Maintenance Dosing: Sustaining Response After Induction
Most responders need some form of continued treatment to sustain benefit. There is no consensus on the best schedule — only competing models with different trade-offs.
Three common maintenance models
1. Fixed-interval boosters
A single session every 2-6 weeks on a calendar schedule. Predictable and easy to plan around. Risk: receiving treatment you may not need.
2. Tapering schedule
Progressively widening the interval (weekly → biweekly → monthly → quarterly) until symptoms guide stopping. The default for many depression patients.
3. Symptom-triggered (PRN)
No scheduled sessions. Patients return for a booster when symptoms recur to a defined threshold. Requires honest self-monitoring and a responsive clinic.
What the evidence supports
- Maintenance reduces relapse rates vs. discontinuation alone in TRD (Wilkinson 2018).
- No randomized trials definitively favor one schedule over others.
- Long-term safety data beyond 1-2 years remains limited.
Questions to ask your provider
- What signals will tell us it's time to space out or stop?
- How will we monitor for tolerance or escalation?
- What's the off-ramp plan from day one?
Independent publisher and editor of Ketalux, based in Chicago, Illinois. Ira commissions, edits, and reviews every article on the site and believes ketamine therapy — used responsibly — offers real hope for people living with depression, anxiety, PTSD, and chronic pain. Contact: ira@idigits.com.
Educational use only. The content on this page is provided for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Ketamine and related therapies carry risks and are appropriate only under qualified medical supervision. Always consult a licensed healthcare professional about your individual situation. Information may change as research evolves.