Spravato carries a boxed warning from the FDA. It can cause dissociation, sedation, a spike in blood pressure, and slowed breathing. It is a controlled substance. You cannot take it home. Every single dose requires two hours of in-person monitoring before you are cleared to leave.
Those facts are real, and they are also the reason the treatment works the way it does. Every safeguard is built into the session itself. At Nushama’s Midtown Manhattan clinic on the 21st floor of 515 Madison Avenue, a clinical team trained in ketamine-assisted therapy monitors each member through every session, from the first vitals check to final clearance. The two-hour window is not a waiting room. It is the safety protocol doing exactly what it was designed to do.
This guide walks through the common Spravato side effects, what each one actually feels like, how long it lasts, and how Nushama’s monitoring keeps you safe.
Spravato (esketamine) is a nasal spray FDA-approved for treatment-resistant depression in adults. It can be used on its own or alongside an oral antidepressant. Because it produces short-lived but noticeable effects, the FDA requires it to be given in a certified office. It is never sent home.
What are the common, temporary Spravato side effects?
Most side effects show up during or shortly after your dose and fade the same day. The 2025 FDA prescribing information lists dissociation, dizziness, nausea, sedation, vertigo, numbness, anxiety, and a temporary rise in blood pressure as the most common. Here is what each one actually feels like.
- Dissociation. This is the one people ask about most. You may feel briefly disconnected from your body, your surroundings, or your sense of time. Colors can shift, and the room may feel dreamy. It usually starts within minutes and eases within an hour or two. At Nushama, a care team member stays with you the whole time.
- Dizziness and vertigo. You might feel lightheaded or sense the room is moving. Staying seated until it passes is the simplest fix.
- Sedation and drowsiness. Spravato can make you sleepy. Many people find this part restful. It is also one reason you will not drive afterward.
- Nausea. Some people feel queasy, occasionally with vomiting. Going in on a light stomach helps, and the team can offer anti-nausea support if needed.
- A short rise in blood pressure. The increase peaks around 40 minutes and lasts about four hours. Your vitals are checked on a schedule throughout the monitoring window.
Both dissociation and blood-pressure changes follow a predictable curve. They peak around 40 minutes and taper from there. Many people also notice that dissociation feels milder over successive sessions as the experience becomes familiar. Our guide to what a session feels like covers the room, the music, and the pacing. Our set and setting for Spravato piece explains how environment shapes the experience.
Is Spravato safe, and why are you monitored for two hours?
Yes, when it is given in a certified setting with proper monitoring, and the FDA requires exactly that. Through a program called the Risk Evaluation and Mitigation Strategy (REMS), you must be monitored for at least two hours after each dose in a certified healthcare setting. The medicine is never dispensed for home use.
During those two hours, your care team:
- Checks your blood pressure at regular intervals
- Stays nearby while any dissociation or drowsiness passes
- Watches your breathing and overall comfort
- Confirms you are clear-headed and steady before you leave
You are not released by the clock alone. A clinician does a final check before clearing you to go.
What happens after your Spravato session?
Spravato can affect attention, judgment, and reaction time for the rest of the day, so the FDA says not to drive or use machinery until the next day after a restful sleep.
In practice, that looks like:
- Arrange a ride in advance. Nushama’s Midtown location is easy to reach by subway (E, F, and 6 lines) or rideshare, but you will need someone else to get you home.
- Keep the rest of your day light. A calm afternoon and an early night go a long way.
- Expect to feel like yourself by morning. After a full night’s sleep, the lingering effects have usually cleared.
This is also a natural time to think about integration: making sense of the experience and applying any insights to daily life.
The Spravato boxed warning, explained
A boxed warning is the FDA’s most prominent safety label. Spravato’s warning flags sedation, dissociation, respiratory depression, abuse potential, and suicidal thoughts and behaviors. That sounds serious, and it is meant to. But it helps to understand what each item actually means when you are receiving treatment in a monitored clinic:
- Sedation and dissociation. These are expected and short-lived. The two-hour window exists so a trained person is with you while they pass.
- Respiratory depression. In rare cases, breathing can slow. A provider watches your breathing throughout the session.
- Abuse and misuse. Esketamine is a controlled substance, which is why it is only given in a certified setting under direct observation and never dispensed for home use.
- Suicidal thoughts and behaviors. Depression itself carries this risk. Your care team checks in on mood changes, especially early in treatment.
The warning and the monitoring serve the same purpose: making sure a medicine with real effects gets real supervision.
FAQs
Does Spravato dissociation go away?
Yes. It tends to begin within minutes, peak around 40 minutes, and ease within about two hours. Many people notice it feels milder over successive sessions. You are monitored the whole time, so you are never going through it alone.
Why can’t I drive after Spravato?
Spravato can affect attention, judgment, and reaction time for the rest of the day, so the FDA says not to drive until the next day after a restful sleep. Your care team will ask you to arrange a ride home before your session.
Is Spravato addictive?
Esketamine is a controlled substance with a potential for abuse and misuse, which is part of the boxed warning. That risk is a key reason Spravato is only given in a certified setting under direct observation. Your care team screens for risk factors before treatment begins and continues to monitor throughout.
How Nushama keeps you safe during Spravato treatment
The FDA sets the floor for Spravato safety. Nushama’s protocol goes further.
Before treatment: A medical and psychiatric intake reviews your health history, medications, and risk factors. Issues like uncontrolled blood pressure or contraindicated medications are caught before your first dose.
During each session:
- A registered nurse checks blood pressure before dosing, at the 40-minute mark, and at additional intervals as needed.
- A clinician stays with you throughout, monitoring your breathing, comfort, and level of dissociation.
- You self-administer the nasal spray under direct observation so the team can respond right away if anything feels off.
- The treatment room uses low lighting, comfortable seating, and curated music because set and setting shape how people experience the medicine.
After the session: A clinician confirms your blood pressure has returned to baseline, dissociation has resolved, and you are steady on your feet before clearing you to leave.
Beyond the session: The care pathway includes preparation beforehand and integration support afterward. Licensed therapists and integration coaches help with both. The clinical team (physicians, nurse practitioners, and registered nurses) works from 515 Madison Avenue, so medical support is always close by.
Talk through your safety questions with a certified Manhattan team
The details that matter most are personal: your health history, your current medications, and how your body tends to respond. Those are exactly the things worth talking through with a clinician before you begin.
At Nushama’s Manhattan clinic, Spravato is provided in a REMS-certified setting with anesthesiologist-led monitoring, licensed therapists, and integration support. We offer both IV ketamine and Spravato under one roof at 515 Madison Avenue and accept Oxford, UnitedHealthcare, Cigna, Aetna, and Medicare for Spravato. When you are ready, book a consultation to review your safety questions with our care team.