Spravato treatment starts with twice-weekly sessions for the first four weeks, then gradually spaces out to once a week or every two weeks. There is no fixed end date. Most people stay on it for months, and some continue for a year or longer depending on how well they respond and whether symptoms return.
The First Four Weeks: Induction Phase
During weeks one through four, you’ll visit a certified clinic twice a week. Each session involves self-administering the nasal spray under supervision, then staying for at least two hours of monitoring before you’re cleared to leave. That means eight sessions in the first month alone, which is a significant time commitment. You cannot drive yourself home afterward.
Some people notice improvement within hours or days of their first dose. In clinical trials, some participants reported reduced depressive symptoms within 24 hours. Others need several sessions before feeling any difference. The full picture of how well the medication is working usually becomes clear by the end of this four-week induction period.
Weeks Five Through Eight: Transition Period
Starting in week five, sessions drop to once a week. You’ll still go to the same clinic, still be monitored for two hours, and still need someone to drive you home. This phase lasts four weeks. By this point, most people who respond to the treatment are experiencing significant relief, typically within four to six weeks of starting.
Week Nine and Beyond: Maintenance
From week nine forward, your provider will schedule sessions either once a week or once every two weeks. The exact frequency depends on how stable your symptoms are. This is the open-ended phase of treatment, and it’s where most of the total treatment time accumulates. There’s no predetermined stopping point built into the prescribing guidelines.
In the longest completed clinical trial, patients were treated for up to 48 weeks (about 11 months). A separate ongoing study has tracked patients for up to three years. Of the 802 people in the 48-week study, about 45% stayed on treatment for at least six months and 17% continued for a year or more. These numbers reflect both people who chose to stop and those who stayed the course, so they don’t represent a recommended duration.
How Long Each Session Takes
The nasal spray itself takes only a few minutes to administer. But you’re required to remain at the clinic for a minimum of two hours afterward so a provider can monitor you for sedation and dissociation, two common short-term side effects. A provider then assesses whether you’re stable enough to leave. In practice, plan for each visit to take roughly two and a half to three hours of your day.
When Treatment Ends
There are no strict criteria for stopping Spravato. The decision is based on clinical judgment: how well you’re doing, whether symptoms have stayed in remission, and what happens to your mood if sessions are spaced further apart. Your provider will monitor you closely when considering discontinuation.
One reassuring finding from clinical trials is that patients who stopped Spravato did not need to taper the dose or gradually reduce the frequency. There was no evidence of withdrawal symptoms in the four weeks after stopping treatment. That said, stopping any depression treatment carries the risk of symptoms returning, so the decision is usually made carefully and with close follow-up.
Long-Term Safety Considerations
For people staying on Spravato for many months, the safety data is generally reassuring but not without caveats. Cognitive testing in trials showed no significant negative effects for most patients. However, in adults 65 and older, there was some evidence of slower reaction times after about 44 weeks of treatment, though this varied widely between individuals and partially improved after stopping.
Bladder symptoms are worth knowing about for long-term use, since ketamine-related compounds can irritate the urinary tract. In the year-long study, about 19% of patients reported bladder-related symptoms at some point. The vast majority of these (90%) resolved while still on treatment, and only one person needed a dose reduction because of urinary issues. This is something your provider will likely ask about periodically if you stay on treatment for an extended period.