Maintenance schedules: keeping the response

Spravato

See the Spravato hub, the coverage hub, the coverage checker, treatment comparisons and condition and treatment pages.

• Induction: twice weekly for 4 weeks.
• Maintenance: weekly for weeks 5 to 8, then weekly or every other week from week 9 based on symptoms.
• Evidence: in the maintenance trial, stopping esketamine after remission roughly doubled relapse over the following months, which is why plans reauthorize continued treatment when a rating scale shows sustained response.
• Reauthorization: typically every 3 to 6 months with an updated score. Plans do not usually set a maximum duration but do require ongoing benefit.

Ketamine infusions

• Induction: 6 infusions over 2 to 3 weeks.
• Maintenance: a booster when symptoms begin to return, commonly every 3 to 6 weeks at first, stretching to every 2 to 3 months. Some clinics schedule fixed intervals; others treat on demand.
• Cost planning: boosters are billed individually, so ask for the booster price separately from the series price.

TMS

• Initial course: 30 daily sessions plus a 6-session taper.
• Maintenance: not routinely covered. Insurers cover re-treatment for relapse when the first course produced at least a 50 percent improvement. Some plans allow a limited number of maintenance sessions after a documented response; ask before the taper ends.

Combining with medication and therapy

Every maintenance plan works better with the oral antidepressant continued (required for Spravato under most policies) and with psychotherapy, which has the best evidence for preventing relapse after any acute treatment.

When to taper

Discuss tapering after 6 to 12 months of sustained remission. The usual approach is stretching the interval rather than stopping abruptly, with a plan to resume quickly if symptoms return.