Beyond the first 8 sessions: Your Spravato maintenance roadmap
From induction to Spravato maintenance therapy
Spravato maintenance therapy is designed to help stabilize treatment gains by transitioning from frequent acute dosing to a personalized schedule aimed at sustaining remission. While the first four weeks of treatment focus on rapid symptom reduction through twice-weekly sessions, the maintenance phase shifts the goal toward durability, ensuring that the neural pathways formed during the acute phase have time to strengthen. This phase is critical because managing treatment-resistant depression is rarely about a single course of care; it is often about creating a sustainable lifestyle that supports the prevention of recurrence.
The shift from acute to long-term care
The shift from acute to long-term care involves moving from twice-weekly crisis intervention to a maintenance rhythm that supports stability while preserving gains. During the induction phase, Spravato (esketamine), a nasal spray containing the S-enantiomer of ketamine, which is the more pharmacologically active molecular form, is typically administered twice weekly to address acute symptoms as outlined in our treatment protocol . IV ketamine, which involves administering the medicine directly into the bloodstream via intravenous infusion, is often used off-label, whereas Spravato follows a specific FDA-approved protocol that transitions to once-weekly dosing starting at Week 5. This transition is a guided process where we honor the work you have done, moving gently from intensive oversight to a schedule that allows for more independence while maintaining clinical support.
The evolution of dosing schedules
Dosing schedules naturally evolve based on individual response, moving toward the least frequent dosing necessary to maintain wellness. Around Week 9, the frequency may shift to every two weeks or monthly, moving from crisis intervention to preserving gains. In 2026, the approach to maintenance is highly individualized rather than rigid, prioritizing the member’s unique physiological needs over a strict calendar. Schedules are individualized to find the “least frequent dosing” necessary to maintain remission, rather than following a rigid calendar per FDA labeling guidelines . This customization ensures that Spravato maintenance therapy remains a supportive tool for wellness without becoming an unnecessary burden on a member’s time.
Building a chronic depression management plan
Building a chronic depression management plan involves establishing a collaborative framework with your care team to proactively modify dosing intervals based on real-time feedback and life stressors. Rather than viewing the schedule as fixed, members are encouraged to view it as a flexible strategy that adapts to life’s demands. If a member anticipates a stressful period—such as a job change or family conflict—communicating this to the care team allows for a preemptive “tune-up” session to help maintain balance. Regular check-ins help protect the progress made during the initial induction phase, similar to tending to a garden to ensure it continues to thrive through changing seasons; just as a garden needs more water during a drought, your mental health may need additional support during challenging times.
Recognizing signs you need a tune-up
Changes in sleep patterns, increased irritability, or a return of “brain fog” often serve as the first indicators that a schedule adjustment may be helpful. According to early precursors to a depressive episode identified by WebMD , shifts in sleep (insomnia or oversleeping) and energy levels can appear before mood significantly declines. Proactive monitoring of your emotional baseline allows for early adjustments to your care plan. Communicating these subtle shifts to your care team immediately allows for proactive support, treating the need for a maintenance session not as a setback, but as a strategic tool designed to support sustained wellness.
How long-term esketamine treatment supports neuroplasticity
Long-term esketamine treatment works by continuing to stimulate the production of synaptic proteins, which may help maintain the brain’s ability to adapt and rewire itself. Spravato targets the N-methyl-D-aspartate (NMDA) receptor, a specific type of glutamate receptor in the brain responsible for synaptic connectivity. By modulating these receptors, the medication helps repair the structural damage caused by chronic stress and depression, a mechanism supported by research on ketamine’s impact on synaptic plasticity . Spravato after initial treatment helps keep these neural pathways open and malleable, preventing the brain from reverting to its previous, rigid patterns.
Holistic integration resources
Holistic integration resources maximize the benefits of the medicine by providing supportive environments to process insights and solidify new neural pathways. Nushama members can access supportive offerings like integration groups, sound baths, and breathwork to maximize the benefits of the medicine as part of a comprehensive care plan . Integration; the process of applying insights from your sessions to daily life, is a vital component that supports the durability of the treatment.
Complementary therapies
Nushama offers complimentary psychotherapy sessions as part of your Spravato treatment journey. Members receive two free psychotherapy sessions led by Columbia Advanced Clinical Interns specializing in psychedelic therapy, available on Mondays, Thursdays, and Fridays. Integration has consistently been shown to be an essential component of sustainable change from psychedelics, and these sessions provide structured support to help you process insights and apply them to your daily life.
Some members choose to complement their Spravato treatment with NAD+ (Nicotinamide Adenine Dinucleotide) infusions, which play a role in cellular energy metabolism and mitochondrial function. While some members report that this combination may help with the physical fatigue often associated with depression, clinical evidence for NAD+ infusion therapy in treating depression is still emerging and has not been established through rigorous clinical trials. As with any complementary therapy, we recommend discussing NAD+ with your care team to determine whether it may be appropriate for your treatment plan.
Additionally, Nushama members can access supportive offerings like integration groups, sound baths, and breathwork to maximize the benefits of the medicine as part of a comprehensive care plan. Integration—the process of applying insights from your sessions to daily life—is a vital component that supports the durability of the treatment.
Insurance and costs for ongoing care
Most major insurance plans provide coverage for ongoing maintenance sessions when medical necessity criteria are met, helping to ensure financial barriers do not interrupt access to care. Because Spravato is an FDA-approved medication, it fits within the traditional medical insurance model more seamlessly than some other psychedelic modalities. This financial support helps ensure that members can focus on their health rather than the cost of care.
Insurance coverage for maintenance
Plans such as Oxford, UnitedHealthcare, and Medicare typically cover maintenance sessions beyond the acute phase, as noted on our Spravato service page . Coverage generally includes both the cost of the medication and the clinical observation time required for safety monitoring. This coverage often makes Spravato a more financially sustainable option for long-term care compared to IV ketamine boosters, which are typically out-of-pocket expenses.
Administrative support
The Nushama administrative team manages the prior authorization process for you, relieving the burden of complex paperwork often required for long-term care approvals. This benefit is available at our Aventura, Rockland and Manhattan locations. While there are costs associated with care, maintenance therapy functions as a sustainable investment in your health, especially when compared to the significant personal and financial costs associated with untreated depression, which can lead to lost productivity and compounded health issues.
Common questions about Spravato after initial treatment
The duration and structure of maintenance care are highly individual, with safety data supporting long-term use when clinically indicated and monitored via regular medical screening. Understanding the roadmap helps members feel more secure in their ongoing treatment plan. Research continues to support the efficacy of long-term esketamine treatment for those who require ongoing management of treatment-resistant depression.
FAQs
Q: How long does the maintenance phase last?
A: Maintenance duration is highly individual. The SUSTAIN-3 long-term study followed patients for up to approximately 6.6 years of cumulative treatment, with over one-third of participants completing more than 5 years. The safety profile remained consistent throughout, allowing members to continue treatment as long as it benefits their condition.
Q: Can I stop Spravato cold turkey?
A: Abrupt cessation is generally not recommended; instead, a guided tapering process helps maintain stability and allows for monitoring of any recurrence of symptoms.
Q: Does Spravato repair the brain long-term?
A: Esketamine may help counteract the effects of chronic stress on the brain by promoting synaptic connectivity and helping to restore neural networks.
Planning your next steps
Book a consultation with our care team to discuss a personalized maintenance strategy that helps support your long-term healing journey. The path to sustained wellness often extends beyond the first eight sessions, and we are here to guide you through every phase of recovery. Whether you are transitioning from acute care or seeking a new approach to management, we can help you build a roadmap that fits your life.
