ketamine therapy for depression

Spravato Treatment Schedule: How Many Esketamine Sessions Do You Need for Depression Relief?

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This page has been medically reviewed by a board-certified psychiatrist with clinical experience in mood disorders on .

Michael Alvear

By Michael Alvear, Health Author & Independent Researcher

My research is published on these scholarly platforms:

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The Bottom Line

Most people need 21 Spravato sessions over six months (8 in month 1, 4 in month 2, 9 in months 3-6), with nearly 50-77% of patients seeing their depression lift by half or more during this period.

Spravato isn’t taken forever. It’s frontloaded—intense at first, then tapering down. But how many sessions you’ll actually need depends on one thing: how your depression responds.

This page walks you through the full treatment map: how many times you’ll come in during the first six months (Wave 1), what happens if you keep going into Months 7–12 (Wave 2), and why only a small number of patients continue into Year 2 (Wave 3).

You’ll see real numbers, evidence-based protocols, and key decision points. Whether you’re planning ahead or trying to make sense of what your doctor told you, this is your guide to how Spravato works in the real world—session by session.

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Considering Other Options?

Curious about alternatives? See our guide on how many IV ketamine infusions you’ll need for depression treatment—the treatment requires a lot fewer sessions.

Ready to explore the complete treatment timeline? We’ve organized everything you need to know into 6 comprehensive sections.

Explore the Complete Guide Below
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Spravato Treatment Guide

Your Complete Spravato Treatment Timeline Guide

Everything you need to know about Spravato treatment schedules and duration

1
How Many Spravato Treatments Will I Need?
Understanding the first 6 months of treatment and what to expect

5 min read ›

2
Why Does Spravato Require So Many Treatment Sessions?
The science behind the intensive treatment schedule

3 min read ›

3
How Many Spravato Treatments Will I Need After 6 Months?
Maintenance phase scheduling and long-term treatment plans

4 min read ›

4
Extended Maintenance (Year 2 and Beyond)
What happens after the first year of treatment

3 min read ›

5
Spravato Treatment Schedule & Recovery Timeline FAQ
Quick answers to your most pressing questions

6 min read ››

6
Scientific Notes & Citations
Research references and clinical evidence supporting this guide

2 min read ›

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1

How Many Spravato Treatments Will I Need?

The first 6 months of Spravato treatment follows a structured protocol approved by the FDA. This schedule is designed to build therapeutic effects during an intensive induction phase, then gradually reduce frequency as your response stabilizes.

Treatment Phase Month # of Spravato Sessions Total Monthly Sessions
Induction Phase Month 1 2x per week 8
Initial Maintenance Phase Month 2 1x per week 4
Continued Maintenance Phase Months 3–6 1x every other week 9
Total # of Sessions needed in first 6 months: 21*

*Important note: This represents the standard FDA-approved protocol. Some people may need many more sessions for extended maintenance.

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2

Why Does Spravato Require So Many Treatment Sessions?

It’s not arbitrary. It’s what worked in the trials.

The 21-session structure in Wave 1 isn’t a guess. It’s the schedule used in Spravato’s pivotal clinical trials—8 sessions in Month 1, 4 in Month 2, and 9 spread out every other week from Month 3 to Month 6. That’s what gave patients the best shot at response or remission.

This rhythm wasn’t picked at random. It’s built around how esketamine works in the body—and how long its antidepressant effects typically last. The early, frequent dosing builds momentum. The biweekly sessions in Months 3–6 help hold the gains and stop relapse before it starts.

But it’s not one-size-fits-all.

Some people don’t need all 21 sessions. If you hit remission early, your provider might taper sooner. Others might need more frequent sessions in Months 3–6 if symptoms come back. It’s common for doctors to shift patients from every-other-week to weekly for short stretches based on clinical judgment.

So yes, 21 is the standard. But no, it’s not rigid. It’s a research-backed starting point—and it leaves room to adjust as needed.

What Happens During The First 6 Months Of Spravato Treatment And Why Do Most People Stop Here?

Spravato tends to work fast. For many, it works early. Across 33 systematic reviews, 49–77% of patients see a clinical response during Wave 1. About 32–58% reach full remission.

Here’s what that means: a clinical response means your depression lifts by at least 50%. You’re not all the way better, but it’s lighter. A remission means symptoms are minimal or gone. You feel well again. You feel like you.

Most people who reach remission do it by the end of Month 6. And many stop treatment completely at that point.

Takeaway

The 21-session Spravato protocol is based on clinical research that helped 49-77% of patients achieve significant depression relief, while still allowing for personalized adjustments.

Before starting Spravato treatment, patients should arrange reliable transportation for all 21 sessions, as you cannot drive yourself home after each appointment due to dissociative effects and post-session grogginess. Many insurance plans, including Medicaid and Medicare Advantage, cover medical transportation to mental health treatments. Our guide, NEMT: Who Qualifies and How to Book walks through eligibility requirements and the scheduling process. Planning transportation in advance prevents missed appointments, which can disrupt the frontloaded protocol and delay your path to remission.

The 21-session structure means you’ll need eight rides in the first month alone, followed by weekly and then biweekly trips through month six. If you qualify for Medicaid NEMT services, you can establish recurring rides through Medicaid rather than calling to schedule each appointment individually. This standing-order approach reduces administrative burden during the intensive first three months when consistency matters most for clinical outcomes.

Because dissociation, imbalance, and mental fog persist for 4–6 hours post-session, same-day driving is medically prohibited—you’ll need a ride home after every appointment, not just the first few. Patients often underestimate how many transportation arrangements the full protocol requires or assume they’ll “feel fine” after early sessions. Understanding NEMT benefits (Non Emergency Medical Transportation) before your first dose ensures you have a safe, sustainable plan through remission or the 12-week decision point.

3

How Many Spravato Treatments Will I Need After 6 Months?

Treatment Phase Month # of Spravato Sessions Total Monthly Sessions
Late Maintenance Months 7–12 Monthly or every-other-week sessions 0–12

What Happens In Months 7-12 Of Spravato Treatment: Do I Need To Continue After The Initial Phase?

After the first 6 months, your Spravato journey splits into three paths: stopping or tapering off after remission, continuing with less frequent sessions if you’ve improved but aren’t fully well, or stopping if you haven’t responded by week 12.

By Month 6, most people fall into one of three groups.

1. You reached remission late and are tapering off.

If remission came around Month 5 or 6, your provider may slow things down instead of stopping cold. That might mean 2–4 more sessions, spaced monthly or every six weeks, just to lock in progress and lower the risk of relapse.

2. You haven’t hit remission, but the response is strong.

In clinical terms, a response means your symptoms dropped by 50% or more. That doesn’t mean you’re fully well—but life might feel livable again. In that case, Wave 2 can help hold the line, keep things steady, and buy more time to heal.

3. You haven’t responded—and it’s time to stop.

Spravato is frontloaded. Most of its power shows up in the first 4 to 8 weeks. If nothing’s changed by Week 12, the odds of a delayed response are slim. At that point, continuing often does more harm than good—especially given the time, cost, and demands of in-clinic dosing.

Our research summary backs this up: if there’s no response in the first 12 weeks, future benefit is unlikely. The only exception? Rare cases of extreme, multi-drug-resistant depression—where a cautious extension might be considered as a last resort.

What’s The Bottom Line On Continuing Spravato Beyond 6 Months?

Late maintenance isn’t about waiting to see if Spravato will finally work. It’s about supporting something that already is—or easing out of it on your own terms.

Takeaway

If Spravato hasn’t improved your depression by week 12, it’s unlikely to work later, but if you’ve had a 50% symptom reduction or reached remission, months 7-12 can solidify those gains.

My Personal Take

Author

I Went Through 30 Spravato Treatments

I built this page out of frustration—not frustration with the medicine, but with the lack of clear, honest information. I searched medical websites, ketamine clinic pages, and patient forums, and almost no one would tell you upfront how many Spravato treatments you might realistically need. It’s like providers are afraid to say the number out loud.

Why Are Providers So Vague?

I understand some of the hesitation. The FDA labeling says dosing should be individualized to the least frequent schedule that maintains remission or response, and the need for continued treatment should be reevaluated after the induction phase. That’s cautious, responsible guidance. But if you follow the official recommendations, you’re looking at at least 21 sessions over six months. Personally, I completed 23 sessions during that period, then another seven between months seven and nine. After that, I stopped completely because I didn’t need more.

Why Don’t They Just Say It?

Here’s the thing: providers do post the schedule—twice a week for four weeks, once a week for the next four, then every other week. But notice what happens? I made you do the math. Why not just say: you’ll probably need around 21 treatments, though some people may need fewer and some may need more?

The Elephant in the Room: Cost

I suspect part of the hesitation is money. Spravato is expensive. If someone gives you a rough number like 21 and you start adding it up, you’ll quickly see eye-popping totals. Maybe clinics fear that being upfront will scare people off. But in my view, leaving patients guessing is unfair.

Why This Page Matters

I created this page because you deserve real numbers. You can’t plan your finances, time off work, childcare, or the other burdens of ketamine treatment if no one gives you an honest ballpark. I want you to make the best decision for yourself—and that starts with knowing what you’re realistically signing up for.

4

Extended Maintenance (Year 2 and Beyond)

Year 2 Spravato treatment is rare, limited to occasional boosters for those with a history of relapse or patients who experienced substantial but incomplete relief, with most people finishing treatment within the first six months.

Very few people continue into Year 2—and there’s a reason for that.

Most patients stop by the end of Wave 1 or Wave 2. But for a small group, using Spravato for extended maintenance has a role. These are the exceptions, not the norm.

Some use it to hold on to remission.

If you reached remission earlier and have a history of relapse, your provider might recommend occasional boosters—monthly, quarterly, or as-needed—to keep you steady. These aren’t full treatment cycles. They’re light-touch interventions to hold the line when stability is fragile.

Others keep going without full remission.

If Spravato brought major relief but didn’t get you all the way there, it might still be worth continuing—at a slower pace. For some, the risk of stopping is higher than the burden of staying in treatment. That’s a clinical call.

But this phase should never be the default.

Spravato is a frontloaded treatment. The strongest effects happen early. If you haven’t made real progress by Month 6—many would say by Week 12—there’s little reason to expect a breakthrough in Year 2.

Extending treatment without clear benefit isn’t harmless. It drains time, money, and trust. And it delays the pivot to other options that might actually work.

Who Should Consider Extended Spravato Maintenance Beyond One Year?

Extended maintenance isn’t a failure. But it should never be automatic. It’s a deliberate choice—used sparingly, for the right reasons, and only when the benefits are still real.

Takeaway

Year 2 Spravato treatment is reserved for specific situations—maintaining fragile remission with history of relapse or continuing substantial relief—not as a last-ditch effort for non-responders.

5

Spravato Treatment Schedule & Recovery Timeline FAQ

Your guide to depression treatment with Spravato: sessions needed, response times, and when to continue or stop

How many Spravato sessions will I need in total, and what does the treatment schedule actually look like?

Most patients receive 21 Spravato sessions in the first six months. The schedule is frontloaded: two sessions per week in the first month (8 total), once a week in month two (4 total), and every other week from months three to six (9 total).

Spravato is fast-acting. Most people know within the first few weeks if it’s helping. A clinical response means your depression improves by at least 50%. Remission means your symptoms are minimal or gone. For the majority of patients, one of those outcomes—response or remission—happens within the first three months.

If there’s progress but not full recovery, treatment can continue into months 7–12 with less frequent sessions. Beyond that, some patients receive occasional booster treatments, but that’s rare.

That means you’ll usually know early if Spravato is working—and most people either taper, stop, or adjust treatment after the 21-session protocol.

What’s supposed to happen during the first few months of Spravato treatment—and how do you know if it’s working?

The first few months follow a stepped schedule: two sessions per week in month one, once a week in month two, and every other week in months three to six. This is the standard protocol—called Wave 1—designed to give the drug enough time and intensity to trigger a therapeutic response.

Spravato is fast-acting. That means you’ll usually know early if it’s working. A clinical response means your depression improves by at least 50%. That might feel like your energy coming back, your thoughts softening, or the weight lifting just enough to function again. Remission means your symptoms are minimal or gone—you feel normal, not just better.

Most people who benefit reach one of those points in the first three months. If nothing shifts by week 12, the odds of it working later are low.

That means you’re not waiting forever—you’ll know within the first few months whether it’s helping, and how far it can take you.

What if Spravato doesn’t help at all—how long do you give it before deciding it’s not working?

Most clinics give Spravato about 8 to 12 sessions—roughly two months—before making that call. If there’s been no shift in mood, thinking, energy, or function by then, it’s a strong signal that the treatment isn’t effective. This early window is the critical stretch.

Spravato acts quickly for most people who benefit. Some feel lighter within a few sessions. Others notice that thoughts quiet, emotions loosen, or their ability to get through the day improves. A clinical response usually means symptoms drop by 50%. Remission means you feel like yourself again—steady, clear, well. These turning points tend to happen within the first three months if they’re going to happen at all.

If none of that shows up by week 12, the likelihood of success drops off fast—and the treatment plan usually shifts.

That means no real movement after two to three months is the red flag that it’s time to stop and reassess.

Who decides how long you stay on Spravato—and how flexible is the treatment plan if things change?

Your doctor decides your Spravato treatment length based on how your depression responds, with substantial flexibility to adjust the plan. The standard protocol follows a three-wave structure: 21 sessions over the first 6 months (Wave 1), potential continuation for months 7-12 (Wave 2), and rarely, extended maintenance in year 2 (Wave 3).

Your treatment plan can shift based on your response. If you reach remission early, your provider might taper sooner than scheduled. If symptoms return during months 3-6, sessions might increase from bi-weekly to weekly.

Most patients who see benefits respond within the first 3 months, with depression symptoms lifting by at least 50%. Those reaching full remission (minimal or no symptoms) typically do so by month 6 and often stop treatment entirely.

That means your Spravato journey isn’t locked in stone—it’s a clinical partnership that adapts as your needs change, with decision points built into the treatment timeline.

When should I consider stopping Spravato treatment, and what signs indicate it’s not working for me?

If you’ve completed the early phase—typically 8 sessions in the first month and 4 in the second—and nothing has shifted, it may be time to stop. That means no change in your thinking, energy, or ability to function. Just the same weight, session after session.

Spravato tends to show its hand quickly. For most patients who benefit, progress shows up early. That might mean lighter moods, fewer dark thoughts, or a sense that you’re finally surfacing. A strong response usually means symptoms are cut in half. Full remission means you feel well again—symptom-free or close.

If none of that happens by the 12th week, the odds of it kicking in later are low. Most clinicians use that point to reevaluate.

That means the first few months aren’t just a beginning—they’re the test. No change by then is the clearest sign to move on.

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EVIDENCE-BASED RESEARCH

What Does Scientific Research Show About IV Ketamine’s Effectiveness For Depression?

Systematic Reviews of Ketamine Therapy Report Cover

I pulled together 33 systematic reviews from the last five years into one report—so you don’t have to rely on hype, guesses, or anecdotes. This is the highest level of real-world evidence we have.

Inside My Report You’ll Find

  • What percent of patients enter remission—broken down by delivery method
  • Which method is most effective—IV, injection, or Spravato nasal spray
  • How fast ketamine can work to reduce or end symptoms
  • Which combinations (like psychotherapy) may enhance response
  • And a lot more…

Verified by the Platforms That Matter

This research summary report has been published across four trusted platforms that host peer-reviewed or open science content, including:

– Published ketamine research on Zenodo
– Ketamine evidence summary hosted on SSRN
– Scientific report on ketamine outcomes on Figshare
– Evidence-based ketamine therapy report on OSF

View the PDF Report Here:

6

Scientific Notes & Citations

The treatment phases and session counts on this page are based on published clinical trial protocols, FDA guidance, and systematic reviews of Spravato (esketamine) outcomes. Click to expand the supporting evidence behind each phase:

Click to view clinical notes and citations

Wave 1: Induction + Initial Maintenance (Months 1–6)

The 21-session structure—8 sessions in Month 1, 4 in Month 2, and 9 every-other-week from Months 3–6—comes directly from Spravato’s pivotal Phase 3 trials and the FDA-approved protocol. This is the schedule used in TRANSFORM-2 and the FDA medical review.

The biweekly maintenance frequency reflects how long esketamine’s antidepressant effects typically last post-dose, as shown in studies like this one. It’s not arbitrary—it’s grounded in the pharmacokinetics of NMDA antagonism and relapse-prevention modeling.

Wave 2: Late Maintenance (Months 7–12)

Continuation beyond 6 months is supported for patients who (1) reached remission late and need reinforcement, or (2) had a strong partial response. The SUSTAIN-1 study is the primary evidence base here, showing continued benefit for select patients at reduced dosing frequencies.

However, Sustain-3 study shows diminishing returns in non-responders by Week 12, reinforcing the importance of reassessing treatment value at the end of Wave 1.

Wave 3: Extended Maintenance (Year 2+)

Long-term use of Spravato into Year 2 is rare. The FDA label permits as-needed maintenance, but this is based on clinical judgment, not a standardized protocol. Ongoing treatment is typically reserved for patients with severe, chronic, treatment-resistant depression who relapse upon discontinuation.

Guidance from experts like the ASKP3 Consensus Statement on Esketamine supports strategic booster sessions for stability—not indefinite continuation. These decisions are shaped by patient history, relapse risk, and functional outcomes.

Response & Remission Estimates

Response and remission ranges (49–77% response, 32–58% remission) come from a synthesis of 33 systematic reviews between 2020–2024. For full methodology and links to each review, see our publication on Zenodo: Systematic Reviews and Meta-Analyses of Ketamine Therapy for Depression (2020–2024).

Definitions align with the standard: response = ≥50% symptom reduction; remission = minimal/no symptoms per validated scales (e.g. MADRS, PHQ-9).