Quick answer : After an initial ketamine infusion series (typically six infusions over two to three weeks), patients move into a monitoring and maintenance phase. Some patients sustain improvement for six to twelve months or longer with no further treatment. Others benefit from periodic maintenance infusions, typically every four to eight weeks, to sustain their response.
One of the most common things I hear from patients after a successful initial series — and I mean this in the best possible way — is some version of: “Okay, now what?”
You have completed the infusions. Something has shifted. The weight that sat on your chest has lifted, or at least become lighter. You are sleeping again. You can feel things you had not felt in months or years.
So what comes next?
That is a good question. Many clinics do not answer it with enough honesty. Let me try to do better than that.
A standard initial series of six infusions over two to three weeks has two primary goals. First, it helps determine whether you respond to ketamine. Second, it creates an opportunity to build on that response through continued treatment and integration.
For patients who respond well, the initial series can mark an important turning point. Some people maintain significant improvement for six months, a year, or longer without additional ketamine treatment.
Several factors may influence how long that improvement lasts. These can include how long someone has experienced symptoms, their overall health, their support system, and how they approach integration after treatment.
Therapy, nervous system regulation, lifestyle changes, and stronger social connections can all become part of that process. These steps may help patients build on the changes they experience during treatment.
Other patients have a different experience. Those with longer illness histories, more complex symptoms, or difficult life circumstances may notice their improvement begin to fade within weeks or months.
For these patients, ongoing treatment may become part of the long-term plan.
That does not mean treatment failed. Chronic conditions often require ongoing management. A return of symptoms also does not necessarily mean ketamine has “stopped working.”
Patients who need ongoing treatment may move to a maintenance schedule. We typically individualize the timing based on each patient’s response and needs.
Some patients find that an infusion every six weeks helps them maintain stability. Others may need treatment every four weeks. A smaller number may do well with a booster every few months.
The goal is to find the minimum treatment frequency that supports your quality of life.
I am not interested in keeping someone in treatment longer than necessary. The goal is for you to feel well and function independently. Over time, that may mean needing less treatment rather than more.
Spravato patients follow a different maintenance schedule. After the initial treatment period, the schedule typically shifts to once-weekly or every-other-week sessions, depending on the treatment phase and clinical plan.
Spravato also has established insurance coverage pathways for eligible patients. That can provide an important option for managing treatment costs.
I coach patients on this before they leave their final infusion of the initial series.
Your experience of feeling better gives you something valuable: a reference point. You now know what “better” feels like. That makes it easier to recognize subtle changes when symptoms begin to return.
In most cases, this drift happens gradually rather than all at once.
The early signals will look different for each person. Common examples include:
Sleep quality starts to decline before mood changes
Familiar intrusive thoughts begin returning
Interest in activities starts to decrease
Emotional numbness begins to return
A familiar sense of heaviness starts creeping back in
The goal is to recognize these changes before symptoms become severe.
For some patients, an appropriately timed maintenance treatment may help address an early retu
Not necessarily, and I want to be honest that the answer varies widely. Some patients finish their initial series and stay well for over a year with no further treatment — especially those who engage seriously with therapy and integration work during the neuroplasticity window. Others find they need a maintenance infusion every six to eight weeks to stay stable. For them, that’s not a failure — it’s a management strategy, the same way some people need ongoing antidepressants or ongoing physical therapy. What I try to avoid is an open-ended treatment relationship with no clear rationale. Every patient I treat has an explicit conversation about what the long-term picture looks like and what we’re working toward.
This is something we talk through specifically before you finish your initial series. Bad weeks happen — they’re part of life, not necessarily a sign you need treatment. What we’re watching for is a pattern: two to three consecutive weeks of declining sleep, mood, or function, a return of the specific symptoms that characterized your illness before treatment, or a sense of losing ground that persists beyond what normal life variability would explain. If in doubt, call us. A brief check-in conversation is free, and it’s far better to assess early and decide against a maintenance session than to wait until you’ve lost the gains you worked for.
Yes. Both clinics are the same practice, and your records transfer seamlessly between them. Some patients start their initial series at one location and prefer to do maintenance sessions at the other because it’s more convenient for their schedule at that point in their life. That’s completely fine. You’ll always be seeing the same physician and operating within the same protocol framework regardless of which location you’re at.
