SPRAVATO / esketamine dosing · Cranford and Edison, NJ
Esketamine Nasal Spray: Finding the Right Spravato® Dosage for Your Depression
For treatment-resistant depression, each SPRAVATO dose is 56 mg (two nasal spray devices) or 84 mg (three devices). You take it twice a week in weeks 1 to 4, once a week in weeks 5 to 8, then once a week or every two weeks, always in a certified office with at least two hours of observation.
Labyrinth Psychiatry Group · Updated · Doses checked against the FDA label revised September 2026 · Reviewed by Dr. Salvatore G. Savatta on
SPRAVATO runs on a calendar: eight visits in the first month, four in the second, then one every one or two weeks. Stock photo (CC0), not a Labyrinth patient.
At Labyrinth Psychiatry Group, we focus on personalized, evidence-based treatment and have had encouraging results with SPRAVATO. However, esketamine therapy isn’t a one-size-fits-all approach. Finding the right dosage involves careful monitoring, medical expertise, and ongoing communication between patient and provider. Here is the FDA schedule in plain words, what changes the dose, and what each dosing visit looks like at our offices.
28 mgin each nasal spray device, one spray per nostril (FDA label).56 or 84 mgper dose: two devices or three, 5 minutes apart.12 visitsin the first eight weeks: twice a week, then once a week.2+ hoursof observation in the office after every dose.
Why SPRAVATO dosing matters
Esketamine is a nasal spray approved for adults with treatment-resistant depression and, in some cases, depression with suicidal thoughts. The correct dose plays a key role in both the effectiveness and safety of SPRAVATO. Too low a dose may not provide enough symptom relief, while too high a dose can increase side effects such as dizziness, nausea, or dissociation.
SPRAVATO dosing at a glance
The FDA label sets one schedule for treatment-resistant depression, whether SPRAVATO is taken on its own or with an oral antidepressant. Every dose in the label’s table is either 56 mg or 84 mg.
SPRAVATO dosing for treatment-resistant depression in adults, from the FDA label (Table 1), with the number of devices and visits
Phase and weeks
How often
Dose (devices)
Visits
Induction: Weeks 1 to 4
Twice a week
56 mg (2 devices) or 84 mg (3 devices)
8 visits
Maintenance: Weeks 5 to 8
Once a week
56 mg (2 devices) or 84 mg (3 devices)
4 visits
Maintenance: Week 9 and after
Every 2 weeks or once a week, at the least frequent schedule that keeps you well
56 mg (2 devices) or 84 mg (3 devices)
2 to 4 visits every 4 weeks
For depression with acute suicidal thoughts or behavior, the label dose is different: 84 mg twice a week for 4 weeks, always together with an oral antidepressant; it may be lowered to 56 mg twice a week if 84 mg is not tolerated. Use beyond four weeks has not been systematically studied for that group. If you are in crisis now, call or text 988 rather than waiting for an appointment.
Some guides online still say the first dose is always 56 mg. The current label lists 56 mg or 84 mg for weeks 1 to 4, and the manufacturer’s dosing guide for prescribers says to start with 56 mg or 84 mg based on clinical judgment.
The week-by-week SPRAVATO schedule
Weeks 1 to 4: twice a week. Eight treatment visits. Your psychiatrist chooses 56 mg or 84 mg and can change it based on how well it works and how well you tolerate it. At the end of week 4, you and your psychiatrist look at whether SPRAVATO is helping and whether to continue, as the FDA label directs.
Weeks 5 to 8: once a week. Four treatment visits at 56 mg or 84 mg. The dose can still be adjusted.
Week 9 onward: once a week or every two weeks. The label’s goal is the least frequent schedule that keeps you in remission or response. Some people stay weekly; others move to every other week. How long treatment continues is decided with your psychiatrist.
If you miss a visit. If your symptoms have not worsened, you carry on with the same schedule. If you miss visits during maintenance and your depression gets worse, your psychiatrist may go back to the previous, more frequent schedule, for example from weekly to twice a week.
In the label’s long-term study, the schedule after week 8 depended on how well people were doing: 69% of patients in stable remission were treated every other week for most of the maintenance phase and 23% weekly, while among patients with a response but not remission, 55% were treated weekly and 34% every other week.
Every four weeks? The U.S. label schedule goes no further apart than every two weeks. In a long-term extension study analysed by the manufacturer’s medical team, 137 of 1,097 patients (12%) were mostly treated every four weeks, 34% every other week and 54% weekly. That is study data, not the label schedule, so spacing beyond two weeks is a question for your psychiatrist.
56 mg or 84 mg: what the difference means
The difference is one device. A 56 mg dose is two 28 mg devices with one 5-minute rest; an 84 mg dose is three devices with two rests. The higher dose is common rather than unusual:
Your psychiatrist does, at your treatment visits. The FDA label says dose changes should be based on two things: how well SPRAVATO is working and how well you tolerate it. Esketamine dosing follows that structured, FDA-approved schedule, and we adjust within it based on how your body responds over time. Several factors help determine the right dose for each patient:
Your medical history
Current medications
Previous response to antidepressants
How you tolerate treatment sessions
We also consider how your symptoms change between visits. Improvements in mood, energy, and daily functioning signal that the current dose is working. If symptoms persist, the dose may go up from 56 mg to 84 mg; if side effects interfere with daily life, it may come down. A few other points can change the plan:
Blood pressure. If your blood pressure is high before a dose, treatment may wait for another day. In the label’s studies, 3% to 19% of patients on SPRAVATO had a rise of at least 40 points systolic or 25 points diastolic in the first 1.5 hours at least once in the first four weeks; increases peak about 40 minutes after a dose and last about four hours.
Liver problems. People with moderate liver impairment may need to be watched for a longer time after each dose. SPRAVATO is not recommended with severe liver impairment.
Nasal sprays. A steroid or decongestant nasal spray should be used at least one hour before SPRAVATO on a treatment day.
With an oral antidepressant, or on its own
Since January 2025, the FDA has approved SPRAVATO for treatment-resistant depression either on its own or together with an oral antidepressant, and the dose schedule is the same either way. For depression with acute suicidal thoughts or behavior, it is used with an oral antidepressant. At Labyrinth, SPRAVATO is given either on its own or with an oral antidepressant, whichever is right for the individual patient, and your psychiatrist decides with you what to continue. (Background on the medicine itself is in how SPRAVATO works for treatment-resistant depression.)
What a dosing visit looks like at Labyrinth
Every dose is taken in a certified office under supervision, because SPRAVATO is only available through an FDA-required safety program, the SPRAVATO REMS. Here is a treatment visit at our Cranford office (our new Edison office is opening soon):
Before you arrive. Do not eat for at least 2 hours before a treatment and do not drink liquids for at least 30 minutes before. If you use a steroid or decongestant nasal spray that day, use it at least 1 hour before. Arrange for someone to drive you home.
Blood pressure check. Your blood pressure is taken before any dose. If it is too high, treatment may wait for another day.
The doses. You spray the medicine yourself while a clinician watches. Each device gives two sprays, one in each nostril, and holds 28 mg. A 56 mg dose is two devices and an 84 mg dose is three, with a 5-minute rest between devices.
Observation. You stay in the office for at least 2 hours. The team rechecks your blood pressure about 40 minutes after the dose and watches your breathing and oxygen level.
Going home. You leave when the clinician decides you are stable. Do not drive or operate machinery until the next day, after a night of restful sleep.
Each visit includes at least two hours of observation after the last device. Stock photo (CC0).
Many patients describe temporary sensations such as feeling detached, lightheaded, or sleepy. In the label’s studies, 61% to 84% of patients had some dissociative or perceptual change and 48% to 61% had some sedation, and these effects happened on the day of dosing. They usually fade within a couple of hours, which is why the observation period comes before you leave.
Book the ride before the visit: no driving or operating machinery until the next day, after a restful night’s sleep. Stock photo (CC0).
SPRAVATO is given at 11 Commerce Drive, Lobby Floor, Cranford, NJ 07016. Our new Edison office is opening soon, and we are already scheduling patients there for the new year. It is at 1 Ethel Road, Suite 103B, Edison, NJ 08817. Because the first month is eight visits and each one needs a ride home, the closer office matters. SPRAVATO treatment hours at Labyrinth:
Monday: 9 AM to 5 PM
Tuesday: 9 AM to 7:30 PM
Wednesday: 9 AM to 5 PM
Thursday: 9 AM to 7:30 PM
Friday: 9 AM to 5 PM
Saturday: 8 AM to 4 PM
How we measure your progress on SPRAVATO
Finding the right SPRAVATO dosage is an ongoing process. We track your progress using symptom questionnaires, conversations about daily functioning, and feedback that you provide. Improvements may include:
Better sleep
Reduced sadness
Increased motivation
Fewer negative thoughts
More energy
Progress doesn’t always follow a straight line. Some patients notice rapid improvement, while others experience more gradual changes; our article on how long SPRAVATO takes to work covers the timing. Open communication helps ensure that dosing decisions support long-term mental health goals.
Safety and long-term care
Esketamine therapy includes built-in safety measures. Treatments only occur in certified settings, and we monitor patients closely. This structure helps reduce risks and ensures that side effects receive prompt attention.
Long-term care focuses on maintaining improvement while supporting overall mental health. Esketamine often works best as part of a broader treatment plan that may include therapy, lifestyle support, and medication management. We also offer transcranial magnetic stimulation (TMS), a nonpharmacological approach to treatment-resistant depression; our TMS vs. SPRAVATO page compares the two schedules.
Is esketamine right for me?
A psychiatric evaluation helps determine whether esketamine is appropriate and how to structure treatment safely. If you have depression that continues despite multiple treatments, esketamine nasal spray may be worth exploring. With the right support and individualized dosing, many patients find renewed hope and meaningful improvement in their quality of life.
To learn more about SPRAVATO esketamine therapy for treatment-resistant depression, call our Cranford or Edison, New Jersey, office at 908-336-1187, or complete the online request form.
SPRAVATO dosing questions
What is the usual SPRAVATO dosing schedule?
For treatment-resistant depression, the FDA label schedule is twice a week in weeks 1 to 4, once a week in weeks 5 to 8, and then once a week or every two weeks from week 9. Each dose is 56 mg or 84 mg. For depression with acute suicidal thoughts or behavior, the label dose is 84 mg twice a week for 4 weeks, together with an oral antidepressant, and it may be lowered to 56 mg if 84 mg is not tolerated.
How many SPRAVATO treatments do you need?
The first eight weeks are 12 visits: eight in weeks 1 to 4 and four in weeks 5 to 8. Whether to continue is reviewed at the end of week 4. After week 8 there is no set end date; visits continue once a week or every two weeks for as long as you and your psychiatrist decide treatment is still helping.
Is 84 mg of SPRAVATO a lot?
It is the higher of the two doses in the label, and it is common. In the main four-week study behind the approval, 67% of patients on SPRAVATO were taking 84 mg twice a week by day 28. In the long-term study, 61% of patients on SPRAVATO took 84 mg and 39% took 56 mg. The label says the dose is adjusted for how well it works and how well you tolerate it.
What is the difference between 56 mg and 84 mg?
One extra device. A 56 mg dose is two 28 mg devices with one 5-minute rest between them; an 84 mg dose is three devices with two rests. In the study of SPRAVATO on its own, both doses lowered depression scores more than placebo over four weeks. Your psychiatrist chooses between them and can move you from one to the other.
Does the first SPRAVATO dose have to be 56 mg?
Not under the current label. Some dosing guides still say the first dose is always 56 mg, but the FDA label revised in September 2026 lists 56 mg or 84 mg for weeks 1 to 4, and the manufacturer’s dosing guide for prescribers says to start with 56 mg or 84 mg based on clinical judgment.
How long does a SPRAVATO treatment take?
Plan for the doses plus at least two hours. The doses take a few minutes each, with a 5-minute rest between devices, and then you stay for at least two hours of observation until the clinician decides you are stable. Arrange a ride home before the visit.
How many hours before SPRAVATO can you eat?
Stop eating at least 2 hours before the treatment and stop drinking liquids at least 30 minutes before, because some people feel sick to their stomach after a dose.
How does SPRAVATO make you feel?
Many people feel detached, lightheaded or sleepy for a while after a dose. In the label’s studies, 61% to 84% of patients had some dissociative or perceptual change and 48% to 61% had some sedation; these effects happened on the day of dosing. That is why you stay for at least two hours and do not drive until the next day.
Can SPRAVATO be given every 4 weeks?
Every four weeks is not on the U.S. label schedule, which goes no further apart than every two weeks. In a long-term extension study, 137 of 1,097 patients (12%) were mostly treated every four weeks. Ask your psychiatrist about spacing; it is a clinical decision, not a default.
Can I drive after a SPRAVATO treatment?
No. You need a ride home, and you should not drive or operate machinery until the next day after a restful night’s sleep.
SPRAVATO at Labyrinth
Start with an evaluation.
Who qualifies, the insurance plans the office takes for SPRAVATO, and how long it usually takes to reach the first treatment are on the practice’s SPRAVATO page.
