Spravato vs ketamine: what’s actually different.
They’re closely related. Spravato is esketamine, one half of the ketamine molecule. The real differences are how each is approved, how it’s given, and who pays for it. Here’s how they compare, and why we offer Spravato rather than infusions.
The comparison in one table.
| Spravato (esketamine) | IV ketamine | |
|---|---|---|
| The molecule | Esketamine: one of the two mirror-image halves of ketamine | Ketamine: both halves together |
| Insurance | Covered by most plans, with prior authorization | Usually not covered |
| FDA approval for depression | Yes, for treatment-resistant depression, and with an oral antidepressant for depression with suicidal thoughts | No. Approved as an anesthetic; depression use is off-label |
| How it’s given | Nasal spray you take yourself | An IV started every time, then an infusion through a drip, usually around 40 minutes |
| Where | Only certified offices, under a federal safety program | Infusion clinics; rules set by each clinic |
| After each dose | At least two hours of monitoring; no driving until the next day | Monitoring and recovery time vary by clinic |
| Typical cost to you | $0 with NJ Medicaid; up to $40 with commercial insurance after the manufacturer’s savings program | Often $500 to $600 a session |
IV ketamine hasn’t been shown to be superior in a large randomized controlled study.
No large trial has pitted the two against each other. When researchers pooled the smaller studies that did compare them directly, there was no statistically significant difference, and most of those studies weren’t randomized.1
What is well established is that Spravato beats a common alternative for treatment-resistant depression: in the head-to-head ESCAPE-TRD trial against quetiapine, 55.7% were in remission at 32 weeks on Spravato, against 36.3%.2
Find out what Spravato would cost you before you decide.
We check your insurance first, usually within a day. If you’ve already tried IV ketamine, tell us how it went.
Name, date of birth and insurer. We check your plan and call you back. No commitment.
Check my coverageRegister once, and our team starts your insurance check and reaches out to schedule your evaluation.
Request an evaluationApproved, covered, and monitored.
- Cost: for most people, insurance covers it and the out-of-pocket cost is small.
- A clear standard of care: the same dosing schedule and monitoring rules apply everywhere it’s given.
- No IV: a nasal spray you take yourself, in a reclining chair.
Not approved, not covered, and it needs an IV.
IV ketamine isn’t FDA-approved for depression, it usually costs $500 to $600 a session out of pocket, and every session means an IV line. Given that Spravato is approved, covered by most insurance and taken as a nasal spray, we think it’s the better choice for most people, and it’s what we specialize in.
If Spravato hasn’t helped you, tell us; it’s worth talking through what to try next.
What people ask about Spravato and ketamine.
Is Spravato the same as ketamine?
Not exactly. Ketamine is made of two mirror-image halves; Spravato is one of them, esketamine, made as a nasal spray and FDA-approved for depression.
Is Spravato or IV ketamine more effective?
IV ketamine hasn’t been shown to work better. There’s no large head-to-head randomized trial, and the studies that compared them directly found no statistically significant difference.
Why is Spravato covered by insurance and IV ketamine isn’t?
Spravato is FDA-approved for depression, so insurers cover it, usually with a prior authorization. IV ketamine for depression is off-label, so most plans don’t.
Do you offer IV ketamine?
No. It isn’t FDA-approved for depression, it’s usually self-pay at $500 to $600 a session, and it needs an IV. We specialize in Spravato.
Can I switch from IV ketamine to Spravato?
Often, yes. Tell us about your ketamine treatment at your evaluation, and we’ll check your insurance and talk through the switch.