Spravato vs. Ketamine Infusions: Which One Is Right for You?
Spravato vs. ketamine infusions sounds like a comparison between two similar things, and at the molecular level it is — both use ketamine. But the practical experience, cost, coverage, and evidence base are different enough that the choice often comes down to factors that have nothing to do with the medication itself. Here's how to think it through.
FDA approval status
Spravato (esketamine) is FDA-approved for treatment-resistant depression and for major depression with acute suicidal ideation. IV ketamine for depression is used off-label — it's FDA-approved as an anesthetic, but its use for depression rests on extensive clinical research without an FDA depression indication. The approval matters mostly because of insurance.
Insurance coverage — the biggest practical difference
Spravato is covered by Medicare, Medicaid, and most commercial insurers. IV ketamine for depression is rarely covered, meaning out-of-pocket costs of $400 to $800 per session for a typical induction series of six to eight sessions. For many patients, this single factor is decisive.
Delivery — nasal spray vs. IV
Spravato is a nasal spray you self-administer in clinic. IV ketamine is delivered through an intravenous drip over 40 to 60 minutes. The IV route produces more predictable blood levels; the nasal route is easier and doesn't require an IV line.
Dose precision and standardization
Spravato's dose is fixed by formulation (56 mg or 84 mg). IV ketamine is dosed by body weight and clinical response. Both work; the standardization of Spravato makes prior auth and insurance billing more straightforward.
Effect duration and maintenance cadence
Effects of a single IV ketamine session typically last several days. Spravato sessions produce effects that build with the induction series and consolidate during maintenance. Both modalities can maintain remission with periodic dosing — every two to four weeks is common, depending on the patient.
Side effect profile
Both share similar acute side effects: dissociation, mild dizziness, nausea, BP elevation. IV ketamine sometimes produces more pronounced dissociation. Spravato's effects often feel softer. Neither produces lasting cognitive issues at clinical doses.
Who should choose which
If you have insurance that covers Spravato and meet eligibility criteria, start there — strongest evidence, lowest cost, most established safety protocol. If you're self-pay and want the strongest single-session effect, IV ketamine may make sense. If you've tried Spravato without response, IV ketamine is a reasonable next step.
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