One of the most practical questions people ask before starting ketamine-based treatment is how many sessions they’ll actually need — and what those sessions look like. It’s a reasonable thing to want to know before you commit, and the answer varies depending on whether you’re receiving Spravato or ketamine therapy, and how your body responds to treatment.
This post walks through the full picture: both treatment types, the phases involved, the time commitments, and what factors influence how many sessions are right for you.
Rivendell Health offers two forms of ketamine-based treatment: Spravato (esketamine nasal spray) and ketamine therapy administered by injection or infusion. These are distinct treatments with distinct session schedules.
Spravato follows an FDA-approved protocol with defined phases and frequency. Ketamine therapy follows clinical best practices that are somewhat more flexible and individualized. Both involve an initial intensive period followed by a maintenance phase, but the specifics differ — so it’s worth understanding each on its own terms.
Spravato follows a structured, FDA-approved schedule that unfolds in three phases.
During the induction phase, you come in for two sessions per week for four weeks — a total of eight sessions. Sessions are typically spaced two to three days apart within each week.
The purpose of this phase is to establish a therapeutic response. Spravato can begin producing noticeable effects quickly, sometimes after the first or second session, but the full induction series is what creates a stable, meaningful response for most patients. Consistency during this phase matters; irregular attendance can reduce the overall benefit.
Each session in this phase runs approximately two to three hours from check-in to discharge, including a mandatory two-hour monitoring period after administration.
If you’re responding well to treatment, sessions reduce to once per week during weeks five through eight. This phase allows your provider to fine-tune dosing and assess how durable your response is before tapering further.
From week nine onward, most patients move to sessions every one to two weeks, depending on symptom stability and how well gains are holding. The goal of the maintenance phase is to sustain the improvement achieved during induction using the least frequent dosing necessary — not to keep you on a rigid calendar indefinitely.
Some patients eventually taper off treatment entirely. Others continue with periodic maintenance sessions long-term. Your provider will evaluate this based on your response over time.
Total time commitment for the first eight weeks: Approximately sixteen sessions. That’s a meaningful investment of time, which is worth factoring into your schedule before you start.
Ketamine therapy (administered by injection or infusion) follows a similar two-phase structure, though the protocol is somewhat more flexible than the FDA-mandated Spravato schedule.
The standard induction protocol is six sessions over two to three weeks, typically scheduled two to three times per week. This concentrated schedule is intentional — the cumulative effect of closely spaced sessions is what produces the therapeutic response, not any single session in isolation.
Each session typically runs forty minutes to an hour for the treatment itself, followed by a recovery period. You will not be able to drive on the day of a session, so transportation arrangements need to be planned in advance.
Most patients who respond to ketamine therapy notice some shift within the first few sessions — improved sleep, reduced hopelessness, or a lightening of the heaviness that characterizes treatment-resistant depression. The full induction series typically confirms whether ketamine is producing a meaningful clinical response for you.
Response rates vary, but research consistently shows that roughly 60-70% of patients with treatment-resistant depression respond meaningfully to a full induction course.
After induction, sessions space out considerably. Most patients transition to maintenance sessions every four to eight weeks, adjusted based on how long their response holds and how they’re doing clinically. Some patients find they need maintenance sessions every few weeks; others go months between sessions.
There is no universal endpoint. Your provider will assess your response over time and adjust accordingly. Some patients eventually discontinue treatment; others continue periodic maintenance as a long-term strategy.
Knowing what to expect inside a session reduces the uncertainty that keeps a lot of people from taking the first step.
Spravato sessions: You arrive at Rivendell Health and complete a pre-treatment check-in, including a review of vitals and any side effects from previous sessions. You then self-administer the Spravato nasal spray under clinical supervision. The two-hour monitoring period follows, during which you rest in our care suite while your provider monitors your blood pressure, level of sedation, and overall response. You will not drive on the day of treatment.
Ketamine therapy sessions: Your provider administers the treatment, and you spend time resting during and after. The dissociative and perceptual effects that some patients experience during a session — a sense of detachment, altered perception, or dreamlike mental states — are temporary and resolve before you leave the clinic. You will not drive on the day of treatment.
For both treatment types, bringing something to make your monitoring or recovery time comfortable is reasonable — music, an eye mask, or anything that helps you rest. Some patients find the monitoring period reflective or even calming; others simply use the time to rest. Your care team is present throughout.
Several factors influence your total session count and how your maintenance phase is structured:
Diagnosis and symptom severity. Patients with more severe or longer-standing depression typically require more sessions to achieve and maintain a meaningful response. Conditions like PTSD and OCD may follow different response patterns than depression alone.
Treatment history. How many prior treatments you’ve tried, and how treatment-resistant your condition is, can influence both how you respond to ketamine and how durable that response is.
Co-occurring conditions. Depression layered with anxiety, chronic pain, or PTSD may require a more individualized maintenance schedule.
Whether therapy is part of your plan. Research suggests that combining ketamine treatment with psychotherapy can meaningfully extend the time between maintenance sessions — in one study, adding cognitive behavioral therapy extended the median time to relapse from roughly 18 days with ketamine alone to about 12 weeks. If you’re already working with a therapist, that’s worth discussing with your Rivendell Health provider.
Your individual neurobiology. Response to ketamine varies from person to person. Your early response during the induction phase is one of the strongest predictors of how durable your results will be — which is why your provider monitors those early sessions closely.
Unlike traditional antidepressants where you might wait weeks to notice anything, ketamine-based treatments tend to produce noticeable shifts relatively quickly. Signs that treatment is producing a meaningful response include:
Not every patient responds, and not every response is dramatic. Partial responses — where some symptoms improve significantly but others remain — are common and still clinically meaningful. Your provider will use validated rating scales alongside your own reported experience to track progress across sessions.
If a full induction course doesn’t produce a meaningful response, your provider will discuss what that means for your treatment plan and what other options exist.
At Rivendell Health, the first step is an initial psychiatric evaluation. Your provider will review your mental health history, your prior treatment background, and your current clinical picture to determine whether Spravato or ketamine therapy is the right fit — and which protocol makes sense for your situation.
If you’re a candidate, you’ll leave that appointment with a clear treatment plan: which treatment, what schedule, and what to expect in the first weeks. You won’t be handed a pamphlet and told to figure it out.
If you have questions before scheduling, you’re welcome to call our office at (719) 726-6573.
Phone: (719) 726-6573
Fax: (719) 771-0460
Email: support@RivendellHealth.com
Location: 1465 Kelly Johnson Blvd. Ste 310
Colorado Springs, CO 80920
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