Spravato™ VS Ketamine

September 27, 2023 by Steve Suntala

Spravato vs Ketamine – what’s the difference?

Ketamine infusions are a reliable treatment for Major Depressive Disorder (MDD) and have been proven to be a successful treatment option for 70% of treatment-resistant patients. Ketamine has been the subject of extensive research over the last 17 years. Its high success rate and lack of side effects makes it the most promising treatment for the tens of millions of people who cannot find relief from standard anti-depressants such as SSRIs, or therapy alone, and paved the way for Spravato™ to be created. Learn more about Ketamine infusions from our links directly below.

About Ketamine

Ketamine FAQs

Ketamine Research

What Is Spravato? – Meet The Esketamine Nasal Spray

Due to the success Ketamine has had in treating Major Depressive Disorder (MDD), it was inevitable that a more easily deliverable version would be created for FDA approval. Because Ketamine is a generic drug that has existed since the 1960’s, pharmaceutical companies explored small variations of the Ketamine molecule that could also be effective for treating depression. Enter Spravato!

In 2019, the Esketamine nasal spray Spravato was approved by the FDA for the treatment of MDD that is treatment resistant or includes suicidal thoughts. With its approval, patients now have the choice between Ketamine IV infusions and esketamine treatments in the form of a nasal spray for MDD. When deciding on Spravato vs ketamine, there are a few differences to consider, below.

What Are the Differences Between Ketamine and Esketamine Treatments?

“What is the difference between Ketamine and Esketamine” is a question we often hear. There are two different types of Ketamine: R-Ketamine and S-Ketamine. While they are nearly identical molecules, they have slightly different effects on the brain. The type of Ketamine used in IV infusions is racemic, which means that is a mixture of R-Ketamine and S-Ketamine. Meanwhile, Esketamine is isolated to only contain S-Ketamine, which makes Spravato unique for Esketamine treatments.

Early scientific evidence suggests that both are effective treatments.  IV Ketamine infusions of racemic Ketamine may present better outcomes due to a number of factors including delivery method, dosage, and chemistry. “Intravenous ketamine appears to be more efficacious than intranasal Esketamine for the treatment of depression.” (Journal of Affective Disorders

Spravato vs Ketamine

Comparison of IV Ketamine Infusions vs Spravato™ Esketamine Treatments

Ketamine IV Infusions Spravato Esketamine Treatments
Method of Delivery Ketamine is given through an IV over 40 minutes precisely. This allows the provider exact control of the experience and enhance the cognitive effects of the treatment. Spravato™ is self-administered in two to three intranasal sprays admin in five-minute increments. An alternative for patients who would prefer to avoid an IV.
Insurance Coverage Insurance will only cover the psychiatric care given at the clinic not the Ketamine infusion itself. There are out-of-pocket costs even with coverage. Your insurance may cover the cost of Spravato™. Prior approval will be established before treatment.
Your responsibility could be as little as $0 for each treatment.
Bioavailability The bioavailability of IV ketamine is 100%.
This means the full dose that is given will reach the brain.
Nasal spray of applications has a bioavailability of approximately 50%.
Spray can remain in the nasal passages and be swallowed, which the affects the amount of medication that reaches the brain.
Treatment Schedule Six Ketamine infusions are administered over the course of 2-3 weeks.

Maintenance booster infusions are needed by many patients. The frequency depends on the strength and length of the patient’s response. The schedule varies from once a month to two times a year.

Weeks 1 to 4: Spravato ™ is administered twice a week, eight times.

Weeks 5 to 8: One treatment weekly

Week 9 and after: Every 2 weeks or as needed, depending on patients response.

Dosage IV dose is determined by weight (Kg/Kilograms) and titrated to provide a consistent, controlled, and comfortable delivery. Spravato™ is provided in two doses: 56mg and 84mg.

The prescribing health care provider will select the dose based on the patient’s treatment response.

Eligible Disorders Treated Major Depressive Disorder
All Types of Treatment Resistant Depression
Anxiety Disorders
Bipolar Disorder
Substance Abuse
FDA Approved for Major Depressive Disorder and Acute Suicidality
Medication Requirements Treatments can be given by themselves without any other medications or while taking any psychiatric medication Spravato™ must be administered in combination with an oral antidepressant.
Length of Appointment Between 90 and 120 Minutes 2 and 1/2 Hours

Why Choose New Pathways Clinic for Your Spravato Esketamine Treatments?


The New Pathways Team has over a decade of experience treating treatment-resistant patients with Ketamine and we are ready to help guide you through your Spravato Esketamine treatments. With a simple nasal spray application, Spravato offers patients another option for treating their major depressive disorder and suicidal ideation.

Do anti-depressants feel like they are merely treating surface level symptoms?

Have anti-depression medications and counseling left you feeling like no treatment works for you?

Schedule a free phone consultation with the experienced team at New Pathways Clinic and see if Spravato could help you.

At New Pathways Clinic our heartfelt mission is to establish a holistic mental wellness campus that touches the lives of individuals in the greater Cleveland and Columbus regions. We are dedicated to combining state-of-the-art mental health treatments, like Ketamine therapy infusions and Spravato nasal spray, with the expertise of compassionate mental health professionals to treat depression, anxiety, PTSD, migraines, and bipolar disorder.

Our unwavering commitment drives us to continuously evolve and adapt as the scientific landscape of ketamine research expands and diversifies, leading to innovative mental health treatments. We are determined to pave the way for a healthier future for Cleveland and central Ohio. 

New Pathways Clinic also offers Semaglutide & Tirzepatide weight-loss shots, ketamine-assisted psychotherapy, ketamine/Spravato support groups for patients, and medication management for psychiatric medications.

Keep In Touch

Stay informed on ketamine treatments, Spravato, and mental-health wellness at New Pathways Clinic in Cleveland via our free newsletter.

© New Pathways 2023