Spravato and Ketamine Therapy: What Are the Risks?
Ketamine has become one of the most talked-about treatments in mental health and chronic pain care.
Clinics offering ketamine infusions have expanded across the United States, online services have promoted compounded ketamine, and Spravato, a prescription nasal spray containing esketamine, has become an option for certain adults living with difficult-to-treat depression.
For someone struggling with depression or chronic pain, the possibility of rapid relief can be appealing.
But the term ketamine therapy can describe very different situations.
FDA-approved Spravato administered under medical supervision is not the same as receiving off-label ketamine from an independent clinic, using compounded ketamine at home, or taking ketamine recreationally.
Ketamine is also a psychoactive dissociative drug with recognized potential for abuse and misuse.
What Is Ketamine?
Ketamine is a dissociative anesthetic that has been used medically for decades.
Unlike many traditional antidepressants, ketamine primarily affects the brain’s glutamate system, including activity involving NMDA receptors.
At anesthetic doses, ketamine can cause substantial changes in consciousness and awareness. At lower doses, researchers have investigated its potential effects on depression and certain types of chronic pain.
Those psychoactive effects are also part of the reason ketamine can be misused.
Ketamine may alter perception, mood, thought, coordination and a person’s sense of connection to their body and surroundings.
What Is Spravato?
Spravato is the brand name for esketamine, a chemical relative of ketamine.
Spravato is not simply a take-home ketamine nasal spray.
It is an FDA-approved prescription medication used for specific depressive conditions. Because esketamine can cause sedation, dissociation, respiratory effects, increased blood pressure, abuse and misuse, treatment includes significant safeguards.
Patients administer Spravato in a healthcare setting under professional supervision and are monitored afterward.
Spravato vs. Ketamine Therapy
| Treatment | What It Is | Important Considerations |
|---|---|---|
| Spravato | FDA-approved intranasal esketamine | Administered under healthcare supervision with required monitoring. |
| Ketamine Infusion | Ketamine administered intravenously, typically off-label for depression or pain | Ketamine itself is FDA-approved as an anesthetic, not specifically as a psychiatric medication. |
| Compounded Ketamine | Ketamine prepared by a compounding pharmacy in forms such as lozenges or nasal products | Compounded drugs do not undergo the same FDA premarket review for safety, effectiveness and quality as approved medications. |
| Recreational Ketamine | Nonmedical ketamine use for intoxication or dissociation | Can involve unpredictable doses, repeated use, polysubstance use, addiction and serious physical complications. |
Why Is Ketamine Used for Depression?
One reason ketamine has received so much attention is its potential to affect depressive symptoms more rapidly than many traditional antidepressants.
This can make ketamine-related treatments especially interesting to people who have experienced severe depression despite trying other approaches.
However, rapid symptom improvement does not necessarily equal long-term recovery.
Depression can involve biological, psychological, behavioral, interpersonal and environmental factors. Medication may help some people, but psychotherapy, healthy routines, meaningful relationships, psychiatric care and treatment of co-occurring conditions can remain important.
Why Is Ketamine Used for Chronic Pain?
Ketamine has also been investigated for certain chronic pain conditions because NMDA receptors are involved in pain processing and nervous-system sensitization.
Some studies suggest ketamine may provide short-term pain reduction in certain circumstances.
The bigger question is what happens over time.
Long-term effectiveness for chronic non-cancer pain remains less certain, and improvements in pain intensity do not always translate into improved mobility, sleep, physical function or overall quality of life.
That is one reason chronic pain treatment frequently works best when it addresses several parts of the problem rather than depending entirely on one medication.
What Are the Dangers of Ketamine?
Ketamine’s risks vary depending on the dose, frequency of use, route of administration, whether the drug is medically supervised and whether other substances are involved.
Dissociation
Ketamine can make someone feel detached from their body, thoughts or surroundings. The experience may be confusing or frightening, particularly at higher doses.
Sedation and Impairment
Dizziness, sedation, slowed reactions and impaired coordination can make driving or performing other activities unsafe.
Cardiovascular Effects
Ketamine and esketamine can temporarily increase blood pressure and heart rate, making medical screening and monitoring important.
Nausea and Vomiting
Some people experience gastrointestinal symptoms during or after treatment.
Thinking and Memory Problems
Frequent or heavy ketamine use may be associated with problems involving attention, thinking and memory.
Abuse and Misuse
Ketamine has recognized abuse potential, especially when someone begins seeking the dissociative or intoxicating effects rather than using it strictly according to a medical treatment plan.
Can You Become Addicted to Ketamine?
Ketamine can be misused, and repeated nonmedical use can become problematic.
This does not mean that everyone receiving medically supervised ketamine or Spravato will develop an addiction.
The concern grows when someone begins increasing the dose, using ketamine more frequently than intended, obtaining it outside medical care, using it primarily to escape emotional distress or repeatedly seeking its dissociative effects.
For some people, feeling temporarily disconnected from depression, anxiety, trauma or pain can become reinforcing.
What Is a K-Hole?
One of the better-known consequences of recreational ketamine use is an intense dissociative state commonly called a K-hole.
At high doses, someone may experience profound detachment from their body and surroundings.
Movement and communication can become extremely difficult.
A person may experience hallucinations, distorted perceptions of time and space, confusion, memory loss or a frightening sense of being disconnected from reality.
Combining ketamine with alcohol, opioids, benzodiazepines or other sedating substances can create additional dangers.
Ketamine Can Damage the Bladder and Urinary System
One of the most serious consequences associated with repeated heavy ketamine use is ketamine-induced cystitis, sometimes called ketamine bladder syndrome.
Repeated exposure can cause inflammation and potentially severe damage involving the bladder and urinary tract.
Urinary Symptoms
People may experience severe urinary frequency, urgency, painful urination, blood in the urine and reduced bladder capacity.
Pelvic and Bladder Pain
Ketamine-related urinary damage can cause significant pelvic discomfort and chronic bladder pain.
Kidney and Urinary Complications
Severe disease can extend beyond the bladder and may affect other parts of the urinary system.
Examples of Harm From Chronic Ketamine Use
Published medical literature contains real-world cases showing that chronic recreational ketamine use can cause substantial physical harm.
Daily Ketamine Use and Severe Urinary Damage
One published case involved a 46-year-old man who reported daily recreational ketamine use for approximately seven months.
He presented to an emergency department with lower abdominal pain and blood in his urine.
Imaging showed significant urinary abnormalities, including a markedly thickened bladder wall. He ultimately required urological intervention and was diagnosed with ketamine-induced cystitis.
Escalating Use While Trying to Control Pain
Another published case described a 56-year-old man whose recreational ketamine use escalated from intranasal use to injections.
He experienced severe pelvic pain, painful urination, urinary frequency and blood in his urine.
Particularly concerning, the patient reportedly increased his ketamine use while attempting to control the pain that had developed.
Evaluation identified urinary complications and acute kidney injury.
Severe Abdominal Pain and “K-Cramps”
A separate published case involved a 31-year-old man with a three-year history of nonmedical ketamine use through several routes.
He visited an emergency department repeatedly with severe abdominal and back pain.
After clinicians considered chronic ketamine use as a possible cause and the patient stopped using ketamine, his pain substantially improved. He subsequently sought addiction treatment.
What Are K-Cramps?
K-cramps is an informal term used to describe severe abdominal discomfort reported by some people who chronically misuse ketamine.
The exact mechanisms can be complicated, and severe abdominal pain should never automatically be assumed to come from ketamine.
However, published medical cases have described substantial abdominal and back pain occurring alongside chronic nonmedical ketamine use.
Anyone experiencing severe or unexplained abdominal pain should receive appropriate medical evaluation.
The Risk of Using Ketamine to Escape Emotional Pain
Not every danger associated with ketamine appears on a laboratory test.
For people living with depression, trauma, anxiety or addiction, dissociation itself may become appealing.
Temporarily feeling disconnected from painful thoughts or emotions can feel like relief.
But repeatedly escaping emotional pain is different from learning how to process and manage it.
Psychotherapy can help people recognize the connection between thoughts, emotions and behavior while developing coping strategies that remain available when a medication or drug is no longer producing an effect.
Alternatives to Ketamine for Depression
Ketamine and Spravato are not the only options for depression, including difficult-to-treat depression.
Treatment should be individualized, but several evidence-based approaches may be considered.
Cognitive Behavioral Therapy
CBT helps people recognize relationships between thoughts, emotions and behaviors and develop healthier responses to depressive thinking patterns.
Behavioral Activation
Behavioral activation helps people gradually reconnect with activities, responsibilities and relationships that provide structure, accomplishment or meaning.
Interpersonal Therapy
Interpersonal therapy can address grief, relationship stress, communication difficulties and major life transitions that contribute to depression.
Acceptance and Commitment Therapy
ACT can help people relate differently to difficult thoughts and emotions while making choices that are consistent with their values.
Mindfulness-Based Therapy
Mindfulness-oriented treatments may help patients observe difficult thoughts and emotions without automatically reacting to them.
Appropriate Medication Management
Traditional antidepressants and other psychiatric medications may still be appropriate depending on the person’s diagnosis, history and previous response to treatment.
Alternatives to Ketamine for Chronic Pain
Chronic pain is rarely a one-dimensional problem.
Sleep, mood, stress, physical conditioning, trauma, inflammation, nervous-system sensitization and underlying injuries or illnesses may all influence how pain is experienced.
A multidisciplinary strategy can therefore provide more than relying exclusively on one psychoactive medication.
Physical Therapy
Physical therapy can improve strength, mobility, balance, flexibility and physical function depending on the underlying condition.
Therapeutic Exercise
Appropriate movement, resistance exercise, aerobic activity or aquatic exercise may help some people improve function and reduce disability.
CBT for Chronic Pain
CBT for chronic pain helps patients identify patterns involving pain, fear, avoidance, activity and stress while building healthier coping strategies.
Mindfulness and Stress Reduction
Mindfulness-based approaches can help reduce stress reactivity and change how some patients respond to uncomfortable sensations.
Nonopioid Medication Options
Depending on the condition, clinicians may consider anti-inflammatory drugs, selected antidepressants, anticonvulsant medications, topical treatments or other nonopioid therapies.
Integrated Pain Care
Some people benefit from a treatment plan combining medical care, rehabilitation, behavioral therapy, sleep support and lifestyle interventions.
When Depression, Chronic Pain and Addiction Overlap
Depression, chronic pain and substance use can become closely connected.
Someone experiencing persistent physical pain may begin using substances to obtain relief.
Someone living with depression may use drugs or alcohol to temporarily numb emotional distress.
A person already in addiction recovery may also become interested in ketamine after hearing that it can treat depression or pain.
None of these circumstances means that a person should automatically be excluded from every medication with abuse potential.
It does mean that treatment decisions should include careful consideration of substance-use history, psychiatric symptoms, medical conditions, other medications and recovery goals.
Questions to Ask Before Considering Ketamine Treatment
What Exactly Am I Receiving?
Ask whether the treatment is FDA-approved Spravato, intravenous ketamine, compounded ketamine or another formulation.
Who Is Monitoring Treatment?
Understand who evaluates you, monitors your response, addresses side effects and determines when treatment should be changed or stopped.
What Is the Long-Term Plan?
Ask what happens if symptoms improve and whether psychotherapy, psychiatric care, lifestyle changes or other treatments are included.
What About My Addiction History?
People with current or previous substance misuse should discuss how treatment could affect cravings, compulsive behaviors or recovery stability.
Signs Ketamine Use May Be Becoming a Problem
Someone does not need to wait until their ketamine use becomes a medical crisis before seeking help.
Warning signs may include using ketamine more frequently than intended, needing larger amounts, obtaining ketamine outside legitimate medical care, becoming increasingly interested in dissociation, hiding use, spending substantial time obtaining ketamine, or continuing despite bladder, cognitive, psychological or relationship problems.
Another important warning sign is beginning to rely on ketamine as the primary way to manage depression, trauma, anxiety or chronic pain.
At that point, an addiction and mental health assessment may help clarify what is happening and what type of treatment would be appropriate.
Ketamine Treatment Is Not the Same as Ketamine Addiction
People receiving legitimate medical treatment should not be stigmatized.
A patient receiving FDA-approved Spravato through an appropriately supervised healthcare setting should not automatically be labeled as having a substance use disorder.
The issue is appropriate patient selection, risk assessment, monitoring and ongoing evaluation.
Some people with severe treatment-resistant depression may receive meaningful benefit from esketamine. Others may respond better to different medications, psychotherapy, behavioral interventions or combinations of treatments.
The goal should be finding the safest effective treatment for the individual rather than choosing a treatment simply because it is new or receiving significant attention.
Treat the Person, Not Just the Symptom
The growing interest in ketamine reflects an important reality: many people continue to struggle with depression and chronic pain despite receiving treatment.
People deserve effective options.
But innovation does not eliminate the need for caution.
Spravato represents an FDA-approved treatment for certain depressive conditions and includes significant safeguards because esketamine can produce substantial psychoactive and physiological effects.
Ketamine also has the potential for misuse, and chronic recreational use has been associated with addiction, bladder damage, urinary complications, severe abdominal pain and other health consequences.
For many people, long-term improvement requires more than temporary symptom suppression.
Psychotherapy, physical rehabilitation, behavioral activation, appropriate medications, exercise, mindfulness, treatment of co-occurring disorders and supportive relationships may all contribute to lasting recovery.
Ketamine Addiction Treatment in Murfreesboro, Tennessee
If ketamine, prescription medications, alcohol or other substances have become a way of coping with depression, chronic pain, trauma or emotional distress, professional treatment can help address more than the substance itself.
Tulip Hill Recovery in Murfreesboro, Tennessee provides addiction and dual diagnosis treatment designed around each person’s substance use, mental health symptoms, recovery history and current needs.
Treatment may incorporate evidence-based approaches including cognitive behavioral therapy, dialectical behavior therapy, trauma-informed care, individual counseling, group therapy, relapse prevention and treatment for co-occurring mental health concerns.
The goal is not simply to remove one substance while leaving the underlying problem untouched.
Recovery involves developing healthier strategies for managing pain, depression, stress, trauma and difficult emotions without becoming dependent on intoxication or dissociation for relief.
Frequently Asked Questions About Spravato and Ketamine
Is Spravato ketamine?
Spravato contains esketamine, which is chemically related to ketamine. It is an FDA-approved nasal medication used for specific depressive conditions under healthcare supervision.
Is ketamine FDA-approved for depression?
Ketamine itself is FDA-approved as an anesthetic rather than as a psychiatric medication. Spravato, which contains esketamine, has specific FDA-approved uses involving depression.
Can ketamine become addictive?
Ketamine has recognized abuse and misuse potential. Risk can increase with frequent, escalating, recreational or unsupervised use.
Can Spravato be abused?
Spravato’s prescribing information includes warnings related to abuse and misuse. This is one reason administration and monitoring occur within a controlled healthcare setting.
What does ketamine do to the bladder?
Frequent heavy ketamine use has been associated with ketamine-induced cystitis, which can cause painful urination, severe urinary frequency, urgency, pelvic pain, blood in the urine and potentially serious urinary complications.
What are K-cramps?
K-cramps is an informal term describing severe abdominal discomfort reported by some people with chronic ketamine use. Severe abdominal pain should receive medical evaluation because many different conditions can cause it.
What is a K-hole?
A K-hole is an informal term for an intense dissociative state associated with high-dose ketamine use. Someone may experience profound detachment, hallucinations, confusion, impaired movement and altered perception of time and space.
Does ketamine work for chronic pain?
Ketamine may provide short-term pain relief for certain patients and conditions, but evidence regarding long-term benefits for chronic non-cancer pain remains less certain.
What can be used instead of ketamine for chronic pain?
Depending on the cause of pain, options may include physical therapy, therapeutic exercise, cognitive behavioral therapy, mindfulness-based approaches, nonopioid medications and multidisciplinary pain treatment.
What therapies can help depression without ketamine?
Evidence-based options include cognitive behavioral therapy, behavioral activation, interpersonal therapy, acceptance and commitment therapy, mindfulness-based approaches and appropriately prescribed psychiatric medications.
Should someone in addiction recovery use Spravato?
This requires an individualized medical decision. A history of substance use does not automatically rule out treatment, but the patient’s addiction history and risk of abuse or misuse should be discussed with the prescribing healthcare professional.
Can someone become dependent on dissociation?
Some people may begin repeatedly seeking ketamine because they find the dissociative experience emotionally reinforcing. Increasing preoccupation with the drug, escalating use or using it primarily to escape emotional distress can indicate a developing problem.
Where can I get help for ketamine addiction in Tennessee?
Tulip Hill Recovery in Murfreesboro provides addiction and co-occurring mental health treatment for people who need structured help changing problematic substance use and developing healthier coping strategies.
The Bottom Line on Spravato and Ketamine
Ketamine is neither a miracle treatment nor a substance whose legitimate medical uses should be dismissed simply because it can be abused.
The distinction between treatment and misuse matters.
FDA-approved Spravato is administered within a controlled medical framework for specific depressive conditions.
Recreational and uncontrolled ketamine use can look very different and has been associated with addiction, dissociation, cognitive effects, urinary damage and severe abdominal symptoms.
People considering ketamine for depression or chronic pain should understand exactly what treatment they are receiving, what evidence supports it, what risks apply to their individual situation and what alternatives are available.
For people with a history of substance misuse, that conversation becomes even more important.
Clinical Sources and References
U.S. Food and Drug Administration. Spravato prescribing information and Risk Evaluation and Mitigation Strategy information.
U.S. Food and Drug Administration. FDA warning regarding compounded ketamine products for psychiatric disorders.
National Institute on Drug Abuse. Research and educational information regarding ketamine and dissociative drugs.
Centers for Disease Control and Prevention. Clinical guidance regarding nonopioid and nonpharmacologic approaches for chronic pain.
American Psychological Association. Clinical practice guidance for evidence-based treatment of depression.
VA/DoD Clinical Practice Guideline. Management of Major Depressive Disorder.
Peer-reviewed case literature. Reports describing ketamine-induced cystitis, urinary complications and severe abdominal pain associated with chronic recreational ketamine use.
Medical Disclaimer: This page is for educational purposes and is not intended to diagnose a medical condition, recommend stopping a prescribed medication or replace individualized medical care. Do not discontinue Spravato, ketamine or another prescribed treatment without discussing the decision with the healthcare professional managing your care.
