Ketamine Therapy in Denver: A Patient's Guide to Spravato, IV Infusions, and Lozenges

Ketamine Therapy in Denver: A Patient's Guide to Spravato, IV Infusions, and Lozenges 

If you've been researching ketamine therapy in Denver, you've probably noticed three completely different things being marketed under the same word. Spravato. IV ketamine infusions. Compounded oral lozenges. They all use the same molecule — but the experience, cost, evidence, and insurance coverage are very different. Here's how to tell them apart, based on what we see in our Denver patients every week. 

Spravato (esketamine nasal spray) 

This is the FDA-approved version of ketamine medicine. Specifically, it's esketamine — one mirror-image half of the ketamine molecule. It's been approved for treatment-resistant depression since 2019, and for major depression with acute suicidal ideation since 2020. Sessions are in-clinic only, with two-hour observation. Most major insurance plans cover it. This is what we administer at Stellar Genesis Professional. 

IV ketamine infusions 

Intravenous racemic ketamine has been used off-label for depression since the early 2000s. The evidence is strong, but it's not FDA-approved for depression, so insurance rarely covers it. Sessions are typically 40 to 60 minutes in a clinic chair with a slow IV drip. Effects often feel stronger and more immediate than Spravato. Out-of-pocket cost in Denver typically runs $400 to $800 per session. 

Oral or sublingual ketamine lozenges 

Compounded ketamine lozenges (sometimes called "troches") are the cheapest option — sometimes mailed to your home through telehealth services. The trade-off is significant: lower and less predictable absorption, less clinical oversight, a weaker evidence base, and no FDA approval for depression. They have a place for some patients, especially in maintenance, but they're rarely where most people should start. 

How to choose between them 

Insurance is often the deciding factor. If you have commercial insurance, Medicare, or Colorado Medicaid, Spravato is typically the lowest out-of-pocket option and has the strongest evidence base. If you've already tried Spravato and didn't respond, or you need a faster onset, IV ketamine is the usual next step. Lozenges fit best as a low-cost maintenance option after you've responded to in-clinic treatment. 

A few honest cautions 

Watch out for telehealth services that prescribe ketamine after a 15-minute video call with no real psychiatric history. Watch out for clinics that don't tell you about Spravato (the only FDA-approved option) before steering you toward what they happen to sell. The right ketamine treatment for you depends on your diagnosis, history, and insurance — not on a clinic's preferred margin. 

Schedule a free consult and we'll help you figure out which path actually fits your situation.