Esketamine Blood Pressure Monitor
Blood Pressure Assessment Tool
Use this tool to understand how blood pressure typically changes during esketamine treatment and when you might be safe to resume activities.
When traditional antidepressants donât work, people with treatment-resistant depression often face a long, exhausting road. Esketamine nasal spray - sold as Spravato - became a breakthrough option in 2019, offering hope where few existed. But itâs not a simple pill you pick up at the pharmacy. It comes with intense side effects, strict rules, and a monitoring process unlike any other antidepressant. If youâre considering it, you need to understand what happens in your body during treatment, why the monitoring is so tight, and what to expect when you walk into that clinic.
How Esketamine Works (And Why Itâs Different)
Most antidepressants - like SSRIs or SNRIs - target serotonin, norepinephrine, or dopamine. Esketamine doesnât. It works on glutamate, the brainâs main excitatory chemical. Specifically, it blocks NMDA receptors, which are like locks that control how much calcium flows into brain cells. By blocking these receptors on inhibitory neurons, esketamine essentially removes the brakes on other brain cells, leading to a surge in neural activity. This rapid change is why people can feel better within hours or days, not weeks. This mechanism is powerful, but itâs also why side effects like dissociation and blood pressure spikes happen. The same brain pathways that help lift depression also cause temporary disconnection from reality and stress on the cardiovascular system. Unlike other antidepressants, esketamine isnât meant for daily use. Itâs given in controlled settings, usually twice a week for the first month, then less often. And every single dose is watched.Dissociation: More Than Just Feeling âWeirdâ
Dissociation is the most common side effect of esketamine. In clinical trials, more than half of patients - 56% - reported feeling detached from themselves or their surroundings. Thatâs not just zoning out. People describe it as:- Feeling like youâre watching yourself from outside your body
- Time slowing down or speeding up
- Seeing colors more intensely or hearing sounds differently
- Feeling unreal, like youâre in a dream
Blood Pressure Spikes: Why Itâs Not Just a Number
Esketamine doesnât just affect your mind - it affects your heart and blood vessels. Within 5 minutes of spraying, your systolic blood pressure (the top number) can jump by 14 to 23 points. Diastolic (the bottom number) may rise 7 to 16 points. These spikes peak at the same time as dissociation - around 40 minutes - and drop back to normal within 90 to 120 minutes. About 33% of users experience whatâs called âtreatment-emergent hypertensionâ - meaning their blood pressure goes above 140/90. Thatâs not dangerous for healthy people. But for someone with uncontrolled high blood pressure, heart disease, or a history of stroke or aneurysm, itâs a red flag. Thatâs why youâre screened before every session. If your blood pressure is over 160/100 when you arrive, you wonât get the spray that day. Thatâs not a delay - itâs a safety rule. In rare cases, patients with pre-existing hypertension report spikes up to 170 or higher, even while on medication. One patient on PatientsLikeMe stopped treatment after two sessions because their systolic hit 170. Thatâs why monitoring isnât optional. Every clinic follows the same protocol: check BP before, then every 5 to 10 minutes for the first 30-40 minutes, then every 15-30 minutes after that. Oxygen monitors and emergency equipment are required. This isnât bureaucracy - itâs prevention. The risk of a stroke or heart event during treatment is extremely low, but not zero. And with a drug this potent, you donât take chances.
The Monitoring Protocol: Why You Canât Just Go Home
You canât buy esketamine online. You canât take it home. You canât even leave the clinic for 2 hours after each dose. Thatâs not a suggestion - itâs the law. The FDA requires a Risk Evaluation and Mitigation Strategy (REMS) program, and itâs one of the strictest for any psychiatric drug. Hereâs what happens during that 2-hour window:- Before administration: Your blood pressure, heart rate, and mental state are checked. You sign a form confirming you understand the risks.
- During administration: You spray it yourself under direct supervision. The clinic staff watches you closely.
- After administration: You sit in a quiet room. Staff check your vitals every 5-10 minutes. They ask you how youâre feeling. They use the CADSS scale at the 40-minute mark.
- At discharge: Youâre cleared only when your BP is back to normal, dissociation has faded, and youâre alert enough to go home safely (no driving, no operating machinery).
Real People, Real Experiences
On Healthgrades, Spravato has a 3.7 out of 5 rating. About 62% of reviewers mention dissociation. Of those, 41% say it was âmanageable.â Only 21% called it âsevere.â But the ones who had bad experiences often had pre-existing conditions - like uncontrolled hypertension or anxiety disorders. Positive reviews almost always mention the staff. âThey knew exactly what to do,â âThey didnât rush me,â âThey explained everything beforehand.â Thatâs the key. The side effects are real - but the care around them makes the difference. One patient on Drugs.com wrote: âI cried during my first session because I felt so disconnected. But the nurse held my hand and told me it was normal. I didnât feel alone.â That kind of human support is part of the treatment.
Is It Worth It?
Esketamine isnât for everyone. But for people whoâve tried four, five, or six antidepressants and still canât get out of bed - itâs life-changing. In trials, about 70% of patients with treatment-resistant depression saw a significant drop in symptoms within 28 days. Some felt better in 24 hours. The trade-off is time, cost, and discomfort. Each session costs hundreds to over a thousand dollars. Insurance often requires prior authorization. The 2-hour commitment means taking half a day off work. The dissociation can be scary the first few times. But for those whoâve lost years to depression, itâs not a luxury - itâs a lifeline. As Dr. John Krystal from Yale put it: âThe side effects are real, but so is the suffering of these patients. This isnât just another drug. Itâs a reset button.âWhatâs Next?
In September 2023, the FDA approved a new option: for patients who respond well and have stable vitals, the monitoring time can be cut from 2 hours to 1 hour. Thatâs a big deal. It means more people can access treatment without needing to take half a day off. Companies are also working on next-gen versions - oral pills or IV forms that might cause less dissociation. But so far, none match esketamineâs effectiveness in the toughest cases. The future isnât about removing monitoring - itâs about making it smarter. Digital tools are being tested to track dissociation remotely. But experts agree: as long as esketamine works by blocking NMDA receptors, there will always be some risk. The goal isnât to eliminate the side effects - itâs to manage them safely so the benefits can reach more people.Can I drive after using esketamine nasal spray?
No. You cannot drive, operate heavy machinery, or make important decisions for the rest of the day after receiving esketamine. The dissociation and sedation effects can linger even after your blood pressure returns to normal. Clinics require you to have someone drive you home. Even if you feel fine, the risk is too high.
How long do I need to keep getting esketamine treatments?
Most patients start with two doses per week for the first month, then reduce to once a week for the next month, and then every 1-2 weeks or monthly depending on response. Long-term use (beyond 6-12 months) is still being studied, but early data shows no worsening of side effects over time. Your doctor will adjust your schedule based on how well youâre doing and whether your symptoms stay under control.
Does esketamine cause addiction?
Esketamine is chemically related to ketamine, which has abuse potential. But under the REMS program, itâs given only in controlled settings, and patients canât take it home. Studies show no signs of compulsive use or dependence in patients using it for depression. The dissociation is unpleasant for many, which actually acts as a natural deterrent. The risk of addiction is extremely low when used as directed.
Can I take other medications with esketamine?
You must be on an oral antidepressant while using esketamine - it doesnât work alone. But you should avoid benzodiazepines, opioids, or alcohol on treatment days, as they can worsen sedation and breathing issues. Always tell your provider about every medication, supplement, or substance you use. Some blood pressure meds may need adjustment. Never change your meds without consulting your treatment team.
What if I canât get to a certified clinic?
Access remains a major barrier. There are over 2,800 certified centers in the U.S., but many are in cities. Rural areas have far fewer. Some clinics now offer telehealth consultations to help with prep and follow-up, but the actual spray must be given in person. If youâre struggling to find a center, ask your doctor about patient assistance programs or check the official Spravato REMS website for a location finder. Some nonprofit mental health organizations also help with transportation or cost support.
Janette Martens
December 29, 2025 AT 07:18Marie-Pierre Gonzalez
December 29, 2025 AT 23:43Louis Paré
December 31, 2025 AT 18:21Payton Daily
January 1, 2026 AT 01:16Kelsey Youmans
January 2, 2026 AT 21:47oluwarotimi w alaka
January 3, 2026 AT 19:59Debra Cagwin
January 5, 2026 AT 09:48Teresa Marzo Lostalé
January 7, 2026 AT 04:48Gran Badshah
January 8, 2026 AT 16:09Ellen-Cathryn Nash
January 10, 2026 AT 02:36Nicole Beasley
January 10, 2026 AT 21:36