Spravato (esketamine) is an FDA-approved intranasal spray for adults with treatment-resistant depression. It targets NMDA glutamate receptors and can produce noticeable relief within 24 hours of the first dose.
The drug promotes neuroplasticity, essentially encouraging the brain to form new connections. In practice, that process doesn't always feel smooth. Some people come out of sessions feeling lighter. Others come out feeling shaken.
Why Spravato Can Trigger Anxiety in Some Patients
Spravato-related anxiety isn't random. It stems from a combination of the drug's direct pharmacological effects. There are three distinct pathways through which Spravato can add to your anxiety load:
The Dissociation-Anxiety Feedback Loop
For many, that detachment from thoughts and surroundings is actually calming. For others, it triggers panic. If you're not prepared for what it feels like, it may appear as anxiety.
Glutamate Activation and Neural Arousal
Esketamine works by stimulating glutamate receptors and promoting synaptic plasticity. That process can produce a state of heightened neural activity that, for some patients, translates to euphoria or calm. For others, it can look like jitters or anxiety.
Emotional Content That Surfaces During Sessions
This is the one that surprises patients most. Spravato doesn't put you to sleep. You remain aware, and your mind stays active. Some people find that during sessions, unpleasant thoughts or memories rise to the surface in a way that feels intense or hard to control.
For someone already carrying a heavy anxiety burden, that can feel like things getting worse before they get better.
Who Is Most Likely to Experience Worsening Anxiety on Spravato?
Not everyone gets hit equally. Certain factors seem to stack the odds toward a rougher experience with anxiety on Spravato:
Pre-existing severe anxiety: If you're starting Spravato with extreme social anxiety or panic disorder, those feelings don't stop during sessions. It can make you feel destabilized.
First session without preparation: Patients who haven't been fully briefed on what the dissociative experience feels like report significantly more distress.
High caffeine intake on treatment days: Caffeine can make things worse, as it can amplify jitters.
Fatigue and poor sleep: Going into a session sleep-deprived lowers your threshold for distress. Consistently poor sleep hygiene can drag on your overall mood.
Can Spravato Make Depression and Anxiety Worse Over Time?
In some patients, Spravato can make anxiety and depression worse, especially in the early treatment phase. Anxiety and mood disruptions associated with Spravato are overwhelmingly tied to dosing sessions themselves. They peak around 40 minutes post-dose and resolve within two to four hours.
What can genuinely worsen anxiety over time is a poor treatment environment and lack of preparation. Using Spravato in isolation without addressing the psychological patterns that fuel anxiety.
If you're tired and hopeless about anxiety that seems to be getting worse instead of better, that's a signal to loop your psychiatrist in.
Practical Ways to Manage Anxiety During Spravato Treatment
If you're dealing with an uptick in anxiety during sessions or between them, these approaches can help.
Pre-session breathing: A few minutes of slow, diaphragmatic breathing before the session can help.
Grounding during the session: If dissociation is making your anxiety go through the roof, focus on one physical sensation.
Skip the morning caffeine: On dosing days, avoid any form of caffeine.
Tell your care team: If anxiety is causing you large amounts of distress during or after sessions, you must tell your supervisor.
Finding the Right Mental Health Support for Spravato Treatment
Spravato works best inside a well-structured care model. Boston Neurobehavioral Associates offers that kind of evidence-based, comprehensive approach. As one of the most trusted Spravato treatment providers in the United States, BNBA specializes in treatment-resistant depression and complex psychiatric conditions.
If standard antidepressants haven't worked and anxiety keeps getting in the way, you can schedule a visit and get complete support.
Frequently Asked Questions
Is anxiety a normal side effect of Spravato?
Yes. Anxiety is listed among the most common side effects of Spravato in FDA-approved prescribing data.
How long does Spravato-related anxiety last?
In most cases, anxiety tied to a Spravato session peaks during or shortly after administration and clears within two to four hours.
Can Spravato make my existing anxiety disorder worse?
There's no strong clinical evidence that Spravato permanently worsens anxiety disorders. However, patients with pre-existing severe anxiety may feel strange and somewhat anxious.
Who should be especially cautious about Spravato and anxiety?
People with pre-existing panic disorder or severe generalized anxiety disorder should discuss their concerns with the provider first.