, then there should be a delay to the therapy to balance the accounts of stakes and benefits. The patients experiencing the symptoms of a hypertensive encephalopathy (including severe headache, loss of consciousness) or hypertensive crises (shortness of breath, pain in the chest) should be referred to the emergency care immediately.


Cognitive impairment:

Long term impairment- The long term cognitive impairment has been reported with ketamine misuse/abuse. No adverse effects of the spravato nasal spray have been there on cognitive functioning in the one-year open-source study. However, there is no information available about the effects of the use of the drug for more than a year.

Short term impairment- A recent study has shown how a single dose of the drug caused a decline in the cognitive performance for almost 40 minutes, post the dose. The spravato treated subjects need a more significant effort to finish off the cognitive tests as compared to the placebo-treated ones.

Impaired ability to drive and operate machinery:

The studies conducted to assess the impact of spravato showed that the spravato treated subjects discontinued their driving test after eight hours post the test because of the spravato related adversities. Before the administration of this medicine, the patients are strictly instructed not to engage themselves in any hazardous chore, such as operating any machinery or driving a motor vehicle to avoid adverse reactions.

Ulcerative Cystitis:

The issues of intestinal cystitis or ulcerative cystitis are there in patients with long term usage of ketamine. The studies with spravato nasal spray talked about the increasing rate of lesser urinary tract symptoms than in placebo-treated patients.

Embryo-fetal toxicity:

The cases based on pregnant animals treated with ketamine exhibit that spravato may cause fatal harm to pregnant women. The women have the risk of the infant getting expos to spravato in the uterus.

Nausea and vomiting:

The recommended usage of spravato might cause vomiting and nausea. The case studies show how the issues arose on the day of the dosing and also automatically got resolved the same day. Recently, the rates of reported vomiting have reduced over time.

Abuse and misuse:

Spravato is sometimes a subject to exploit and diversion as it contains esketamine (a controlled subject). A report should be there of all patients receiving this drug to analyze the risk of exposure to abuse. Analysis of the behavior is very crucial if the individual possesses a history of drug dependence. Considering the reliance carefully, treatment needs to be monitored carefully before prescribing this drug.

Author's Bio: 

Ashis Kumar is a professional blogger.