Spravato vs. Ketamine Therapy: Key Differences, Cost, and Coverage

If depression has not improved after trying antidepressants, you may have heard of two ketamine-based options: Spravato, a nasal spray, and ketamine therapy, given by IV or injection. They are related but not the same, and the differences in how they work, what they cost, and whether insurance covers them can shape which one makes sense for you. Here is a clear comparison.

The short answer

Spravato (esketamine) is an FDA-approved nasal spray for treatment-resistant depression, given at certified treatment centers and often covered by insurance. Ketamine therapy uses racemic ketamine, given off-label by IV infusion or intramuscular injection. It is usually self-pay, is often more flexible in dosing, and at some clinics, including ours, it is paired with therapeutic support.

Side-by-side comparison

	Spravato (esketamine)	Ketamine therapy (IV or IM)
What it is	One half (the “S” form) of the ketamine molecule	Racemic ketamine (both forms)
FDA status	Approved for treatment-resistant depression, and for depressive symptoms in adults with major depression and suicidal thoughts or actions	Approved as an anesthetic; used off-label for depression, anxiety, PTSD, and chronic pain
How it is given	Nasal spray you self-administer at a certified center	IV infusion, or intramuscular injection (what we offer)
Monitoring	At least 2 hours on site after each dose	Monitored throughout; at our clinic, the provider stays with you for the whole session
Typical schedule	Twice weekly for 4 weeks, then weekly, then weekly or every 2 weeks	A short series (ours is 6 sessions, 2 per week), then maintenance only if needed
Insurance	Often covered, usually with prior authorization	Usually self-pay
Conditions	Depression only	Depression, anxiety, PTSD, insomnia, and chronic pain (off-label)

How they work

Both medicines act on the brain’s glutamate system, blocking NMDA receptors. That is a different pathway from traditional antidepressants, which mainly target serotonin. Researchers believe this helps the brain form new connections quickly, which may explain why some people notice improvement within hours or days rather than weeks. Esketamine is one of the two mirror-image forms that make up ketamine, so the two treatments are chemically related, but they are dosed and delivered differently.

Cost and insurance

Because Spravato is FDA-approved for depression, many insurance plans cover it, although out-of-pocket costs depend on your plan. Ketamine therapy is off-label, so insurance rarely covers it and most patients pay directly. At Vigor Wellness Space, ketamine-assisted therapy starts with a $400 evaluation, and a six-session series with integration is $3,300. Read our full ketamine therapy cost guide for details.

Which one may be right for you?

Spravato may make more sense if insurance coverage is important to you, your main concern is depression, and you are comfortable with an ongoing weekly or every-other-week schedule at a certified center.

Ketamine therapy may make more sense if you want a focused series rather than open-ended treatment, you are also dealing with anxiety, PTSD, insomnia, or chronic pain, or you value therapeutic support around each session.

Neither option is right for everyone. Uncontrolled high blood pressure, certain heart or blood vessel conditions, a history of psychosis, some substance use histories, and pregnancy can rule either treatment out. That is why every patient starts with an evaluation.

Ketamine-assisted therapy at Vigor Wellness Space

We offer intramuscular ketamine-assisted therapy in Johns Creek, with no IV required. Sessions happen in a calm, private room with curated music, and our provider stays with you for the full session. Integration support helps you turn insights into lasting change. We treat adults with treatment-resistant depression, anxiety, PTSD, insomnia, and chronic pain. We do not currently offer Spravato.

Frequently asked questions

Is Spravato the same as ketamine?

Not exactly. Spravato contains esketamine, one of the two mirror-image forms that make up ketamine. It is related to ketamine but is a separate, FDA-approved product with its own dosing and safety program.

Which works faster?

Both can work quickly compared with traditional antidepressants, and some people notice changes within days. Responses vary, and no treatment works for everyone.

Can I switch from Spravato to ketamine therapy?

Sometimes. Bring your treatment history to your evaluation, and your provider will review whether ketamine therapy is appropriate.

Have questions about whether ketamine therapy fits your situation? Book a free consultation or call or text (770) 676-3330.

This article is for general information and is not medical advice. Ketamine is used off-label for these conditions. If you are in crisis, call or text 988.