Since being FDA-approved in 2019 for adults with treatment-resistant depression, Spravato® (esketamine) therapy has proven to be one of the biggest advancements in depression treatment in decades.
For people living with severe or treatment-resistant depression (TRD), it can be a true game-changer, helping many to finally find relief when other treatments haven’t worked.
Because Spravato is a relatively new medication, and the only one of its kind, it’s natural to have questions about what it involves – from the typical treatment schedule and esketamine dosage, to how it’s administered and what it actually involves.
Below, we’ll walk you through the essentials, step by step.
An overview of Spravato esketamine therapy
Spravato® is an FDA-approved medication for adults with treatment-resistant depression or major depressive disorder (MDD) with suicidal thoughts or behaviors. It’s the first and only medication of its kind, and represents a major step forward in depression care.
The active ingredient in Spravato is esketamine, a derivative of ketamine that works differently from SSRIs and SNRIs. Instead of targeting serotonin or norepinephrine, it acts on the glutamate system – helping repair and strengthen communication between brain cells involved in mood regulation.
This unique mechanism means Spravato can start working much faster than standard antidepressants, sometimes improving symptoms within just hours or days.
How is Spravato administered?
Spravato is a nasal spray, making it a comfortable and accessible treatment option. It’s self-administered by the patient, but always within a certified clinical setting under medical supervision.
Each single-use Spravato device contains a 28 mg esketamine dosage (the important active ingredient, which is dispensed in two sprays (one per nostril). Depending on your treatment plan, you’ll be prescribed a Spravato dose of 56 mg or 84 mg, which means you’ll use either two or three devices per session; a total of four or six sprays.
Here’s exactly what to expect at a typical Spravato session:
- Check-in and preparation: Your psychiatrist or nurse reviews how you’ve been feeling, checks your vital signs, and confirms your dosage for the day.
- Self-administration: You’ll be given your dose kit, which contains either 2 or 3 nasal spray devices. You self-administer the Spravato nasal sprays under medical guidance, with short rests between sprays to ensure comfort and correct timing.
- Observation period: You’ll rest in a comfortable chair for about two hours, while your care team monitors your blood pressure, comfort, and any short-term effects.
- After the session: Because Spravato can cause temporary drowsiness or disorientation, you’ll need someone to drive you home. You also shouldn’t use any other machines or do anything where you need to be completely alert until the next day, after a restful sleep.
It’s normal to experience mild, short-lived side effects from Spravato, which is the main reason it’s administered in a medical setting – to ensure your comfort and safety at all times. These side effects include dizziness, drowsiness, mild dissociation (feeling “dream-like” or detached), and temporary increases in blood pressure, but typically all resolve before you leave the clinic.
What is the typical Spravato treatment schedule?
Spravato therapy follows a structured schedule that gradually reduces in frequency as you adapt to the treatment and your symptoms improve.
The schedule includes three main phases:
- Weeks 1–4: Induction phase – Two sessions per week to begin establishing response.
- Weeks 5–8: Optimization/Maintenance phase 1 – One session per week at your optimized dosage.
- Ongoing maintenance (after week 8): Usually once per week or every two weeks, depending on your progress and your psychiatrist’s recommendation.
Every person’s plan is individualized and continuously monitored. Your psychiatrist will adjust the treatment frequency and/or dosage depending on your responses, such as if you improve quickly, need a slower pace, or benefit from longer intervals.
Spravato® treatment schedule
What is the esketamine dosage in Spravato?
Spravato comes in single-use nasal spray devices that each contain 28 mg of esketamine, but the typical dosage per treatment is either 56 mg (2 devices) or 84 mg (three devices).
The dosage you’ll receive depends on your type of depression and where you are in your Spravato treatment schedule. Typically as follows:
For treatment-resistant depression (TRD):
- 56 mg for the first treatment
- Either 56 mg or 84 mg thereafter, based on individual response and tolerance
For major depressive disorder with suicidal ideation (MDSI):
- 84 mg for all treatments; twice weekly for 4 weeks
- Dose may be reduced to 56 mg based on tolerability
Your psychiatrist determines the right dose for you based on your symptoms, response, and overall health. A higher dose doesn’t necessarily mean better results – it’s about finding the most effective and comfortable balance for each person.
Spravato® medication dose packs
What to expect as treatment progresses
One of the most exciting things about Spravato is how quickly it can start to work.
- Within 24–72 hours: Most patients feel lighter, calmer, or more clear-headed within 24 hours of their first treatment. Many report fewer suicidal thoughts within days.
- 1–4 weeks: Clinical studies show significant reduction in depression symptoms within the first month – often a dramatic improvement compared to traditional antidepressants.
- After 4 weeks: By week 5, symptoms should have reduced to a point of stability. By this stage, ongoing treatment is about maintaining this new-found relief from symptoms. Treatment for people with MDSI often stops at this point.
It’s important to highlight that Spravato isn’t a “cure” for depression, but for many, it’s a vital foundation for recovery – providing the necessary relief from severe depressive symptoms so that therapy and other supports can then truly take hold.
Why personalized care with Spravato is so important
Spravato should never be prescribed in isolation. It’s designed for people with treatment-resistant depression or MDD with suicidal thoughts or behaviors – which means it follows earlier first-line treatments, and usually works alongside them.
Spravato can be taken with or without oral antidepressants, but it’s most common to be in combination with other medication – all of which is monitored and managed as part of your overall psychiatric treatment plan.
However, for long-term recovery, psychotherapy is also essential. Studies have proven that depression is far more complex than just brain chemistry, and while medications are often necessary to reduce symptoms, it’s therapy that helps create lasting change – through developing coping mechanisms, perspective shifts, and healthier patterns.
Spravato treatment at REACH Behavioral Health in Ohio is integrated into a complete care model that includes:
- Medication management and psychiatric care to monitor your progress and adjust your treatment dosages and frequencies as needed.
- Psychotherapy, such as CBT or DBT, to process emotional changes, strengthen long-term coping strategies, and maintain long-term stability.
- Collaborative communication between your providers to ensure every part of your care plan works together.
This personalized, integrated approach helps improve both short-term relief and long-term stability.
Get Spravato esketamine therapy at REACH, Ohio
Spravato® is a breakthrough treatment that’s changing lives for people with treatment-resistant depression – giving hope where it once felt lost.
At REACH Behavioral Health, Spravato is administered at our Westpark clinic on Cleveland’s West Side, a certified setting staffed by experienced psychiatrists and nursing professionals.
We also provide psychiatric care and therapy services through our other Ohio locations and via teletherapy, so you can continue your ongoing care conveniently in-between your Spravato treatments.
If you’d like to learn more about Spravato or explore whether it might be right for you, reach out to our team. We’ll guide you through the process, answer your questions, and help you take the next step toward finding relief.
FAQs about Spravato
What is Spravato used to treat?
Spravato® is approved for adults with treatment-resistant depression (TRD), and major depressive disorder with suicidal ideation (MDSI)
How frequently is Spravato administered?
Most people start with two sessions per week for four weeks, then transition into a maintenance phase. Maintenance is usually weekly or biweekly, depending on individual response.
What are the doses for Spravato?
Spravato is taken in either 56 mg or 84 mg doses – depending on the type of depression you have (TRD or MDSI) and your individual response and tolerance.
How long do people stay on Spravato?
Treatment duration for Spravato varies; many patients continue maintenance sessions for several months or longer to sustain recovery. The best outcomes come from combining Spravato with therapy for long-term recovery.
What happens if I miss a Spravato session?
If you miss a scheduled Spravato treatment, contact your psychiatrist to reschedule. Your treatment plan may be adjusted to keep you on track.
Is Spravato the same as ketamine?
Not quite. Spravato contains esketamine, which is derived from ketamine but works differently in the body. Esketamine is FDA-approved for treating depression; ketamine itself is not.
Is Spravato covered by insurance?
Most major insurers cover Spravato for eligible adults. Our staff can help confirm your coverage and eligibility.