You monitor patients for 2 hours post-administration under REMS. What happens in the other 166 hours of the week is largely invisible — and that's where response durability is determined.
The Spravato REMS program requires 2 hours of post-administration monitoring. That's rigorous, appropriate, and well-designed. It's also 2 hours out of 168 in a week.
In those other 166 hours, your patient goes home. They sleep, work, interact with family, experience good days and bad ones. Their response to esketamine — or the beginning of its degradation — plays out entirely outside your view.
Three patterns invisible without continuous monitoring
In practices that have deployed Emobot monitoring for Spravato patients, three distinct patterns emerge that are invisible in standard-of-care monitoring.
The first is durable responders: patients whose depression index remains stable or continues declining between sessions. These patients are on the right trajectory. You'd suspect this from their PHQ-9 at session visits — but the between-session data confirms it and removes ambiguity.
The second is partial responders with between-session decay: patients whose depression index drops immediately post-session (acute effect) but rebounds toward baseline before the next session. These patients may report feeling "fine" at their REMS visit — they're experiencing the post-session peak. The between-session decay is invisible without continuous monitoring. And it has direct implications for session frequency decisions.
The third is non-responders trending toward dropout: patients with no sustained improvement across multiple sessions. These are your highest-risk patients for program discontinuation — and the ones most likely to disappear quietly without telling you why.
What to do with this information
For durable responders: use the objective data to support prior authorization documentation. Payers want evidence of treatment response. Continuous passive monitoring data is stronger evidence than periodic PHQ-9 scores.
For partial responders with decay: consider session frequency optimization. If your data shows consistent between-session rebound, the clinical conversation about frequency has an objective foundation rather than relying on patient self-report.
For non-responders: early identification creates an intervention window. Protocol review, augmentation discussions, or escalation conversations can happen before the patient drops out — not after.
The 166 hours between REMS sessions aren't visible to you today. They don't have to be invisible.
Tanel Petelot
CEO & Co-founder, Emobot
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