Ketamine-based treatments for depression have become widely available in major cities over the last five years. For patients trying to make sense of their options, the choice between intravenous ketamine and Spravato is often confusing because both treatments use related compounds and target similar conditions but differ in important practical ways.
Here is the clear comparison between the two treatments, what each one involves day to day, and how clinicians actually decide which one fits a given patient.
| What to know |
| • Spravato is an FDA-approved nasal spray version of esketamine administered in a certified clinic under structured monitoring, while ketamine therapy is typically delivered as an intravenous infusion in a clinic setting under a different regulatory framework. |
| • The two treatments share a related mechanism of action but differ in dosing, delivery, monitoring requirements, and how insurance typically handles them. |
| • Clinical decision making between the two depends on the patient diagnosis, insurance situation, prior treatment history, and the practical logistics of attending sessions over several weeks. |
The basic distinction between the two treatments
Spravato is a branded prescription medication containing esketamine, one of two molecular forms of ketamine. It is delivered as a nasal spray in a certified healthcare setting. The FDA has approved it specifically for treatment-resistant depression and for major depressive disorder with acute suicidal ideation, in conjunction with an oral antidepressant.
Ketamine therapy in a clinical setting typically refers to intravenous infusion of racemic ketamine, the compound that contains both molecular forms. Ketamine itself has been used in medicine since the 1970s as an anaesthetic. Its use as a treatment for depression and related conditions is typically delivered under a different regulatory framework, drawing on accumulating clinical evidence and clinical judgement.
Both treatments share a mechanism of action that involves the NMDA receptor system in the brain, which is different from the mechanism of standard antidepressants. This is why they can produce response in patients who have not responded to multiple standard antidepressants.
What a Spravato session involves
A Spravato session takes place in a certified clinic where the patient receives the nasal spray under medical supervision. After administration, the patient is monitored for at least two hours because the medication can cause sedation, dissociation, and changes in blood pressure. The patient cannot drive themselves home and needs to arrange transportation. A typical induction phase involves twice-weekly sessions for four weeks, followed by a maintenance phase with progressively less frequent sessions. For patients considering Spravato NYC options, the practical commitment in the first month is significant. Two visits per week with a two hour monitoring period after each one represents a meaningful time investment, and patients need to factor in the transport arrangements at each session.
According to the FDA prescribing information for Spravato, the medication is administered only through a restricted distribution program under a Risk Evaluation and Mitigation Strategy, which is the structured monitoring framework that governs how clinics deliver the treatment safely.
What a ketamine infusion session involves
A clinical ketamine infusion typically takes place in a clinic with appropriate monitoring infrastructure. The medication is delivered intravenously over forty to sixty minutes while the patient is reclining in a comfortable chair. After the infusion, the patient is monitored for a short period until they have recovered fully from the immediate effects and is then discharged with arrangements for transportation home. A typical course involves an induction phase of six infusions over two to three weeks, followed by maintenance infusions at intervals based on response. For patients considering ketamine therapy NYC the time commitment per session is typically shorter than Spravato in total clinic time, but the experience during the infusion itself is more immersive and may feel more intense for patients who have not had similar treatments before.
Both treatments produce dissociative experiences during the active phase, which patients often describe as a feeling of being detached from normal awareness for a period of time. The clinic environment, the support of the staff, and the framing provided before the first session all influence how patients experience this phase.
How clinicians actually decide between them
Several factors weigh into the decision. Diagnosis is the first. Spravato is FDA approved specifically for treatment-resistant depression and certain depression presentations with acute suicidal ideation. For these conditions, Spravato has the regulatory clearance and the clinical research that supports the use. For other conditions, including certain anxiety presentations and obsessive-compulsive disorder, clinical ketamine is more commonly used and the clinical evidence base is different.
Insurance coverage is the second. Spravato is typically covered by insurance for the approved indications, including Medicare and most commercial plans. Clinical ketamine infusions are usually paid out of pocket because the use is not specifically FDA approved for the depression indication. This makes a substantial practical difference for many patients.
Prior treatment history is the third. A patient who has not yet tried multiple antidepressants is typically a candidate for those first. A patient who has tried multiple antidepressants without adequate response is a candidate for either ketamine treatment, with the choice depending on the other factors.
Personal preference and logistics also matter. The frequency and length of sessions, the dissociative experience, and the type of clinic setting all influence which treatment fits a given patient situation.
How the treatments work alongside other care
Both treatments are typically used alongside ongoing psychiatric care, including continued medication where appropriate and therapy. Spravato is specifically required to be used in conjunction with an oral antidepressant for the standard depression indication. Clinical ketamine is also commonly used alongside other treatments and is rarely a standalone therapy.
Therapy in particular is increasingly recognised as an important component of ketamine-based treatments. The dissociative experience during sessions can produce psychological openings that therapy is well positioned to integrate. Some clinics structure the treatment to include integration therapy in the days following each session, which appears to improve outcomes for some patients.
For patients evaluating their options, the right question is rarely whether ketamine or Spravato by itself will resolve their condition. The more useful question is how either treatment will be integrated with the rest of their care, and whether the clinic they are considering has experience structuring that integration well.
What to ask before committing
Three questions help patients evaluate their options. The first is to ask the clinician to explain why they are recommending one treatment over the other for the specific clinical situation. A clear explanation that connects the diagnosis, prior history, and insurance picture to the recommendation is the right answer. A generic recommendation that does not engage with the specifics is not.
The second is to ask about the practical structure of the course. How many sessions in the induction phase, what the maintenance schedule looks like, what happens if the response is partial, and how the clinic coordinates with the patient existing prescriber.
The third is to ask about cost and coverage in concrete terms. For Spravato, what the insurance picture actually looks like for the specific patient, including any required prior authorisations. For ketamine, what the out of pocket cost is for the course and whether any insurance support is available. Both treatments are serious decisions, and patients deserve to understand the financial picture before they start, not after.
