Spravato, also known as esketamine nasal spray, follows a structured dosing schedule designed for adults receiving treatment for treatment-resistant depression. Unlike a medication that is taken independently at home, Spravato is administered under the supervision of a healthcare provider. The dose and frequency can change as treatment progresses, based on response and tolerability.
Each Spravato nasal spray device delivers 28 mg of esketamine. For adults being treated for treatment-resistant depression, the recommended doses are generally 56 mg or 84 mg. The starting dose is typically 56 mg, while later dosing may be adjusted according to how well the treatment is tolerated and whether it is providing therapeutic benefit.
The dose is not something patients determine themselves. A qualified healthcare provider evaluates your response and decides whether an adjustment is appropriate.
Spravato treatment usually begins with a more frequent schedule before moving toward less frequent maintenance sessions.
For adults with treatment-resistant depression, the standard schedule is:
The goal during maintenance is to use the least frequent schedule that continues to maintain a patient’s response or remission.
This schedule provides a framework, but your treatment plan is individualized according to your clinical response and tolerability.
The initial phase involves more frequent treatment because the provider needs to evaluate how you respond to esketamine and whether it is helping your depressive symptoms.
After the first four weeks, the prescribing information recommends evaluating evidence of therapeutic benefit before determining whether continued treatment is appropriate. If treatment continues, sessions generally become less frequent.
At Scottsdale TMS & Spravato, patients receive a personalized treatment schedule after their initial psychiatric evaluation. The practice describes an induction phase followed by less frequent maintenance treatment, with ongoing monitoring of progress.
Spravato is self-administered as a nasal spray while a healthcare professional provides direct supervision. The process takes place in a certified treatment setting rather than at home.
Before administration, your provider may assess your blood pressure and overall condition. After using the prescribed dose, you remain at the clinic for observation.
The FDA requires patients to be monitored for at least two hours following administration because Spravato can cause sedation, dissociation, respiratory depression, and increases in blood pressure.
The treatment team evaluates your condition before determining whether you are ready to leave.
Yes. For treatment-resistant depression, the recommended dose can be adjusted between 56 mg and 84 mg based on effectiveness and tolerability. Your provider considers how you are responding rather than automatically increasing the dose.
It is important not to change the dose or treatment frequency independently. Spravato is administered under clinical supervision, allowing your healthcare team to evaluate side effects and therapeutic response throughout treatment.
Your provider may also consider your progress, current symptoms, and ability to tolerate treatment when determining the most appropriate ongoing schedule.
Missing a session does not necessarily mean you have to restart treatment from the beginning. The appropriate response depends on when the treatment was missed and whether your symptoms have changed.
If you miss an appointment, contact your treatment provider rather than attempting to compensate by changing the timing or dosage yourself. The FDA prescribing information provides specific guidance for missed sessions, with treatment decisions based on the patient’s clinical situation.
Maintaining communication with your provider helps keep the treatment plan safe and appropriate.
Spravato dosage is only one part of treatment. Your provider also evaluates whether the medication is producing meaningful improvement and whether side effects remain manageable.
Dr. Michael Vines and Our Team at Scottsdale TMS & Spravato monitor patients throughout the treatment process and can adjust the plan when clinically appropriate. The practice provides supervised sessions and ongoing progress tracking as part of its Spravato program.
Spravato dosage and frequency are structured around the patient’s response to treatment. For treatment-resistant depression, adults generally begin with twice-weekly sessions during the first four weeks, followed by weekly treatment during weeks five through eight. From week nine onward, treatment may continue weekly or every two weeks, using 56 mg or 84 mg based on individual response and tolerability.
Because Spravato can cause temporary changes in alertness, perception, and blood pressure, every dose is administered under medical supervision with a required observation period. Scottsdale TMS & Spravato provides individualized treatment planning and monitoring to help eligible patients receive esketamine safely as part of their depression care.
Dr. Vines has practiced psychiatry in Arizona for for over 25 years and has experience working with diverse populations that include children, adolescents, adults, geriatrics, SMI patients, and the chemically dependent.
September 3, 2026
