How Often Do You Need Spravato® Treatments?
The short answer: Most patients receive Spravato® (esketamine) twice per week during the initial induction phase, which typically lasts four weeks. After that, treatment frequency gradually decreases to once weekly, and eventually to once every one to two weeks during the long-term maintenance phase. Your exact schedule will always be determined by your prescribing provider based on how you respond to treatment.
If you or someone you love has been living with treatment-resistant depression (TRD) or major depressive disorder with acute suicidal ideation or behavior (MDSI), you may have already heard that Spravato® is one of the most meaningful breakthroughs in psychiatric medicine in decades. But one of the most common questions people have before starting is simple: how often do I actually have to come in?
That is a fair and important question, and the answer is more personalized than most people expect. This guide will walk you through the full Spravato® treatment schedule, what each phase involves, and what factors may influence how frequently you need sessions.
What Is Spravato® and Why Is the Dosing Schedule Unique?
Spravato® is the brand name for esketamine nasal spray, a prescription medication developed by Janssen Pharmaceuticals and approved by the U.S. Food and Drug Administration (FDA). It is a derivative of ketamine and works by targeting NMDA (N-methyl-D-aspartate) receptors in the brain, which plays a key role in modulating glutamate, a neurotransmitter closely linked to mood, cognition, and emotional regulation.
Unlike traditional oral antidepressants, Spravato® is not something you take at home on your own. Every single session must take place in a certified healthcare setting under direct medical supervision. After each dose, patients are monitored for at least two hours to watch for side effects such as dissociation, sedation, or blood pressure changes. You cannot drive yourself home after a session.
This is part of what makes the dosing schedule unique. You are not just managing a pill bottle. Each visit is a clinical event, which is why understanding the frequency ahead of time helps patients plan their lives accordingly.
To learn more about what Spravato® is and how it works, visit our Spravato® service page or read our detailed overview, Understanding Spravato® Esketamine: A Breakthrough for Treatment-Resistant Depression.
The Standard Spravato® Treatment Schedule
The FDA-approved dosing protocol for Spravato® follows a phased approach, moving from frequent early sessions to a less intensive long-term maintenance schedule. Here is how each phase is generally structured:
Phase 1: Induction (Weeks 1 through 4)
During the first four weeks, patients receive Spravato® twice per week. These sessions are spaced at least two days apart. This intensive start is designed to build therapeutic effect in the brain relatively quickly. Clinical trials showed that many patients began to notice improvements in depressive symptoms within the first two weeks of treatment, though individual responses vary considerably.
This phase is the most time-intensive part of the protocol. If your schedule is demanding, this is the period to plan for and arrange support, including transportation to and from your appointments.
Phase 2: Maintenance Phase One (Weeks 5 through 8)
After the induction period, most patients transition to once-weekly sessions for the next four weeks. At this stage, the goal shifts from building initial therapeutic response to stabilizing and sustaining it. Your provider will be closely evaluating how you are responding and whether the reduced frequency continues to support your progress.
Phase 3: Maintenance Phase Two (Week 9 and Beyond)
Beginning around week nine, treatment frequency typically decreases further to once every one to two weeks, based entirely on the individual patient’s clinical response and the judgment of their prescribing provider. Some patients may remain on once-weekly sessions if their provider determines that is the best path forward. Others may taper to every two weeks. There is no universal rule here, which is exactly why working with an experienced psychiatric provider matters so much.
Spravato® for MDSI: Is the Schedule Different?
Spravato® is approved for two distinct indications, and the dosing schedule can look slightly different depending on which condition is being treated.
For patients with major depressive disorder with acute suicidal ideation or behavior (MDSI), the protocol is designed to work fast. The induction phase is still twice weekly for four weeks, but the clinical urgency of this indication means providers are monitoring response closely and may adjust accordingly. Spravato® in this context is typically used alongside an oral antidepressant and is not intended to be a standalone long-term solution in every case.
For treatment-resistant depression (TRD), the phased schedule described above is the standard approach, with the long-term maintenance phase being potentially ongoing for patients who continue to benefit.
If you are unsure which category applies to you, the first step is a thorough evaluation with one of our mental health providers at Mental Health and Wellness of Southern Utah.
What Factors Can Affect How Often You Need Treatment?
While the FDA-approved schedule provides a clear framework, your actual treatment frequency will ultimately be shaped by several personal factors. Your provider will consider all of these when determining the right pace for you.
- Your initial response to treatment. Patients who respond strongly during induction may be able to transition to a less frequent maintenance schedule sooner. Those who show a partial response may benefit from staying at a more frequent pace longer.
- The severity of your depression. Patients with more severe or long-standing symptoms may need a longer or more intensive course before reaching a stable maintenance phase.
- Your history with other treatments. How many antidepressants you have tried, which ones, and how your body responded all give your provider important context for setting realistic expectations.
- Your ability to attend sessions. Because Spravato® requires in-office visits and supervised monitoring, practical factors like your schedule, transportation, and support system are all part of the conversation.
- Co-occurring conditions. Other mental health diagnoses, substance use history, cardiovascular conditions, or certain medications may influence dosing decisions. Transparency with your provider is essential.
- Your ongoing symptom monitoring. Your provider will use validated clinical tools to track your depression symptoms throughout treatment. If you show signs of relapse or incomplete response, they may recommend returning to a more frequent schedule for a period of time.
There is no shame in needing a longer or more intensive course. Depression is a complex neurobiological illness, not a reflection of willpower or character. If you are curious about what a personalized plan might look like for you, contact our team to schedule an evaluation.
How Long Does a Single Spravato® Session Take?
Understanding treatment frequency is only part of the picture. You also want to know what to expect from each individual visit.
Here is a general breakdown of what a session typically involves:
- Preparation and check-in (approximately 15 to 30 minutes). Your care team will review any changes in your health, medications, or mood since your last visit. Your blood pressure will be checked before dosing begins.
- Administration of the nasal spray (approximately 5 to 10 minutes). You will self-administer the nasal spray under clinical supervision. The standard doses are 56 mg or 84 mg, as prescribed.
- Monitored observation period (at least 2 hours). This is required by the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program. During this time, you may experience dissociation, drowsiness, or perceptual changes. These are expected, typically short-lived, and monitored carefully by staff.
- Discharge evaluation. Before you leave, your provider will assess whether you are safe to be discharged. You will need a responsible adult to drive you home. You should not operate heavy machinery or make critical decisions for the remainder of that day.
Plan for a total time commitment of roughly two and a half to three hours per session, depending on your clinic’s workflow.
Is Spravato® Treatment Permanent Or Finite?
Many patients ask whether Spravato® treatment lasts forever. The honest answer depends on your condition and response.
Some patients use Spravato® as a short-term intervention. It helps break through a severe depressive episode. After stabilization, they transition back to oral antidepressants or other therapies.
Others live with chronic, treatment-resistant depression. They may need long-term maintenance to sustain remission.
Your provider always aims to use the lowest effective dosing frequency. They reassess your symptoms regularly. Together, you decide whether to continue, adjust, or gradually taper treatment. Treatment decisions evolve over time. They do not remain static.
Clinicians typically include Spravato® in a comprehensive treatment plan. That plan may involve oral antidepressants, psychotherapy, and lifestyle support. If you want to build a stronger foundation for recovery, read our article on Mental Health Goals for Depression.
What Happens If You Miss A Session?
If you miss a scheduled Spravato® session, contact your care team as soon as possible.
Missing one maintenance session rarely causes a major setback. However, repeated gaps can reduce effectiveness and increase relapse risk.
If you miss sessions during the induction phase, your provider will likely reschedule quickly. Early treatment requires consistency to build momentum. Clear communication helps protect your progress.
Spravato® Vs. TMS Therapy: A Quick Comparison
Some patients compare Spravato® with Transcranial Magnetic Stimulation, often called TMS therapy.
TMS delivers repetitive magnetic pulses to targeted brain regions. Most patients attend sessions five days per week for about six weeks. TMS does not cause dissociation and does not require sedation monitoring. However, it works through a completely different neurological pathway.
Each treatment suits different patients. Your provider evaluates your psychiatric history, medical background, symptom severity, and prior treatment response before recommending an approach.
To learn more about TMS, visit our article on the Benefits of TMS Therapy for Mental Health.
The best treatment plan reflects your full clinical picture and long-term goals.
Who Offers Spravato® in Southern Utah?
Spravato® must be administered in a certified healthcare facility enrolled in the Spravato® REMS program. Not every clinic offers it.
At Mental Health and Wellness of Southern Utah, our team of board-certified psychiatric providers and mental health professionals offers Spravato® at our St. George and Cedar City locations. We take pride in providing compassionate, individualized care for patients living with treatment-resistant depression, and we work closely with each person to develop a treatment schedule that fits both their clinical needs and their daily life.
We serve patients across Southern Utah, including St. George, Cedar City, Washington, Hurricane, and surrounding communities.
To find out if Spravato® may be right for you, contact us today or visit one of our convenient locations.
Frequently Asked Questions About Spravato®
How many Spravato® sessions will I need in total?
There is no fixed number that applies to everyone. The induction phase alone involves eight sessions over four weeks. After that, the number of maintenance sessions depends on your individual response and the judgment of your provider. Some patients continue long-term maintenance indefinitely; others complete treatment after stabilizing.
Can I do Spravato® more frequently than prescribed if I feel like I need it?
No. Spravato® must only be administered according to the FDA-approved protocol and your provider’s orders. Self-adjusting your treatment schedule is not safe and is not permitted under the REMS program. Always speak with your provider if you feel your symptoms are not adequately controlled.
Does Spravato® treatment get less frequent over time?
Yes, for most patients. The schedule is designed to be most intensive at the beginning and to taper down to a sustainable maintenance frequency as you progress through treatment.
What if Spravato® stops working after a while?
It is possible for any treatment to become less effective over time. If your symptoms return or you notice a decline in response, contact your provider promptly. They may recommend returning to a more frequent schedule temporarily, adjusting your overall treatment plan, or exploring other options.
Is Spravato® covered by insurance?
Many major insurance plans, including Medicare and Medicaid, cover Spravato® for FDA-approved indications. However, coverage varies by plan and insurer. Our team can help you navigate your benefits. Reach out to us through our contact page for more information.
Will I need to take an oral antidepressant alongside Spravato®?
In most cases, yes. For treatment-resistant depression, Spravato® is typically prescribed alongside an oral antidepressant. For MDSI, it can be used as a standalone treatment in certain situations. Your provider will make this determination based on your specific clinical picture.
Am I a candidate for Spravato®?
Spravato® is generally considered for adults who have tried at least two different antidepressant treatments without adequate relief. A full psychiatric evaluation is required to determine eligibility. Visit our FAQ page or contact our office to get started.
This article is intended for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before beginning, changing, or stopping any psychiatric treatment. Spravato® is a prescription medication with specific eligibility requirements and must be administered under medical supervision in a certified clinical setting.