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Does Spravato Cause Weight Gain? Plus 5 More Spravato FAQs

Jill Barat, PharmDBailey E. Eason, PharmD, MS, BCPS
Published on May 30, 2024

Key takeaways:

  • Spravato (esketamine) is a prescription nasal spray you’ll use in the presence of a healthcare professional. It can start improving depression symptoms within 24 hours of your first treatment.

  • Spravato doesn’t seem to cause weight gain on its own. But the oral antidepressant you take with it may cause weight gain, depending on which one you’re prescribed. Talk to your prescriber if weight gain is a concern for you.

  • Spravato only stays in your system for a couple of days after you use it. And after the first 4 weeks of treatment, you’ll likely only need one dose of Spravato every week or every other week. Your prescriber will determine how long you need to continue using Spravato based on your response.

  • There are many ways to save on Spravato. If you’re eligible, a manufacturer savings card can help you get Spravato for as little as $10 per treatment. A patient assistance program is also available.

A healthcare professional speaks with a patient.
adamkaz/E+ via Getty Images

Traditional antidepressants are helpful for many people living with depression. But they can take several weeks to start working, and they aren’t effective for everyone. That’s where Spravato (esketamine) comes in. Spravato is a nasal spray you’ll receive in the presence of a healthcare professional. It’s FDA approved to treat depression with suicidal thoughts or behaviors or treatment-resistant depression. And it works faster than most traditional antidepressants.

Spravato is a form of ketamine, an anesthetic that’s long been used as a recreational drug due to its psychedelic effects. So you may have questions about how Spravato works for depression and if it’s safe. You may also wonder if Spravato causes weight gain like some other antidepressants. Let’s take a look at the answers to these and more commonly asked questions about Spravato.

1. How does Spravato work?

We don’t know exactly how Spravato works for depression. It belongs to a class of medications called N-methyl-D-aspartate (NMDA) inhibitors. It attaches to and blocks NMDA receptors (chemical binding sites) in the brain. This changes the levels of a chemical called glutamate that’s known to help regulate mood.

Most antidepressants work by affecting the levels of chemicals such as serotonin and norepinephrine. Glutamate is a newer target for treating depression. This may be why Spravato helps with depression that hasn’t responded to traditional antidepressant treatments.

GoodRx icon
  • Treatment-resistant doesn’t mean untreatable: Explore the different options to help improve depression symptoms when other treatments haven’t worked. 

  • Spravato side effects: What to expect after a Spravato treatment, from common side effects to rare reactions.

  • Auvelity vs. Spravato: Learn how these fast-acting antidepressants compare.

2. Does Spravato cause weight gain?

No, Spravato doesn’t seem to have a significant effect on body weight. Both short- and long-term studies show no notable body weight changes with Spravato treatment.

If you’re noticing weight changes while using Spravato, there may be a few reasons why. Spravato is meant to be used alongside an oral antidepressant medication. And some oral antidepressants can cause weight gain. Another reason is that depression can lower your appetite. So as your symptoms improve, your appetite may increase. And this can also lead to weight gain. 

Getting regular exercise and paying attention to your diet can help you manage your weight while you’re using Spravato. But if weight changes are a concern for you, talk with your prescriber. They can recommend an oral antidepressant with a lower risk of this side effect. And they can make sure there’s not another cause that needs to be addressed.

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3. How long does it take Spravato to work?

You’ll feel Spravato’s side effects right away, but the antidepressant effect can take a little longer.

Most people feel the immediate side effects of Spravato soon after using it. You may feel disconnected from your thoughts and feelings during this time. You may also feel tired and nauseated. This is also when more serious side effects can happen, such as high blood pressure or trouble breathing. These effects should peak after about 20 to 40 minutes, then gradually go away over the next few hours. You’ll be monitored in a healthcare setting for at least 2 hours after your dose to help ensure your safety.

In treatment-resistant depression studies, most people noticed a significant change within 24 hours of their first Spravato treatment. For those with severe depression, the results appeared even faster — within 4 hours of their first dose. For both groups, symptoms continued to improve over the first 4 weeks of Spravato treatment. 

Your prescriber will likely check in with you to track your symptoms and progress over the course of your Spravato treatment sessions. Try to be open and honest about how you’re feeling. If you haven’t noticed any change in your symptoms after using Spravato for 4 weeks, it may not be the right medication for you.

4. How long does Spravato stay in your system?

Spravato levels drop significantly about 2 to 4 hours after you use it. But it can take up to 2.5 days for it to completely clear from your system. And this can vary from person to person. So you may feel tired and groggy for a day or so after your treatment. You should plan to avoid driving after using Spravato until you’ve had a full night’s sleep.

Keep in mind that Spravato’s antidepressant effects shouldn’t go away once the medication is cleared from your system. Unlike other medications, you don’t need to keep Spravato levels consistent in your body in order for it to work. After the first 8 weeks of treatment, you may only need a dose of Spravato once every 2 weeks to maintain its effects.

5. How long do you use Spravato?

How long you continue Spravato treatments depends on how well it’s working for you and how well you tolerate its side effects

Most people will take Spravato twice a week for 4 weeks to get started. If your symptoms haven’t improved at this point, it’s likely that your prescriber will suggest a different treatment option.

If you respond well to the first 4 weeks of Spravato, your dose may go down to once a week for the next 4 weeks. From there, your prescriber may start to increase the time between your Spravato treatments or stop them altogether. The length and frequency of your Spravato treatments will be tailored to you.

6. Is Spravato a safe medication?

Yes, the FDA determined that Spravato is a safe and effective medication for adults when used as directed. Spravato also has a Risk Evaluation and Mitigation Strategy (REMS) program that ensures it’s used as directed to help protect your safety. Both you and your prescriber are required to enroll in the Spravato REMS program in order for you to receive Spravato. But there are still certain risks and side effects you should know about. 

As mentioned, you may feel drowsy, dizzy, or nauseous after using Spravato. And in some cases these feelings may linger for the rest of the day after your treatment.

More serious side effects are also possible. Spravato can slow down your breathing and may also cause a spike in your blood pressure. This is part of the reason you need to use it in a medical office — so if these side effects happen you can receive care right away. It’s also why it’s not safe to use Spravato on your own at home.

Spravato may not be safe for those with any type of aneurysm (a weak spot in a blood vessel) or a history of bleeding in the brain. It’s also best to avoid Spravato during pregnancy or while breastfeeding. And it may not be a good choice if you have a history of substance misuse. 

Your healthcare team can help you weigh the pros and cons of Spravato based on your medical history to help decide if it’s an appropriate treatment option for you.

How to save on Spravato

There are ways to save on Spravato, which is only available as a brand-name medication. GoodRx can help you navigate between copay savings cards and patient assistance programs to save money on your prescription.

  • Save with a copay savings card. You may be eligible to pay as little as $10 for each Spravato treatment session If you have commercial insurance by using a savings card from the manufacturer.

  • Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Spravato’s patient assistance program, which offers the medication free of cost.

Good to know: Spravato is administered in a healthcare setting. In most cases, your prescriber will have the medication in the office when you get there — it isn’t a prescription you’ll pick up at your local pharmacy. So it may be covered by your medical insurance plan (instead of your prescription benefits). Your prescriber’s office will help you determine the best way to access Spravato and apply any available savings.

The bottom line

Spravato (esketamine) is a prescription nasal spray that treats depression with suicidal thoughts and behaviors and treatment-resistant depression. It works by blocking N-methyl-D-aspartate (NMDA) receptors in the brain. Most people notice an improvement in depression symptoms within the first 24 hours of the first Spravato treatment.

Spravato doesn’t seem to cause weight gain on its own. But in most cases, you’ll take it along with an oral antidepressant. And some oral antidepressants are known to cause weight gain as a side effect. Talk to your prescriber if this is a concern for you. 

Spravato only stays in your system for a couple of days after each dose. But you don’t need to use it every day for it to work. Most people use Spravato twice a week for at least 4 weeks. After that, your prescriber may reduce your treatments to once a week or every other week as you continue treatment. How long you’ll continue using Spravato is something your prescriber will determine based on your response. 

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Jill Barat, PharmD
Jill Barat, PharmD has nearly 10 years of experience as a pharmacist, including serving as the pharmacist in charge at an independent sterile and non-sterile compounding pharmacy. She also worked as the head of medical content for a telemedicine company.
Stacia Woodcock, PharmD
Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.
Bailey E. Eason, PharmD, MS, BCPS
Bailey Eason has been licensed for 6 years and has held licenses in three states (North Carolina, Virginia, and Illinois). She has held positions as a health-system pharmacy administration resident, operating room pharmacy manager, pharmacy manager of clinical operations: surgery, neurology and controlled substances, and most recently as program director  of drug diversion for a large academic health system.
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GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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