How Often Is Spravato Treatment Given?

This timeline reflects the FDA-approved dosing for treatment-resistant depression in adults. [FDA label] It is the labeled schedule, not a prediction of any individual course of treatment.

Two sessions a week for four weeks is eight appointments, each with at least two hours of monitoring afterward and no driving until the next day. For most patients this is the most demanding part of the schedule to arrange, and it is worth planning transportation and time off before starting rather than week by week.

The labeling directs that evidence of therapeutic benefit be evaluated at the end of the induction phase to determine the need for continued treatment. In other words, the four weeks are a defined trial with a decision point at the end — not an automatic entry into indefinite treatment.

If treatment continues, the labeled frequency drops to once weekly for weeks 5 through 8, still at 56 mg or 84 mg. [FDA label]

The session itself does not get shorter. Monitoring for at least two hours, blood pressure checks, and the driving restriction apply to every session regardless of phase.

From week 9 onward the labeled options are every two weeks or once weekly, with dosing frequency individualized to the least frequent dosing that maintains remission or response. [FDA label]

The evidence for continuing treatment at this stage comes largely from a randomized withdrawal trial in which patients who had achieved stable remission or stable response were randomly assigned either to continue esketamine with an oral antidepressant or to switch to placebo nasal spray with an oral antidepressant. [JAMA Psychiatry] That trial studied relapse prevention over time; it does not establish how long any particular person should continue.

The labeled dose strengths for treatment-resistant depression are 56 mg and 84 mg. A 56 mg dose is given using two nasal spray devices and an 84 mg dose using three, with a five-minute rest between devices. [FDA label]

Selecting between them is a clinical decision that considers response and tolerability over time. This page describes the labeled range at a general educational level; it is not dosing guidance, and dose changes are made by the treating clinician.

The schedule above applies to treatment-resistant depression. The second indication has a different regimen entirely: for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior, the labeled dosage is 84 mg twice per week for four weeks, in conjunction with an oral antidepressant, with a reduction to 56 mg if needed based on tolerability. [FDA label]

The labeling states that use beyond four weeks for this indication has not been systematically evaluated. It also states that effectiveness in preventing suicide or reducing suicidal ideation or behavior has not been demonstrated, and that treatment does not remove the need for hospitalization when clinically warranted.

Confusing the two regimens is a common error in online summaries. They differ in population, in dose, in duration, and in whether an oral antidepressant is required.

After the first eight weeks the labeling deliberately stops prescribing a fixed interval and instead asks for individualization to the least frequent dosing that maintains remission or response. [FDA label] Factors a clinician weighs include how symptoms have responded, whether benefit is sustained between sessions, tolerability, blood pressure trends, and other treatment the patient is receiving.

Because the schedule is individualized, another patient’s interval is not a useful benchmark for your own.

The prescribing information addresses this directly: if a patient misses treatment sessions and there is no worsening of depressive symptoms, the patient should continue the current dosing schedule. [FDA label]

Worsening symptoms are a different situation and should be discussed with the treating clinician rather than managed by adjusting the schedule independently. If symptoms become severe or you are in danger, seek emergency care.

Coverage runs on a separate schedule from the clinical one. Plans that cover Spravato commonly authorize a defined period or a defined number of sessions rather than an open-ended course, and require a renewal request with updated clinical documentation to continue beyond it.

Practical implications:

• An initial approval may cover only the induction phase, with continuation reviewed separately.
• Renewal requests generally ask for evidence of response and continued clinical need.
• Approval periods, documentation, and renewal timing differ by plan — no clinic can predict your plan's terms.
• A lapse in authorization can interrupt scheduling even when treatment is clinically appropriate.

How coverage is structured is covered in does insurance cover Spravato, and the approval process itself in Spravato prior authorization.

The labeled schedule for treatment-resistant depression tapers in frequency: twice weekly for four weeks, weekly for four weeks, then weekly or every other week. Doses are 56 mg or 84 mg. The regimen for acute suicidal ideation or behavior is distinct — 84 mg twice weekly for four weeks with an oral antidepressant — and has not been systematically studied beyond that period.

Beyond the first eight weeks, the labeling asks clinicians to individualize toward the least frequent dosing that maintains response. Insurance authorizations run on their own clock and usually need renewing, which is a separate process from the clinical schedule.