You’re on the 6 train headed to your Spravato session in Midtown. You’ve felt like yourself for months now: sleeping, laughing, showing up. And then the thought arrives. Am I doing this forever? Most people ask how long you stay on Spravato quietly, with a little guilt, as if wanting an endpoint means they aren’t grateful. Set that down. It’s a fair, practical question, and it deserves a real answer.
This page is about how long treatment lasts and what happens when you’re ready to step back. Spravato is the brand name for esketamine, a nasal spray used for depression that hasn’t lifted after other antidepressants. We won’t re-explain how you start or how doses space out over time. Nushama’s maintenance roadmap covers that well. This picks up where it ends: how long people stay, why they pause, the worry about dependence, and what happens if symptoms return. Everything here reflects how we approach Spravato at our Manhattan location, 515 Madison Avenue, 21st Floor.
How long do people actually stay on Spravato?
Here’s the real number first. In the long-term SUSTAIN-3 study (designed to follow participants for up to 6.5 years), the average cumulative time on esketamine was about three years, and roughly two-thirds of participants stayed on treatment for three years or longer.
In plain words: those are people who chose to keep going because it kept working for them. It’s not a required length, and nobody is serving a sentence. There’s no maximum time on Spravato in the FDA labeling. How long you stay is a decision you and your clinician make together.
The guiding principle is simple: the goal is the least amount of treatment that keeps you well. Not the most. Just enough.
In practice, people tend to follow one of three normal patterns:
- A course, then a pause. You respond, you stabilize, and you plan a wind-down.
- Staying on at a wide interval. A dose every few weeks or once a month, spaced as far apart as your symptoms allow.
- Pausing and restarting. You step away, and return later if you need to.
None of these is the “right” one. The right one is the one that fits your life and keeps you steady.
Why do people pause Spravato?
People pause for three different reasons, and they get mixed up all the time. Pulling them apart matters, because each one has a different answer.
You’re well, and it’s a planned wind-down. This is the good version. You’ve been stable for a while, and you and your clinician decide to space doses further apart and eventually pause. It’s gradual and deliberate, not a door slammed shut. At Nushama, that wind-down involves your full care team: your prescribing psychiatrist, your integration therapist, and your care coordinator all weigh in on the timeline together.
It isn’t the right fit. This is a different conversation, and it usually comes up earlier, within the first few weeks rather than years in. If Spravato isn’t doing enough, the honest move is to notice that quickly and explore what else might help rather than keeping going on hope alone. Spravato doesn’t work for everyone, and that’s part of why our Manhattan clinic offers more than one path forward. Your psychiatrist can talk with you about IV ketamine, medication management, TMS, or a combination of these, all under the same roof at 515 Madison Avenue. The goal isn’t loyalty to any single treatment. It’s finding what actually works for you.
Life gets in the way: cost, a job change, a move. Here’s the honest part. This is the most common reason people pause, and the least talked about. Spravato means regular in-person visits with a two-hour stay each time. That’s a real ask when it comes to your schedule and your wallet. Our Midtown location at 515 Madison Avenue is steps from the E, F, and 6 trains, which helps if you’re fitting sessions around a Manhattan work schedule. If cost is the sticking point, coverage and out-of-pocket costs vary by plan, and our team can help you sort through yours before you decide. We accept United, Aetna, Cigna, Healthfirst, WTC, Medicare, BCBS and Fidelis Care at our Manhattan and Rockland locations, and our care coordinators can walk through your specific coverage before your first visit.
Will I get hooked on Spravato?
This is the question people Google at midnight, so let’s answer it plainly. Spravato carries an FDA boxed warning, the strongest warning a medication label can have. It covers sedation, dissociation (a temporary feeling of being detached from your body or surroundings), slowed breathing, suicidal thoughts, and the potential for abuse and misuse. That’s why every dose is given in a certified clinic, why a nurse monitors you for at least two hours afterward, and why it’s only available through a special safety program called REMS (Risk Evaluation and Mitigation Strategy). At our Madison Avenue location, you’re in a private room during that observation window, not a waiting area with fluorescent lights. You can read the full FDA prescribing information for the complete warning.
Here’s the distinction worth understanding. The warning about abuse and misuse exists because esketamine is a controlled substance, which the U.S. Drug Enforcement Administration lists as Schedule III, and because ketamine can be misused outside a medical setting. That’s a different question from whether people who take supervised doses in a clinic have a hard time stopping when treatment ends.
On that second question, the honest answer is that the research is thinner. Long-term studies of clinic-based esketamine haven’t flagged a pattern of people being unable to stop after supervised treatment. But “less studied” isn’t the same as “proven safe forever,” and we won’t reassure you past what the evidence actually shows. What we can tell you is that the clinic setting, the monitoring, and the controlled dosing are all designed to keep this risk low , and that in our thousands of Spravato patients, we have never seen one case of addiction.
If it comes back, here’s your plan
Let’s name the fear underneath the first question. What if the depression comes back after I pause? Here’s something worth knowing: depression returns for many people. Recurrence rates average around 50% or more within six months of remission when initially effective treatment is not continued, according to a 2016 systematic review and meta-analysis in the journal Psychopharmacology. That isn’t a gloomy number. It’s the reason having a plan is practical, not pessimistic.
So here’s the plan. The early signs of a return tend to show up in a familiar order:
- Sleep shifts first. You’re waking at 3 a.m. again, or sleeping far more than usual.
- Then a shorter fuse. Small things irritate you more than they should.
- Then things you enjoy stop landing. The music, the friend, the walk, all a little flat.
The simple rule: if it’s been about two weeks and these signs aren’t lifting, call our Manhattan clinic. You don’t need to wait until you’re in crisis, and you don’t need to be certain. Sorting that out is our job.
Now the part that matters most. Restarting usually doesn’t mean eight weeks from scratch. If you responded to Spravato before, coming back often looks different from starting cold. Your clinician tailors the restart to your history rather than treating you like a first-timer. There’s good reason to expect it can help again. In the SUSTAIN-1 relapse-prevention trial, esketamine plus an oral antidepressant delayed relapse compared with the antidepressant alone in people who had become stable (Daly et al., JAMA Psychiatry, 2019).
We want to be clear about this: needing to come back is normal. It’s not a failure, and it’s not starting over.
The support around the medicine doesn’t disappear when dosing pauses. At our Manhattan clinic, your aftercare team stays in place. Your psychiatrist keeps an eye on medication and symptom trends. Your integration therapist helps you hold onto what you gained. And your member care coordinator handles scheduling and insurance questions so you can focus on how you’re actually feeling. The weekly integration circle is open to all members, current or past, so that community connection doesn’t end with your last dose.
So, am I doing this forever?
Almost certainly not. Most people are not on Spravato for life. They stay as long as it helps, step back when they’re steady, and keep a clear plan for the return trip if they ever need it. You’re not doing this alone, either. Your psychiatrist, your integration therapist, your nurses, and your care coordinator at our Manhattan clinic know your history and are here whether you’re in active treatment or checking in six months later. Forever was never the goal. Feeling like yourself was.
If you’d like to talk any of this through, whether it’s how long you might stay or how a wind-down would work for you, our Manhattan care team is here. We’re at 515 Madison Avenue, 21st Floor, in Midtown. You can also book a consultation online.
Medically reviewed by the Nushama clinical team. Last updated: June 2025.