How Many Spravato Sessions Will I Need For Depression Treatment?
This guide answers your questions about treatment frequency, duration, and what to expect. Learn how your doctor determines your personalized schedule, signs the nasal spray is working, and when it might be time to continue or try something different.
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.
Curious about other options? See our guide on how many IV ketamine infusions you’ll need for depression treatment—the treatment schedule looks quite different.”
Number of Spravato Treatment Sessions Needed During First 6 Months
| WAVE 1 Treatment Phase | WAVE 1 Month | # of Spravato Sessions | WAVE 1 Total Monthly Sessions for Spravato |
|---|---|---|---|
| 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* | ||
Why Does Spravato Require 21 Sessions And When Might Your Treatment Plan Change?
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 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.
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.
Spravato Treatment Frequency During WAVE 2 (Months 7–12)
| WAVE 2 Treatment Phase | WAVE 2 Month | # of Spravato Sessions | WAVE 2 Total Monthly Sessions for Spravato |
|---|---|---|---|
| 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?
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.
How Can You Be Sure Ketamine Therapy Actually Works?
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:
Is Long-Term Spravato Treatment (Beyond One Year) Necessary For Depression Remission?
| WAVE 3 Treatment Phase | WAVE 3 Month | # of Spravato Sessions | WAVE 3 Total Monthly Sessions for Spravato |
|---|---|---|---|
| Extended Maintenance | Year 2 (12 Months) | Only if needed: monthly, quarterly, or as-needed boosters | 0–12 |
WAVE 3 – Extended Maintenance (Year 2 and Beyond): Rare, and Not Automatic
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, 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.
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 Daly et al. (2021). 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, meta-analyses (e.g. Correia-Melo et al., 2022) show 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).