Can Long-Term Ketamine Therapy Be Part of an Ongoing Treatment Plan?

When depression symptoms begin to improve, it is natural to wonder what happens next. Will the benefits last? Will treatment need to continue? Could long-term ketamine therapy become part of an ongoing mental health care plan?

The answer depends on the individual. Depression does not follow the same path for everyone, and neither does treatment. Some people may receive a short course of ketamine-based treatment and transition to other forms of support. Others may benefit from maintenance sessions scheduled at carefully chosen intervals. The goal is not to keep someone in treatment more often than necessary. It is to find the level of care that helps them maintain meaningful progress while continuing to monitor safety, symptoms, and overall well-being.

What Does Long-Term Ketamine Therapy Mean?

The phrase “long-term ketamine therapy” can sound as though treatment continues indefinitely on a fixed schedule. In practice, ongoing treatment is usually much more individualized.

Ketamine and esketamine are related but distinct treatments. Ketamine may be administered off-label for certain mental health conditions, while esketamine nasal spray, commonly known by the brand name SPRAVATO®, is FDA-approved for adults with treatment-resistant depression. Goodwin Health Cafe currently offers esketamine treatment.

For treatment-resistant depression, esketamine generally begins with a more frequent introductory phase. If a patient responds, the number of appointments may gradually decrease. During the maintenance phase, treatments may occur weekly or every other week, depending on the person’s symptoms and clinical response. The prescribing information recommends using the least frequent schedule necessary to maintain improvement.

This means that ongoing care is not a one-size-fits-all calendar. The appropriate frequency may change over time as the patient and their provider learn more about what supports stable progress.

Why Might Maintenance Treatment Be Considered?

Depression can be recurrent or persistent, particularly when several traditional treatments have not provided enough relief. A person may begin to feel better during an initial course of treatment but notice symptoms gradually returning when sessions become less frequent or stop.

In that situation, a provider may discuss maintenance treatment. The purpose is to help preserve the progress already made rather than waiting for symptoms to become severe again.

Maintenance care may be considered when:

• A patient experienced a meaningful response during the initial treatment period

• Symptoms began returning after the time between treatments increased

• Previous depressive episodes were severe, prolonged, or recurrent

• Other treatments have provided only partial relief

• The benefits of continued treatment appear to outweigh the potential risks

• Ongoing sessions remain medically appropriate and manageable for the patient

Not every patient who improves with ketamine-based treatment will need the same level of maintenance care. Some people may continue treatment at regular intervals, while others may eventually pause treatment and rely on medication management, psychotherapy, lifestyle support, or another form of care.

How Is an Ongoing Treatment Plan Individualized?

A thoughtful treatment plan looks beyond whether a person simply feels “better” or “worse.” Your provider may consider changes in mood, motivation, sleep, concentration, daily functioning, relationships, and the ability to manage stress.

Standardized depression assessments can also help track symptoms over time. These tools give the patient and provider a clearer way to recognize patterns. For example, symptom scores may show steady improvement, a plateau, or early signs that depression is beginning to return.

An individualized plan may take into account:

• The severity and duration of symptoms

• How quickly the person responded to treatment

• How long the benefits appear to last

• Side effects during or after appointments

• Current medications and other health conditions

• Personal treatment goals

• Transportation, scheduling, cost, and access

• The presence of psychotherapy or other mental health support

• Any history of substance misuse or other safety concerns

Treatment plans should remain flexible. A schedule that worked during the first few months may not be the best schedule later. Some patients may be able to gradually extend the time between appointments. Others may need closer support during a stressful period or after symptoms begin to reappear.

Any adjustment should be made with the treating provider rather than by changing or stopping treatment independently.

Is Ketamine Therapy the Entire Treatment Plan?

Ketamine-based care is often most helpful when viewed as one part of a broader mental health treatment plan.

Depression can affect thoughts, behavior, energy, relationships, routines, and a person’s sense of connection to daily life. While ketamine or esketamine may help reduce symptoms, other forms of care can support the work of rebuilding stability.

A comprehensive plan might also include:

• Psychiatric medication management

• Individual or group psychotherapy

• Consistent sleep and daily routines

• Movement or exercise that is appropriate for the patient

• Support for substance use concerns

• Stress-management practices

• Social and family support

• Ongoing medical care for physical health conditions

For some patients, symptom relief can create more room to participate in therapy, reconnect with supportive people, or return to routines that once felt overwhelming. This is one reason ongoing care should focus on the whole person, not only the treatment session itself.

What Kind of Monitoring Is Needed?

Long-term treatment requires regular clinical monitoring. Providers need to know whether the treatment continues to help, whether side effects have changed, and whether the current schedule remains appropriate.

Esketamine is administered in a certified clinical setting under the supervision of a healthcare provider. Patients are monitored after each dose for at least two hours because temporary effects can include sedation, dissociation, dizziness, nausea, and increases in blood pressure. Patients must arrange transportation home and should not drive until the following day after a restful sleep.

Longer-term monitoring may also include conversations about cognition, urinary symptoms, medication changes, mood shifts, and the potential for misuse. Patients should feel comfortable sharing concerns, even if a symptom seems small or unrelated.

Monitoring is not simply a requirement. It is part of what makes individualized care possible. The information gathered at each visit helps the provider determine whether treatment should continue, become less frequent, be adjusted, or be reconsidered.

How Long Will Treatment Continue?

There is no universal timeline that applies to every patient. The decision to continue treatment is based on ongoing conversations about benefits, risks, goals, and alternatives.

Helpful questions to discuss with a provider may include:

• What changes would indicate that treatment is working?

• How will my symptoms be measured over time?

• When might we consider spacing appointments farther apart?

• What side effects should I report?

• How does this treatment fit with my medications or therapy?

• What would the plan be if my symptoms returned?

• How often will we reevaluate whether treatment is still appropriate?

It can be helpful to think of the treatment plan as a living document. It should change when the patient’s needs change.

Building a Plan Around the Individual

For the right patient, long-term ketamine therapy may be one component of an ongoing plan for managing treatment-resistant depression. However, continued treatment should never feel automatic. The frequency and duration should be guided by the patient’s response, side effects, goals, clinical history, and regular evaluation by a qualified provider.

At Goodwin Health Cafe, care begins with the understanding that every patient’s experience is different. Our calming, nonjudgmental environment is designed to support evidence-based psychiatric care while giving patients space to ask questions and participate in treatment decisions.

To learn more about esketamine treatment and individualized mental health care, contact Goodwin Health Cafe at 5625 N. Wall St. Suite 100, Spokane, WA 99205.

This article is intended for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment.