How Often Will I Take SPRAVATO® For Treatment-Resistant Depression?

If you’re planning to try SPRAVATO® for treatment-resistant depression (TRD), knowing the typical SPRAVATO® treatment schedule can help you figure out how to adjust your daily life to accommodate treatment. SPRAVATO® is the brand name for esketamine nasal spray, and it’s one form of ketamine. Like ketamine, esketamine can cause you to feel dissociated, sleepy, and dizzy in the hours after you receive a dose. You’ll need a ride home–and probably a long nap!–after each visit to your local  Greenbrook location.

At Greenbrook, we work with you to map out an esketamine nasal spray treatment schedule that works for you.

Your SPRAVATO® Treatment is Unique to You

SPRAVATO® treatment is usually the most time-intensive during the first four weeks. Whether your provider refers you to Greenbrook or you come to us on your own, your Greenbrook psychiatrist or psychiatric nurse practitioner will review your medical history and evaluate your symptoms. If our provider believes esketamine nasal spray is a good fit, they will build an esketamine nasal spray treatment schedule and dosage plan based on your needs. 

If you’re wondering, “How long will I have to take SPRAVATO®?,” the answer is that your treatment duration will depend on how much the symptoms are improving as you progress. After the first month of SPRAVATO® treatment, your Greenbrook provider will evaluate how well it is working and determine if any dosage adjustments are needed.

How Often Can you Expect to Take SPRAVATO®?

During a typical SPRAVATO® treatment schedule, you’ll take two doses a week for four weeks. Before each treatment, your provider will give you a depression scale to fill out. This helps them—and you!—understand how the treatment is working throughout your esketamine nasal spray treatment schedule. 

Your provider will then confirm that the dose kit belongs to you and show you how to self-administer the sprayer. Each sprayer contains two sprays for a total of 28 mg of esketamine nasal spray. Your prescription can vary depending on which of the two FDA-approved indications you’re taking it for: treatment-resistant depression (TRD) or major depressive disorder with acute suicidal ideation or behavior (MDD). 

If you’re being treated for TRD, you will self-administer medication from two sprayers for a total of 56 mg. After the first treatment, you will take 56 or 84 mg of SPRAVATO®two times per week for the first four weeks of your SPRAVATO® treatment schedule. In weeks five through eight, you’ll take either 56 or 84 mg weekly. By the ninth week and beyond, your Greenbrook provider will evaluate whether you need a 56 or 84 mg dose once a week or once every two weeks. Your total esketamine nasal spray treatment duration after this point will vary based on your symptoms and response to treatment. 

Those being treated for MDD will self-administer 84 mg of medication on their first day of treatment. Patients will continue taking an 84 mg dose twice a week for the first four weeks. After this, a Greenbrook provider will work with the patient to determine the next steps. Some people continue taking 84 mg of SPRAVATO® while others go down to 56 mg.

It’s important to note that esketamine nasal spray is not a substitute for hospitalization related to suicide. 



How to Speak to Your Doctor About SPRAVATO®

While you don’t need a doctor’s referral to begin a SPRAVATO® treatment schedule, we encourage you to speak with your provider about whether the treatment is right for you. It can feel awkward to bring up medication, but you and your doctor are a team. Together, you’re working to figure out how best to manage symptoms of depression. Ask them if they think esketamine nasal spray could benefit you. 

During this conversation, discuss any history of alcohol or substance abuse and tell your provider whether you are pregnant or plan to become pregnant. SPRAVATO® should not be taken if you are pregnant or breastfeeding. Other health conditions, such as blood vessel disease, a ketamine allergy, or a history of psychosis, can make taking SPRAVATO® dangerous for you. 

Your doctor will go over your current and past medications and conditions to determine if esketamine nasal spray is right for you. If your doctor doesn’t think esketamine nasal spray is a good idea based on your medical history, FDA-cleared transcranial magnetic stimulation (TMS) may be an option. Learn more about how TMS works.

Questions You Should Ask Your Doctor About SPRAVATO®

At Greenbrook, our providers are always prepared to answer any questions about esketamine nasal spray. We recommend asking the following questions: 

• How can I know if esketamine nasal spray is working?
• What do I do if I don’t feel esketamine nasal spray is working?

If you struggle with side effects or feel that esketamine nasal spray isn’t working, your doctor may adjust your dosage or esketamine nasal spray treatment schedule. Please share your questions and concerns with the provider who cares for you at Greenbrook—they’re here to help.

Schedule A Free Consultation

If you have tried at least two antidepressants without success, you may qualify for esketamine nasal spray. Thanks to its FDA approval, SPRAVATO® treatment at certified centers is covered by insurance. At Greenbrook, we’ll handle the paperwork so that you can focus on your treatment. We offer esketamine nasal spray consultations to help you get started. Schedule your free consultation today.