If Spravato has helped you feel more like yourself, it’s understandable to wonder: Will I need it forever? The short answer is that there is no standard rule requiring lifelong treatment, and there is no universal date when everyone should stop.
Esketamine maintenance is an individualized decision. Your symptoms, treatment history, side effects, preferences, and the return of symptoms when treatment changes all matter. At Light-tunnel Behavioral Health Services Inc. in New Haven, Dr. Omolola Aragbada, PMHNP-BC, is one of the psychiatric providers who can help you discuss your options and plan care around your needs.
Acute treatment and maintenance: what’s the difference?
The initial induction phase is designed to start treatment and assess your response. Under current FDA labeling for adults with treatment-resistant depression (TRD), Spravato is generally given twice weekly for four weeks. At the end of that period, your prescriber evaluates whether treatment is helping and whether it should continue.
If it does, the schedule generally changes to weekly dosing during weeks five through eight. From week nine onward, treatment may be weekly or every other week. The aim is to find the least frequent schedule that maintains your response or remission, with ongoing clinical reassessment, not to automatically reduce treatment on a fixed timetable. The FDA label does not set one maximum duration for everyone. (FDA prescribing information)
| Acute induction | Maintenance | |
|---|---|---|
| Typical schedule | Twice weekly for four weeks | Weekly in weeks five through eight; then weekly or every other week |
| Main purpose | Assess initial benefit and tolerability | Sustain benefit with an individualized schedule |
| What guides decisions | Symptoms, side effects, and clinical assessment | Ongoing benefit, symptom changes, side effects, and treatment burden |
Spravato is administered under supervision in a certified healthcare setting. The nasal administration itself is brief, but you must remain for at least two hours of observation after each dose. Plan for the visit, observation, and transportation home; the appointment is not simply a quick stop-in. You must not drive or operate machinery until the next day after a restful sleep. (FDA prescribing information.)
What the maintenance research tells us, and doesn’t
A key randomized controlled trial, SUSTAIN-1, studied adults who had first received esketamine with an oral antidepressant and then achieved stable remission or stable response. Researchers randomized these selected participants either to continue esketamine or to switch to placebo nasal spray while continuing the oral antidepressant.
Among participants who had achieved stable remission, relapse occurred in 26.7% of those who continued esketamine, compared with 45.3% of those switched to placebo. Among stable responders who had not reached remission, relapse occurred in 25.8% with continued esketamine and 57.6% after switching to placebo (Daly et al., 2019). These results suggest that, for people who responded and tolerated treatment in this trial, continuing it reduced relapse risk.
But the findings do not show that everyone needs lifelong Spravato. Participants entered the randomized phase only after demonstrating a stable response or remission, and the study did not establish a universal stopping point or prove that every patient benefits from indefinite treatment. Its results are useful evidence for a maintenance conversation, not a personal forecast.
A helpful metaphor: treatment may be like keeping a difficult-to-turn gear moving smoothly. If symptoms remain steady, your prescriber may consider whether a less frequent schedule still works. If depression begins to return, the plan may need to change. A dose reduction or interval change is not a test you need to conduct on your own.
Ongoing treatment, stopping, and other options: a comparison
| Option | Potential benefit | Important consideration |
|---|---|---|
| Continue maintenance | May help sustain improvement; SUSTAIN-1 found lower relapse rates among selected stable responders who continued treatment. | Repeated supervised appointments, observation time, side effects, cost, and ongoing reassessment. |
| Stop or change the schedule with your prescriber | May reduce visit burden if treatment is no longer needed or another plan is appropriate. | There is no single evidence-based stopping date for everyone. Monitor for returning depression and agree on follow-up. |
| Consider other or combined care | Therapy, medication management, or another intervention may fit your goals and history. | Options are not interchangeable, and there is no simple head-to-head maintenance trial proving one is best for every person. |
Stopping and tapering are not the same question. SUSTAIN-1 tested switching from esketamine to placebo nasal spray; it did not compare different tapering schedules. That trial can inform relapse risk after stopping, but it does not establish one taper protocol for everyone. If you are considering stopping, ask your prescriber how to plan the change and when to check in. Do not change your dose or treatment schedule on your own.
How maintenance compares with TMS and other care
Spravato maintenance involves a supervised medication session and at least two hours of observation. TMS uses magnetic pulses to stimulate targeted brain networks and does not require Spravato’s post-dose observation period, but a course typically involves frequent clinic visits over several weeks. BrainsWay is one of the most researched TMS systems. TMS and Spravato have different treatment schedules and considerations; evidence from separate studies does not mean one is automatically better for you or that TMS is a direct substitute for ongoing esketamine.
Psychotherapy and medication management may also be part of a plan, whether or not you continue Spravato. Depending on your diagnosis and past treatment, your clinician may discuss one approach or a combination. If you are comparing options, read our New Haven guide to Spravato or TMS for treatment-resistant depression.
Questions to bring to your next appointment
You do not need to decide on a lifetime of treatment today. Instead, ask your psychiatric provider:
- What improvement are we tracking? Discuss mood symptoms, daily functioning, and other goals that matter to you.
- How often should we review the schedule? Ask how your response, side effects, and treatment burden will inform decisions.
- What should I watch for if treatment changes? Agree on whom to contact and when, especially if depressive symptoms return.
- What are my other options? Ask whether therapy, medication management, TMS, or another approach could be part of your care.
- What will treatment cost? Review insurance benefits, authorization requirements, and any out-of-pocket expenses before making changes.
At Light-tunnel Behavioral Health Services Inc. in New Haven, care is tailored to your circumstances. Dr. Omolola Aragbada, PMHNP-BC, is one of the psychiatric providers available to support treatment planning. If you are self-pay, you can still ask about psychiatric services and whether Spravato, medication management, therapy, or another service may fit your needs. Request a clear estimate of evaluation, treatment, and follow-up costs; insurance coverage and out-of-pocket costs vary. Learn more about Spravato and TMS treatment options or contact the practice.
What to do, and what to avoid
Do:
- Keep scheduled follow-ups and tell your provider about changes in mood, sleep, functioning, or side effects.
- Discuss the benefits and burdens of continuing treatment at regular reviews.
- Contact your care team promptly if you feel depression returning or have new concerns about staying safe.
Avoid:
- Stopping, spacing out, or changing Spravato treatment without discussing it with your prescriber.
- Assuming that a good stretch means you must stop, or that a past response means you must continue forever.
- Waiting for a routine appointment if you are in immediate danger or cannot stay safe.
Medical safety disclaimer and crisis resources
This article is for education only. It is not a diagnosis or a substitute for individualized medical advice. Spravato has important risks and monitoring requirements, including possible sedation, dissociation, increased blood pressure, and respiratory depression. It must be administered under direct supervision in a certified healthcare setting. Your qualified healthcare provider can assess whether it is appropriate for you.
If you may harm yourself or someone else, or cannot stay safe, call or text 988 in the United States for the Suicide & Crisis Lifeline. For immediate danger or a medical emergency, call 911 or go to the nearest emergency department. Do not wait for a routine appointment.
References
- Daly EJ, Trivedi MH, Janik A, et al. “Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression: A Randomized Clinical Trial.” JAMA Psychiatry. 2019;76(9):893–903. PubMed
- U.S. Food and Drug Administration. SPRAVATO (esketamine) nasal spray: Prescribing Information. FDA label
Continue the Series
Next: What to Expect During Spravato Treatment: A Step-by-Step Guide to Esketamine Therapy in New Haven