Spravato vs. Ketamine Infusion: What’s the Difference?

If you’ve been researching newer options for treatment-resistant depression, you’ve probably come across two names over and over again: Spravato® (esketamine nasal spray) and IV ketamine infusion therapy. Both are newer depression treatment options that are gaining attention for people who haven’t responded well to traditional antidepressants.

It’s easy to assume they’re basically the same treatment. After all, both are derived from ketamine, and both are used for people whose depression hasn’t improved with standard antidepressants. However, there are important differences between Spravato treatment and ketamine therapy that patients should understand.

But that’s only part of the story.

Once you dig a little deeper, you’ll find some important differences. They aren’t given the same way; they don’t follow the same regulations, and they aren’t always covered by insurance in the same way. Those practical details often matter just as much as the treatment itself.

So if you’re comparing Spravato vs. ketamine infusion therapy, here’s what you need to know.

What Is Spravato?

Spravato is the brand name for esketamine, a prescription nasal spray that’s FDA-approved for adults with treatment-resistant depression. As an FDA-approved depression treatment, Spravato is also approved for certain people with major depressive disorder who are experiencing acute suicidal thoughts or behaviors. 

Unlike traditional antidepressants that mainly affect serotonin, Spravato treatment works on the brain’s glutamate system. Researchers believe this pathway plays an important role in how brain cells communicate and adapt, which may explain why some people notice improvements sooner than they did with conventional medications.

Because of its potential side effects including dizziness, dissociation, sleepiness, and temporary increases in blood pressure, Spravato can’t be taken at home.

Every treatment is given in a certified clinic under medical supervision. After each dose, patients stay for at least two hours so the care team can monitor how they’re feeling before they’re cleared to leave.

Treatment usually starts with two appointments each week during the first month. If the medication is helping, visits are gradually spaced farther apart.

What Is Ketamine Infusion Therapy?

Ketamine infusion therapy uses racemic ketamine, the original form of ketamine that’s been safely used as an anesthetic in hospitals for decades.

Although the FDA hasn’t specifically approved IV ketamine for depression, doctors can prescribe it off-label when they believe it’s an appropriate treatment option.

The medication is delivered through an IV over about 40 minutes in a controlled medical setting. Throughout the infusion, medical staff monitor blood pressure, heart rate, and overall comfort.

Like Spravato, IV ketamine therapy targets the brain’s glutamate system instead of serotonin. Researchers believe this may help the brain build new neural connections, which could explain why some patients experience relief sooner than expected from ketamine treatment for depression. 

Most people begin with six infusions over two or three weeks, though treatment plans vary. Some continue with occasional maintenance infusions, while others may not need them as frequently.

Spravato vs. Ketamine Infusion: Key Differences

The biggest difference between Spravato vs. ketamine infusion therapy isn’t necessarily how well they work. 

It’s how each treatment is regulated.

Spravato follows an FDA-approved treatment program with strict monitoring requirements. IV ketamine gives physicians more flexibility, but because it’s prescribed off-label, insurance coverage can be much less predictable.

Which One Works Better?

There’s no clear winner.

Both treatments have helped people whose depression didn’t improve with traditional antidepressants.

Clinical studies have shown that Spravato can reduce depressive symptoms when combined with an oral antidepressant. IV ketamine has also shown promising results in both research and everyday clinical practice, with some patients reporting noticeable relief after only a few treatments.

The better option usually depends on factors beyond effectiveness.

Your diagnosis, previous treatments, medical history, insurance coverage, and your psychiatrist’s recommendation all help determine which approach makes the most sense.

Cost and Insurance

For many people, this is where the biggest difference shows up.

Because Spravato is FDA-approved for treatment-resistant depression, many insurance plans cover at least part of the medication and the supervised treatment sessions. Coverage varies, so it’s always worth checking your benefits beforehand.

IV ketamine is different.

Since it’s prescribed off-label for depression, insurance reimbursement is much less common. Many patients pay for treatment themselves, which can make the overall cost considerably higher, especially if multiple infusions are needed.

Side Effects and Safety

Although they’re administered differently, Spravato and IV ketamine have many of the same short-term side effects.

Some people experience dizziness, nausea, drowsiness, blurred vision, a temporary rise in blood pressure, or a feeling of being detached from their surroundings. These effects are usually temporary and tend to wear off within a few hours.

That’s why both treatments are given under medical supervision.

Spravato requires monitoring through the FDA’s REMS program. IV ketamine isn’t part of that program, but it should still be administered by experienced medical professionals in a properly equipped clinic.

Who May Not Be a Good Candidate?

Ketamine-based treatments aren’t right for everyone.

People with uncontrolled high blood pressure, certain heart or blood vessel conditions, active psychosis, or other medical concerns may not be suitable candidates.

Before recommending either treatment, your provider will review your medical history, current medications, and overall health to determine whether it’s a safe option.

Which Treatment Should You Choose?

There’s no one-size-fits-all answer.

If having an FDA-approved treatment that’s more likely to be covered by insurance is important to you, Spravato may be the better choice.

If your psychiatrist believes IV ketamine is a better fit based on your symptoms or treatment history, infusion therapy may still be worth considering, even if insurance doesn’t cover it.

At the end of the day, both Spravato treatment and IV ketamine infusion therapy have opened new possibilities for people with treatment-resistant depression who’ve struggled to find relief with traditional antidepressants. While they share the same roots, they’re delivered differently and come with different practical considerations. 

The right choice is the one that’s made with your mental health provider after carefully weighing your symptoms, medical history, treatment goals, and financial considerations.

Choosing the Right Treatment Provider Westchester & Rockland 

Understanding the differences between Spravato and ketamine infusion therapy is only one part of the decision-making process. Choosing an experienced treatment provider is equally important. 

Marpa Minds specializes in Spravato® treatment for adults with treatment-resistant depression, offering care in a medically supervised environment that follows FDA-required REMS monitoring protocols. The clinic also provides comprehensive evaluations, personalized treatment plans, and assistance with insurance verification and authorization when applicable. Learning more about the treatment process and eligibility requirements can help you have a more informed conversation with your mental health provider and determine whether Spravato or ketamine infusion therapy is the right option for your needs. Visit https://marpaminds.com/ to learn more about their services and treatment approach.

Frequently Asked Questions

Is Spravato the same as ketamine?

Not exactly. Spravato contains esketamine, which is one part of the ketamine molecule. IV ketamine uses racemic ketamine, which contains both forms of the medication. While they work in similar ways, they differ in FDA approval, administration, and treatment protocols.

Which is more effective—Spravato or ketamine infusion?

Both treatments have shown positive results for treatment-resistant depression. Spravato is FDA-approved and supported by large clinical trials, while IV ketamine has strong research backing but is prescribed off-label. The right option depends on your medical history and your provider’s recommendation.

Does insurance cover ketamine infusions for depression?

In most cases, IV ketamine infusions are not routinely covered because they’re considered an off-label treatment for depression. Some insurance plans may offer partial reimbursement, but many patients pay out of pocket.

How long do the effects of Spravato vs. ketamine last?

The effects vary from person to person. Some patients experience relief for several days, while others benefit for weeks. Maintenance treatments are often recommended to help sustain improvements.

Can I do ketamine infusions and Spravato at the same time?

These treatments are not typically used together. If you’re considering switching or combining therapies, it’s important to do so only under the supervision of a qualified mental health provider.

What conditions are treated with ketamine besides depression?

In addition to treatment-resistant depression, ketamine therapy may be used for certain cases of PTSD, anxiety disorders, obsessive-compulsive disorder (OCD), chronic pain, and major depressive disorder with suicidal ideation, depending on clinical evaluation.

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