Spravato (esketamine) is not widely associated with weight gain. Unlike some traditional antidepressants, Spravato does not typically cause metabolic side effects such as increased appetite, slowed metabolism, or fat storage. In fact, across multiple clinical trials and post-marketing surveillance, weight gain was not reported as a common or significant side effect.
What the Research Says
Spravato is an NMDA receptor antagonist, and its mechanism of action is different from SSRIs, SNRIs, or atypical antidepressants — many of which do have weight gain as a side effect.
- In pivotal trials conducted by Janssen Pharmaceuticals, weight gain was not listed among the top adverse reactions.
- Most frequently reported side effects included dissociation, dizziness, sedation, nausea, increased blood pressure, and headache.
- The FDA-approved prescribing information for Spravato does not include weight gain as a notable concern.
When Weight Gain May Still Occur
While Spravato itself may not directly cause weight gain, there are several indirect factors that could influence weight changes during treatment:
- Combination Therapy
Spravato is often used in conjunction with an oral antidepressant — some of which (like mirtazapine or certain SSRIs) can contribute to weight gain. - Improvement in Mood
As depressive symptoms lift, patients may experience increased appetite or a return to normal eating patterns, which might appear as weight gain after a period of poor appetite. - Lifestyle and Activity Levels
Fatigue, sleep changes, or reduced physical activity associated with depression may persist or fluctuate during treatment, affecting weight balance. - Individual Biological Differences
Genetics, metabolism, hormonal fluctuations, and gut-brain interactions can all influence how someone responds physically to psychiatric medication — even if it’s not a direct pharmacologic effect.
What Should I Do If I Notice Weight Gain on Spravato?
If you experience any unexpected weight changes during your treatment:
- Track your weight trends over time to determine if the changes are consistent or temporary.
- Speak with your provider about the possibility of other medications contributing to weight gain.
- Review your nutrition and activity habits, as these may need to be adjusted as your mental health improves.
summary:
No, weight gain is not a common side effect of Spravato (esketamine). Clinical trials and FDA data show that Spravato does not typically impact weight. However, factors like other medications, improved appetite from reduced depression, or lifestyle changes may contribute to weight fluctuations in some patients.