Esketamine Nasal Spray: Finding the Right Spravato® Dosage for Your Depression

Up to 66% of people with depression find that traditional antidepressants and/or therapy don’t provide enough relief from symptoms like extreme sadness, hopelessness, and suicidal thoughts.

Esketamine nasal spray (commonly known by its brand name, Spravato®) offers a newer option for patients with treatment-resistant depression.

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, we explain how Spravato works and how you can be sure you’re getting the optimal dose.

Esketamine basics

Esketamine is a nasal spray approved for adults with treatment-resistant depression and, in some cases, depression with suicidal thoughts.

Traditional antidepressants target neurotransmitter chemicals in the brain, such as serotonin or norepinephrine, that become imbalanced in people with depression. Esketamine works on the brain’s glutamate system, which can also be involved in depression.

Spravato acts more quickly than oral antidepressants and can also be more effective because it targets a different system.

We always prescribe esketamine alongside an oral antidepressant. We administer it in a certified medical setting, where patients remain under observation after each treatment for safety and support.

Why Spravato dosing matters

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.

Esketamine dosing follows a structured protocol approved by the Food and Drug Administration. This helps ensure that patients receive enough medication to benefit while minimizing risks. We then adjust your dose based on how your body responds over time.

How an esketamine dosing schedule works

Esketamine treatment usually begins with an induction phase. During this stage, patients receive treatments twice a week for several weeks to reduce depressive symptoms and stabilize mood.

After the induction, patients enter a maintenance phase. Treatments occur less often, typically once a week or every other week. We determine the schedule based on symptom improvement, side effects, and overall progress.

Factors that influence your esketamine dose

Several factors help determine the right esketamine dosage for each patient. These include:

• Your medical history
• Current medications
• Previous response to antidepressants
• How you tolerate treatment sessions

We also consider how your symptoms change between visits, so improvements in mood, energy, and daily functioning signal that the current dose is effective. If symptoms persist or side effects interfere with daily life, we may need to adjust the dose.

What to expect during treatment visits

Each treatment session follows a clear process. After we check your vital signs, you self-administer the Spravato nasal spray under medical supervision. Our care team monitors your blood pressure, mood, and physical responses during a required observation period.

Many patients describe temporary sensations such as feeling detached, lightheaded, or sleepy. These effects usually fade within a couple of hours, but you must arrange transportation home rather than driving the same day.

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

It’s important to understand that progress doesn’t always follow a straight line. Some patients notice rapid improvement, while others experience more gradual changes. 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.

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 one of Labyrinth Psychiatry Group’s offices, in Cranford or Edison, New Jersey, or complete the online inquiry form.