Spravato is a prescription-only, FDA-approved form of esketamine, while IV/IM ketamine is an off-label treatment typically administered through an intravenous infusion or intramuscular injection.
Both have shown effectiveness in treating depression, but they differ in important ways including safety oversight, clinical monitoring, and insurance coverage.
If you’re considering advanced treatment options for depression in New York City, understanding the differences between Spravato and ketamine therapy can help you make an informed choice.
What is Spravato?
- Medication: Esketamine nasal spray (a refined form of ketamine)
- FDA Approval: Approved in 2019 for treatment-resistant depression and major depressive disorder with suicidal thoughts and behaviors
- Administration: Nasal spray self-administered under supervision in a certified clinic
- Insurance: Often covered by major insurers with prior authorization
What is IV /IM Ketamine?
- Medication: Ketamine (contains both R- and S-enantiomers)
- FDA Approval: Not FDA-approved for depression (approved as an anesthetic)
- Administration: Intravenous infusion or intramuscular injection in a clinic, usually lasting 60 minutes
- Insurance: Not covered by insurance, patients pay out of pocket.
Key Differences: Spravato vs. Ketamine
Spravato (esketamine)
- Route of administration: Nasal Spray
- How it’s given: Self-administered in clinic, under supervision
- FDA status: FDA-approved for treatment resistant depression
- Coverage: Often covered by insurance (may require prior authorization)
- Time to effect: Relief begins in hours or days; benefits build with ongoing treatment
- Therapy pairing: Psychotherapy not required
- Molecular form: Isolated S-ketamine molecule (esketamine)
Ketamine
- Route of administration: Intravenous (IV) infusion or Intramuscular IM injection
- How it’s given: Administered by provider in clinic
- FDA status: Not FDA-approved for depression (off label use supported by research)
- Coverage: Self-pay
- Time to effect: Often rapid, symptom relief may begin within hours of first infusion
- Therapy pairing: Often paired with Ketamine Assisted Psychotherapy (KAP)
- Molecular form: Full ketamine molecules (R-ketamine and S-ketamine)
Safety and Clinical Monitoring
Both treatments can cause short-term side effects such as:
- Dizziness
- Dissociation (feeling detached or dreamlike)
- Nausea
- Sleepiness
Spravato Safety Protocols
Because Spravato is FDA-approved, strict Risk Evaluation and Mitigation Strategy (REMS) requirements are in place. Patients must:
- Receive treatment in a certified clinic
- Be monitored by trained staff for at least two hours after each dose
- Avoid driving until the next day
IV /IM Ketamine Safety
IV /IM ketamine is often monitored in a clinic setting as well, but standards can vary since it is not regulated under the same federal program.
Insurance Coverage Considerations
- Spravato: Many NYC insurers including Aetna, Cigna, and UnitedHealthcare, cover Spravato for patients with treatment-resistant depression, provided prior authorization criteria are met.
- IV/IM Ketamine: Most insurance providers consider IV/IM ketamine “off-label,” meaning patients are responsible for the full cost.
Why Patients Choose One Over the Other
Spravato may be preferred for those seeking:
- FDA-approved treatment for TRD or MDD with suicidal ideation
- Insurance coverage
- Prefer a nasal spray rather than IV infusions or injections
- Value a structured treatment schedule with built-in monitoring in a REMS-certified clinic
IV/IM Ketamine may be considered by patients who:
- Prefer infusion or injection delivery
- Have not responded to other treatments, including Spravato
- Are comfortable paying out of pocket
Spravato vs. Ketamine in NYC: Which is Right for You?
Both treatments can be effective for treatment-resistant depression. The main differences lie in FDA approval, , coverage, and access. At Being Health, we offer Spravato treatment in our NYC clinic with a focus on:
- Expert psychiatric evaluation before treatment to determine eligibility
- Gold-standard safety protocols during every session
- Insurance support to help reduce financial barriers
Next Steps
If you’re exploring advanced treatment options for depression, Spravato may be the right step forward.
For more personalized answers and to learn if Spravato is right for you, schedule a consultation with Being Health today or give us a call at 888-668-7600.
