Esketamine is safe when used as directed under a doctor’s care. Esketamine can only be administered in a certified treatment clinic that has medical staff trained to prescribe and dispense esketamine. The medical staff also has to be certified in Risk Evaluation and Mitigation Strategy (REMS). However, the nasal spray itself is simple and safe enough for patients to self-administer under supervision in the clinic.

While it is safe to use under a doctor’s care, esketamine does carry a risk of abuse as well as psychological and physical dependence. This risk is one of the reasons that it is very important to stay in close contact with your doctor while on the medication. Antidepressants also have a risk of dependence because your body comes to rely on that extra production of dopamine and serotonin. Stopping your use of esketamine or antidepressants cold turkey can cause withdrawal symptoms.

Self-administering esketamine nasal spray does not hurt, but there are some common side effects, including:

  • Sleepiness
  • Nausea
  • Increased blood pressure
  • Bad taste in the mouth
  • Dissociation

These side effects usually only occur within one to two hours after the nasal spray has been administered. To help ensure the safety of patients, there is a two-hour window of supervision at the clinic following the administration before patients can leave and head home.

After treatment, patients may experience some of the side effects listed above. However, some side effects decrease with repeated treatments. Regardless, patients need to arrange for post-treatment transportation home to make sure they get home safely.

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