When symptoms come back on Spravato, there's a lot we can do.
Spravato isn't a cure, and no depression treatment is. Even when depression is well controlled, life happens: a job is lost, stress piles up, a parent or a beloved dog dies, and symptoms can flare and start to return. That usually doesn't mean Spravato has stopped working. It means it's time to adjust, and we have good options.
Why can depression return while you're on Spravato?
Depression can return while you're on Spravato because treatment lowers the pressure, it doesn't remove it. Hard stretches in life push symptoms up for anyone, and for someone with depression they can tip mood, sleep and energy back toward where they were. Missed or stretched-out visits, a change in other medicines, illness and poor sleep can do the same. None of that is a failure on your part, and it rarely means the treatment has run its course.
We've seen this many times, and it's usually manageable.
With more than 30,000 treatments behind us, our team has helped plenty of patients through a rough patch and back to steady ground. A setback is a reason to call us, not to give up.
What if Spravato seems to stop working?
If Spravato seems to stop working as well as it did, your clinician has several things to adjust, usually one at a time so we can see what helps.
| What we look at | What it can mean |
|---|---|
| How often you come | If visits were spaced out to every other week, going back to weekly, or twice a week, for a while. |
| The dose | Moving from 56 mg to 84 mg, if you tolerate it. Spravato dosage. |
| Adding Auvelity | A daily pill that also works on the glutamate system, to strengthen what Spravato is doing. |
| Adding Vraylar | An add-on medicine approved for depression, working through dopamine. |
| Your other medicines | Reviewing your oral antidepressant and anything new that may be affecting mood or sleep. |
| Support around you | Adding or stepping up therapy through a hard stretch. |
Can Auvelity or Vraylar be added to Spravato?
Yes, and both have worked well for our patients. They're two of the strategies we reach for most when symptoms start creeping back.
Auvelity
Auvelity (dextromethorphan-bupropion) is a daily antidepressant that, like Spravato, acts on the glutamate system. Adding it stimulates that system further, and it's especially useful when the oral antidepressant someone is on isn't doing much. Spravato and Auvelity.
Vraylar
Vraylar (cariprazine) is approved by the FDA as an add-on to antidepressants for major depression (Vraylar Prescribing Information). It works through dopamine, a different route again, which is why it can help when other changes haven't been enough.
Whether either fits depends on your health and your other medicines, so we decide together, with your other prescribers where needed.
What should you do if symptoms start to return?
- Tell us earlyCall (908) 450-7002 or raise it at your next visit. Don't stretch out visits or stop on your own.
- We look for the reasonA hard stretch in life, missed visits, a change in sleep or a new medicine often explain it.
- We adjust one thingUsually how often you come, the dose, or an add-on, so we can see what helps.
- We review togetherWe keep adjusting with you until you're back on steady ground.
Feeling less in sessions doesn't mean it's working less.
After the first few treatments, most people barely notice the dissociation. Many mistake that for the medication not working. How strongly you feel a session has nothing to do with how well it's helping. What matters is how your days are going: sleep, energy, motivation and mood.
Spravato works on a different system, and so can the add-ons.
Most antidepressants act on serotonin or norepinephrine. Spravato acts on glutamate, the brain's main signalling chemical. That gives us more than one lever to pull when depression pushes back, rather than starting over.
Why staying on schedule protects the benefit.
Staying on schedule protects the benefit. In the SUSTAIN-1 trial, people in stable remission who continued Spravato had about half the risk of relapse of those who stopped (Daly et al., JAMA Psychiatry, 2019). That's why, during a hard stretch, coming in more often again is often the first step. How often and how long.
What if Spravato isn't the answer for you?
If, after adjusting, Spravato still isn't right for you, there are other treatments, and trying one more doesn't use up your options: a different medication approach, TMS, ECT, or therapy alongside medicine. Your clinician will talk through what fits your history.
More often again, if that's what helps.
30 doses
Every day.
Side effectsEvery single day: sedation, dry mouth, sexual side effects, weight gain.
8 visits
Twice a week.
4 visits
Down to once a week.
2–4 visits a month
Down to once a week or every other week. Dashed: weeks you may or may not need.
Side effectsMostly gone by the end of each visit.
Call us before you change anything.
Tell us what's changed, and we'll get you seen and adjust the plan with you.
Name, date of birth and insurer. We check your plan and call you back. No commitment.
Check my coverageRegister once, and our team starts your insurance check and reaches out to schedule your evaluation.
Request an evaluationWhat people ask when symptoms come back on Spravato.
Can Spravato stop working?
Some people find symptoms creep back over time, often during a hard stretch in life. Usually there's something to adjust, such as how often you come, the dose, or an add-on like Auvelity or Vraylar.
Is Spravato a cure for depression?
No. Like every depression treatment, it lowers the pressure rather than removing it. Many people stay well on maintenance, and when life pushes symptoms up, we adjust.
Can you add Auvelity or Vraylar to Spravato?
Yes. Both are add-ons we use often, with good results in our patients. We decide together based on your health and other medicines.
Do you build a tolerance to Spravato?
Tolerance hasn't been shown to be a common problem at prescribed doses. When the effect seems to fade, we look for the reason first.
What happens if I stop Spravato?
The chance of the depression returning goes up. Talk to us before stopping so we can plan it together.
Can I restart Spravato after stopping?
Yes. Restarting usually means a short period of more frequent visits.