Will I Need to Do This Forever?
It’s one of the first questions almost everyone asks at some point in their consultation or induction: “So…do I have to keep doing this forever?”
It’s a fair question. It is hard to sign up for an open-ended commitment, especially when it's something that involves regular appointments. The honest answer is: it depends, but probably not in the way you’re picturing it. Let’s talk about what treatment actually looks like over time, and why.
Why Treatment Starts Out Frequent
Both ketamine and Spravato (esketamine) work differently from a daily pill you take and forget about. They tend to work in phases, and the first phase, called induction, is intentionally the most frequent.
Early research on these treatments suggests that the antidepressant effects build with repeated dosing, especially at the start, and spacing sessions too far apart early on can mean losing momentum before your brain has a chance to consolidate the changes. Think of it less like taking a pain reliever for a sore muscle and more like restarting a stalled engine. It usually takes a few tries to get it back up and running, but once it’s going, it doesn’t need the same effort to keep running.
Ketamine induction and maintenance schedules can vary clinic to clinic. We have been adapting and honing in our induction schedule for the past eight years we have been working in the ketamine space, and we suspect it will be ever evolving as the field grows and research continues. We currently use a model that has shown to help make the transition from induction to maintenance more seamless.
Spravato follows a protocol similar to IV ketamine but because it is FDA approved and a part of their REMS program there are certain parameters that each administering clinic must follow, including their induction schedule.
Then Comes Maintenance– And This Is Where It Gets Individual
After induction you move into a maintenance phase, and this is where the schedule starts to loosen up- even for Spravato patients. Here’s the part that surprises people: maintenance doesn’t mean the same thing for everyone. Some people find that after a few months, they no longer need scheduled sessions at all. Others do better with an occasional booster every so often, similar to how someone with migraines might not need treatment every day but benefits from having a plan in place when symptoms start creeping back. And some people stay on a longer-term, low-frequency (around monthly) schedule because that’s what keeps them feeling like themselves.
None of these paths are a sign that you’re not working hard enough, or that treatment ‘isn' t working’. In fact, they are all different variations of it doing just that: working.
Why Therapy and Other Medications Matter Here
Ketamine and Spravato are often their best when they’re not working alone. Talk therapy during or after your treatment gives your brain a chance to actually use the window of flexibility these treatments open up, to build new patterns of thinking rather than just experiencing temporary relief. Many people find that combining treatment with therapy helps the benefits last longer and reduces how often booster sessions are needed.
Oral antidepressants can play a role too. Spravato in fact is FDA approved specifically to be used alongside oral medications, not as a stand alone replacement for one. For Ketamine some people will do treatments alongside their existing antidepressants, while others may use it while working with their provider to eventually reduce reliance on a daily medication. What’s right for you depends on your history, your goals, and how your body responds which is why it should always be done with coordination of your care team.
So, Will You Need This Forever?
Probably not in the way that the question implies. Most people don’t stay on an intensive schedule indefinitely. What’s most common is an initial period of more frequent treatment, followed by a gradual tapering to whatever minimum level keeps you feeling well.
If it helps to reframe it: This isn’t so different from how we think about physical therapy after an injury, or ongoing management of a chronic condition like high blood pressure. Nobody considers it a failure to keep managing a condition that responds well to management. The goal was never to need treatment forever. It’s to feel better, stay feeling better, and figure out- with your provider- the least amount of intervention it takes to keep it that way.
