IV Ketamine vs. Spravato: What's the Difference?
The two most common clinic-based ketamine treatments are IV infusions of generic ketamine and Spravato, the FDA-approved esketamine nasal spray. They're related medicines delivered very differently — and the practical differences (insurance, scheduling, experience) matter more to most patients than the pharmacology.
IV Ketamine and Spravato Side by Side
| IV Ketamine | Spravato | |
|---|---|---|
| What it is | Generic (racemic) ketamine given through an IV | Esketamine — one mirror-image molecule of ketamine — as a nasal spray |
| FDA status | Off-label for mental health (FDA-approved as an anesthetic) | FDA-approved for treatment-resistant depression and depressive symptoms with suicidal thoughts |
| Insurance | Rarely covered; usually self-pay | Often covered with prior authorization |
| Typical cost | $350–$800 per infusion, self-pay | Copay per visit when covered; $600+ without coverage |
| Where | Infusion clinic with monitoring | REMS-certified clinic only, with ~2 hours observation |
| Dosing control | Precise, adjustable in real time by weight and response | Fixed doses (56mg / 84mg) |
| Schedule | Usually 6 infusions over 2–3 weeks, then boosters | Twice weekly for a month, tapering to maintenance |
Which Ketamine Treatment Should You Consider First?
A practical rule of thumb many clinicians use: if you have insurance that covers Spravato and your diagnosis fits its approval(treatment-resistant depression), it's often the affordable starting point. If you're self-paying, need precise dose control, or are treating pain conditions, IV ketamine offers more flexibility. Some patients do both at different points. This is a decision to make with a psychiatric provider who knows your history.
Compare clinics offering each: IV ketamine clinics · Spravato providers
Informational only — not medical advice. Discuss treatment selection with a licensed clinician.