Spravato, also known as esketamine nasal spray, follows a structured treatment schedule for adults with treatment-resistant depression. Unlike medications taken at home, Spravato is administered in a certified healthcare setting where patients are monitored after each dose. The schedule begins with more frequent treatments and may gradually become less frequent depending on treatment response and tolerability.
Before starting Spravato, a healthcare provider evaluates your symptoms, medical history, previous depression treatments, and overall suitability for esketamine treatment. This evaluation helps determine whether Spravato is an appropriate option and provides a starting point for monitoring your progress.
Once treatment begins, each appointment includes medication administration followed by a period of observation. Because Spravato can temporarily affect alertness, perception, and blood pressure, patients should plan for the treatment visit rather than expecting to leave immediately after using the nasal spray.
The first four weeks are known as the induction phase. During this period, Spravato is typically administered twice each week for treatment-resistant depression. The FDA-approved dosing schedule lists 56 mg or 84 mg for these treatments, with the first dose starting at 56 mg. Dosage may be adjusted based on effectiveness and tolerability.
This more frequent schedule gives your treatment team an opportunity to observe how you respond to esketamine and assess whether depressive symptoms are improving.
During each visit, the medication is administered as a nasal spray. You then remain under observation while the effects gradually wear off. Your provider can monitor your response and address temporary effects such as dizziness, sleepiness, nausea, dissociation, or changes in blood pressure.
If treatment continues beyond the initial four weeks, the schedule generally becomes less frequent. During weeks five through eight, the FDA-recommended schedule for treatment-resistant depression is once weekly, using either 56 mg or 84 mg depending on the individual’s treatment plan.
By this point, your provider has more information about how your symptoms and overall functioning have responded. The goal is to maintain improvement while using the least frequent schedule that continues to provide benefit.
This does not mean every patient will experience the same progress by week five. Depression can respond differently from person to person, so ongoing assessment remains important.
After the first eight weeks, the schedule may become even less frequent. For adults receiving Spravato for treatment-resistant depression, the FDA labeling allows treatment once weekly or every two weeks during this phase. The frequency should be individualized to the least frequent dosing schedule that maintains response or remission.
Your provider may consider your symptom improvement, tolerability, and overall treatment response when determining how often you should continue receiving Spravato.
Maintenance treatment is not necessarily identical for everyone. Some patients may need more frequent treatment to maintain improvement, while others may be able to extend the time between sessions.
Regardless of the treatment week, the appointment involves more than administering the medication. Patients receive Spravato under direct supervision and remain at the treatment center for monitoring.
The FDA prescribing information recommends monitoring for at least two hours after administration and assessing whether the patient is clinically stable before discharge.
Patients may be advised to avoid food for at least two hours and liquids for at least 30 minutes before administration because nausea and vomiting can occur.
Planning transportation home is also important because Spravato may temporarily affect alertness and coordination.
The treatment schedule provides opportunities to evaluate whether Spravato is helping. Your provider may monitor changes in depressive symptoms, daily functioning, mood, and your ability to participate in normal activities.
The FDA recommends evaluating evidence of therapeutic benefit at the end of the induction phase when determining whether continued treatment is appropriate.
At Scottsdale TMS & Spravato, treatment can be monitored as part of an individualized approach rather than treating the schedule as identical for every patient.
Knowing what happens from week to week can make starting Spravato feel more manageable. The initial phase involves frequent appointments, followed by a gradual reduction in treatment frequency when appropriate.
Dr. Michael Vines and Our Team at Scottsdale TMS & Spravato can explain what to expect during each stage, discuss your response to treatment, and help determine whether Spravato fits into your broader depression care plan.
A typical Spravato treatment schedule begins with twice-weekly sessions during weeks one through four, followed by weekly treatment during weeks five through eight. From week nine onward, treatment may continue weekly or move to every two weeks based on individual response and tolerability. Each appointment includes supervised administration and post-treatment monitoring. Understanding the schedule ahead of time can help you prepare for the commitment and know what to expect as treatment progresses. Scottsdale TMS & Spravato can provide guidance throughout the process and help you understand your personalized treatment plan.
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.
August 23, 2026
