How Long Spravato Results Last and What Maintenance Looks Like
How long Spravato results last varies from person to person. In a major trial – people who stayed on Spravato plus an oral antidepressant relapsed less often than those switched to placebo.
After the first two months, the schedule usually moves to weekly or every-other-week visits, adjusted to the least frequent dosing that keeps you well. Shifa Health can guide this.
Spravato often works fast. That’s the exciting part.
But people who’ve started it tend to ask the same quiet question a few weeks in: okay, so how long does this last?
It’s a fair thing to wonder. Nobody wants to feel better and then wait for it to slip away.
At Shifa Health, we talk with patients about this a lot. So let’s go through what the evidence says, what maintenance looks like, and what’s still unknown. We’ll try not to oversell it, because honestly, no one can promise you an exact timeline.
First, What Is Spravato?
Spravato is esketamine, a nasal spray prescribed for treatment-resistant depression, meaning depression that hasn’t improved enough after trying other treatments. It’s taken along with an oral antidepressant, and it’s given in a clinic with a provider watching.
It isn’t a first-line option for most people. It’s usually something to consider after other things haven’t done enough. If you’d like to know whether it might fit, you can read about Spravato at Shifa.
What Does the Treatment Schedule Look Like?
There are two phases: a more frequent start, then a lighter maintenance schedule.
According to the dosing information from Johnson & Johnson’s medical site, it goes like this:
- Weeks 1 to 4 (induction): twice a week, under direct healthcare provider supervision
- Weeks 5 to 8: once a week
- Week 9 onward: once every 2 weeks, or once a week
The same source says to check how you’re doing at the end of the induction phase, and that dosing frequency should be individualized to “the least frequent dosing to maintain remission/response.”
(Source: Johnson & Johnson Medical Connect, Spravato dosage and administration)
That last line matters. The goal isn’t to keep you on the heaviest schedule. It’s to find the lightest one that still keeps you well.
So How Long Do the Results Last?
Here’s the honest answer: it depends.
For some people, improvement holds with regular maintenance. For others, symptoms creep back, especially if treatment changes or stops. Nobody can tell you ahead of time which group you’ll be in.
What we do have is research. The best-known study is called SUSTAIN-1. It looked at 297 adults with treatment-resistant depression who had responded to or reached remission with esketamine plus an oral antidepressant over 16 weeks. They were then randomly assigned to keep the esketamine or switch to placebo nasal spray, while staying on their antidepressant.
Here’s what happened:
- Stable remitters:7% relapsed on esketamine vs. 45.3% on placebo
- Stable responders:8% relapsed on esketamine vs. 57.6% on placebo
The researchers reported that continuing esketamine plus an antidepressant significantly delayed relapse, with no new or unexpected safety findings.
Worth noticing, though. Roughly a quarter of people relapsed even while staying on treatment. So it helps, but it isn’t a guarantee. And the trial was funded and run by the drug’s maker, which is common, but still worth knowing.
What About People Who Stay on It Long-Term?
A longer follow-up study, SUSTAIN-3, kept people on treatment in an open-label extension. The median time on treatment was about 46 months, and many people stayed on for three years or more.
But there’s a catch. That study had no comparison group, so it can’t tell us how well the treatment works over the long run compared with other options. It shows that many people stayed on it, not that it worked better than the alternatives.
How Long Should You Stay on Maintenance?
Here’s where it gets honest in a different way. There’s no single, agreed answer.
Expert guidance is general. Panels of psychiatrists surveyed in one review generally agreed that treatment should last at least 6 months, but they didn’t agree on how long to continue after remission, or on a maximum. Most said the decision should be based on the person and their clinician’s judgment.
(Source: Johnson & Johnson Medical Connect, duration of therapy)
Things that often shape the decision:
- How severe your depression has been
- How many episodes you’ve had
- How much a relapse would cost you (work, safety, relationships)
- How you feel on lighter dosing
- Side effects, schedule, and cost
- Your own preference
So it’s really a conversation, and it can change as your life changes.
What Does Maintenance Actually Look Like?
Here’s the day-to-day picture.
The visit itself. You still take Spravato at the clinic, and a provider observes you afterward. Many clinics do a two-hour observation period. Because of how the treatment works, most people can’t drive afterward. The label says to wait until the next day after a restful night’s sleep, so plan a ride home.
Blood pressure checks. Spravato can raise blood pressure for a short time, so clinics check it before and after dosing.
Your oral antidepressant continues. Spravato is used alongside one, so you’ll keep taking it and checking in about it.
Regular check-ins. Your provider asks how your mood, sleep, energy, and side effects are doing. You can track this with a tool like the PHQ-9, a short depression questionnaire. You can try Shifa’s PHQ-9 tool to see how you’re doing.
Therapy and lifestyle support. Many people do better when treatment includes more than medication, like psychotherapy, sleep habits, movement, and good support.
A conversation about frequency. Over time, your provider may talk with you about whether you can space out visits, keep the current pace, or adjust.
What If Symptoms Start Coming Back?
It happens. It doesn’t mean you failed, and it doesn’t mean the treatment was a waste.
Tell your provider early. Don’t wait for it to get bad. Signs to watch for include:
- Your mood slipping again
- Sleep or appetite changes
- Losing interest in things
- More irritability or hopelessness
- Feeling like the benefit is wearing off between sessions
Your provider may adjust the schedule, change a medication, add therapy, or look at other options.
If you’re in crisis or thinking about harming yourself, call or text 988 any time. If someone is in immediate danger, call 911.
What Happens If You Stop?
Some people stop because they feel better. Others stop because of cost, time, or side effects. Either way, talk to your provider first. Don’t just drop off without a plan.
The SUSTAIN-1 results showed higher relapse rates in people who switched to placebo, so stopping may raise the risk of relapse for some people. But it doesn’t happen to everyone, and plenty of people do stop and stay well. A plan, with close follow-up, makes it safer.
Does Spravato Have Downsides?
Yes, and they’re worth knowing.
Common short-term effects include feeling dissociated or “out of it,” dizziness, nausea, sleepiness, and a short-term rise in blood pressure. These typically ease within a couple of hours, which is why you’re monitored after each dose.
Spravato isn’t right for everyone. Certain heart and blood pressure conditions, some medical histories, and substance use history can matter, and it has a potential for misuse, which is part of why it’s given in a supervised clinic. Your provider will go through all of this with you.
What Else Could Help?
If Spravato doesn’t give you enough relief, or it isn’t the right fit, there are other things to talk about. Shifa also offers TMS (transcranial magnetic stimulation), medication management, and depression treatment. A psychiatric evaluation can help sort out what makes sense next.
How Shifa Health Can Help
Shifa Health offers psychiatric care across Washington State, with offices in Everett, Mount Vernon, Renton, and Marysville, and telehealth appointments too. Our team includes psychiatrists, psychiatric nurse practitioners, psychologists and counselors.
Meet our providers, browse all our services or check insurance and our FAQ.
Our approach is warm and hopeful, because mental health care should help people feel better and live fully again. If you’re not sure whether Spravato is the right option, we can talk it through.
Quick Answers
How long will I need maintenance?
It depends. Expert panels generally suggest at least six months, with the decision based on your situation.
Will I be on it forever?
Not necessarily. Some people stay on it for a long time, others taper. It’s a decision you make with your provider.
What if I miss a session?
Call your clinic. Don’t double up. They’ll tell you how to reschedule.
Can I drive afterward?
No, not right away. The label says to wait until the next day after a restful sleep.
Does insurance cover it?
Coverage varies by plan. Check with our team about your insurance.
Do I need to keep taking my antidepressant?
Spravato is used with an oral antidepressant, so yes, unless your provider changes the plan.
Take the Next Step
Curious whether Spravato could be right for you, or want help planning maintenance? We’re here.
- Book an appointment
- Contact us
- Everett: (425) 742-4600
- Mount Vernon: (360) 336-6868
- In-person and telehealth appointments available
- Read more on our blog
This article is for general information only and isn’t medical advice. Treatment decisions should be made with your own provider.
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