The Spravato schedule has three phases: induction, twice weekly for weeks 1 to 4 (56 mg first, then 56 or 84 mg); weeks 5 to 8, once weekly; and maintenance from week 9, every week or every two weeks at the lowest frequency that holds your improvement. Each visit takes about two and a half hours.
This page lays out the FDA-labeled schedule, the doses, how long each visit takes, how we decide when to space sessions out, and how long people typically stay on it. Stedfast Psychiatry follows the label schedule at all three of our Palm Beach County Spravato offices and adjusts the maintenance phase to your response.
Who it is for
Anyone starting Spravato, anyone deciding whether they can commit to it, and employers or family members helping a patient plan around it. The schedule is the same for treatment-resistant depression and for major depression with acute suicidal ideation during the first four weeks; for the suicidal ideation indication the label specifies twice-weekly dosing for four weeks and then a decision about continuation based on the depression picture.
How it works
The schedule reflects the biology. Esketamine triggers synapse growth that begins within a day but needs reinforcement to consolidate, so the induction phase stacks doses closely to build and hold the effect. Once a response is established, the connections are more durable and the interval can lengthen. The twice-weekly induction cadence was set in the TRANSFORM trials; the weekly and every-two-week maintenance intervals were tested in SUSTAIN-1, where patients were moved to the longer interval when they stayed in remission and brought back to weekly if symptoms crept up. That flexible approach is what the label describes and what we follow.
The FDA-labeled Spravato schedule for treatment-resistant depression is twice weekly in weeks 1 to 4, once weekly in weeks 5 to 8, and once every week or every 2 weeks from week 9 onward, at 56 mg or 84 mg.
Source: Spravato prescribing information, FDA
In SUSTAIN-1, about 55 percent of stable remitters were able to move to every-two-week dosing, and relapses were most common in the first weeks after esketamine was discontinued.
Source: Daly et al., JAMA Psychiatry, 2019
In TRANSFORM-2, two thirds of patients were titrated to the 84 mg dose by the end of induction.
Source: Popova et al., American Journal of Psychiatry, 2019
In the 52-week SUSTAIN-2 study, 76.5 percent of patients who entered maintenance were in response and 58 percent in remission at study end.
Source: Wajs et al., Journal of Clinical Psychiatry, 2020
What to expect
Induction visits are scheduled in a block, usually two fixed days each week (for example Monday and Thursday) at the same time, for four weeks. Plan each visit at roughly two and a half hours: about 15 minutes of check-in and vital signs, 5 to 10 minutes for the dose, two hours of monitoring, and discharge. At the end of week 4 your provider reviews your rating scale scores with you. If you have responded, you move to weekly sessions for weeks 5 to 8, then to maintenance. If you have not responded at all by week 4, we discuss whether to extend, adjust the dose, or stop and pursue another treatment.
Benefits
- A defined endpoint for the intensive phase: eight sessions in four weeks, then a decision point
- Visit frequency drops by half after week 4 and may drop by half again after week 8
- Dose and interval are individualized to your response using rating scales, not a fixed calendar
- Maintenance can continue for as long as it is helping, with coverage from most plans and Medicare
Risks and side effects
The main risk of the schedule itself is incomplete induction. Patients who miss sessions in the first month, or who stop after three or four because the dissociation was unpleasant or logistics got hard, rarely get the full benefit and sometimes conclude the drug does not work when it was never properly tried. The second risk is spacing maintenance too aggressively; in SUSTAIN-1, relapses clustered in the weeks after stopping. We err on the side of holding a frequency that is working before lengthening it. Dose-related side effects are covered on our side effects and safety page.
Cost and insurance
Most plans authorize the first eight weeks and then require documentation of response to approve maintenance. Original Medicare covers the full course without prior authorization. The twice-weekly induction phase concentrates the cost in the first month, which matters for deductible planning; see our cost and insurance page.
The schedule at a glance
| Phase | Weeks | Frequency | Dose | Sessions |
|---|---|---|---|---|
| Induction | 1 to 4 | Twice weekly | Day 1: 56 mg. Then 56 or 84 mg | 8 |
| Early maintenance | 5 to 8 | Once weekly | 56 or 84 mg | 4 |
| Maintenance | 9 onward | Every week or every 2 weeks | 56 or 84 mg | 2 to 4 per month |
Adults 65 and older: start at 28 mg on day 1, then 28, 56 or 84 mg based on response and tolerability.
A sample first month
- Week 0: evaluation, blood pressure check, medication history, REMS enrollment, insurance authorization. Ride home arranged for all induction dates.
- Week 1: Monday, session 1 at 56 mg. Thursday, session 2 at 56 or 84 mg.
- Weeks 2 to 4: Monday and Thursday sessions. PHQ-9 at each visit.
- End of week 4: review of scores. Response is a 50 percent or greater drop from baseline; remission is a PHQ-9 under 5 or MADRS of 12 or below. Decision: continue weekly, extend induction, or stop.
Deciding when to space sessions out
From week 9 we use your scores to set the interval. If you have been in remission for at least four weeks on weekly dosing, we move to every two weeks. If symptoms rise by a meaningful margin at the longer interval, we return to weekly for a few weeks and try again later. The goal is the lowest frequency that keeps you well, because fewer sessions mean less time, less cost and less cumulative drug exposure.
How long people stay on Spravato
There is no fixed endpoint in the label. The longest controlled data run about a year, and open-label follow-up extends beyond that without new safety signals. In practice, three patterns are common. Some patients, often those with a first or second episode and a strong early response, taper off after six to twelve months and stay well with an oral antidepressant and therapy. Some relapse when they taper and resume every-two-week maintenance long term. Some taper to very infrequent boosters. We revisit the question every few months rather than deciding at the start. Our maintenance and long-term results page goes deeper.
Combining Spravato with other treatment
Most patients continue an oral antidepressant throughout, which is what the trials studied; since January 2025 it is also approved alone. Psychotherapy during induction and maintenance is strongly encouraged, because the period of heightened synaptic plasticity after sessions may make therapy more effective. Deep TMS and Spravato are not usually given concurrently but can be sequenced.
Spravato at Stedfast Psychiatry
We offer Spravato at three Palm Beach County offices, each with a dedicated monitoring room and staff trained under the Spravato REMS program:
- Boynton Beach: 10301 Hagen Ranch Rd, Suite D720, Boynton Beach, FL 33437
- Palm Beach Gardens: 11641 Kew Gardens Ave, Suite 209, Palm Beach Gardens, FL 33410
- Royal Palm Beach: 420 South State Road 7, Suite 112, Royal Palm Beach, FL 33414
Call the office nearest you or request an appointment online. The first step is an evaluation, in person or by telehealth, to confirm you are a candidate and to start insurance authorization.
Frequently asked questions
How many Spravato treatments do I need?
Eight in the first month, four in the second, and then two to four per month during maintenance. A typical first six months involves about 24 to 30 sessions. How long maintenance continues depends on your response and history; some patients taper off after six months to a year of stability, while others stay on every-two-week dosing long term because stopping led to relapse.
How long does each Spravato session take?
About two and a half hours door to door. The dose itself takes 5 to 10 minutes. The FDA requires at least two hours of observation afterward, and we add a short check-in before and a discharge check at the end. If your blood pressure or sedation has not settled at two hours, you stay longer. Plan for the whole morning or afternoon.
What dose of Spravato will I get?
The first session is always 56 mg, which is two devices. From the second session on, your provider chooses 56 or 84 mg based on your response and how well you tolerated the first dose. Most patients in the trials ended up on 84 mg. Adults 65 and older start at 28 mg and increase more gradually. The dose can be changed at any session.
What if I miss a session during induction?
Reschedule it within the same week if possible. A single missed session is not a disaster, but the induction phase is designed to stack doses closely, and gaps of more than a week can slow the response. If you miss several, we may extend induction by a week or two. Tell the office as soon as you know you cannot make it so that we can hold a slot.
How long does Spravato last?
The drug itself is gone within a day. The antidepressant effect from a single session lasts days to a week or more in responders, which is why induction is twice weekly. Once you have responded, the effect from each session holds longer, which is why maintenance can be every one to two weeks. If you stop entirely, benefit persists for a variable period: weeks for some, months for others.
Can I do Spravato once a month?
The label specifies weekly or every two weeks for maintenance, and that is what the evidence supports. Some patients who have been stable for a long time stretch to every three or four weeks under close monitoring, but relapse risk rises as the interval lengthens. We treat monthly dosing as an individualized taper step, not a standard schedule, and we move back to every two weeks if scores rise.
Can I schedule Spravato around work?
Yes, with planning. Late-morning or early-afternoon sessions let you rest afterward and return to work the next day. Many patients use intermittent FMLA leave for the induction month; we provide the documentation. You cannot work the same afternoon in any role that requires driving, machinery or sharp judgment. Weekday hours at our offices are 8 AM to 5 PM; ask about the latest start time that allows a full monitoring period.
Where this treatment is offered
- Boynton Beach, FL
10301 Hagen Ranch Rd, Suite D720 and Suite B710 - Palm Beach Gardens, FL
11641 Kew Gardens Ave, Suite 209 - Royal Palm Beach, FL
420 South State Road 7, Suite 112
Conditions this treats
If you are in crisis, call or text 988 or go to the nearest emergency room. Educational content; individual results vary. Reviewed by Dr. David Husted, board-certified psychiatrist.