Though Spravato and ketamine are closely related, they differ primarily in how they are administered. Spravato is a nasal spray form of esketamine, while ketamine therapy is typically delivered through IV infusions. Both treatments act on similar brain pathways involved in mood regulation and can lead to rapid improvements in depressive symptoms. At New Pathways, our providers can help determine which treatment option may be best suited to your individual needs.
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.
Most IV ketamine treatments use what’s called “racemic ketamine,” which simply means it contains a mix of both R- and S-ketamine. Spravato (esketamine), on the other hand, contains only the S-ketamine part. This difference is what makes Spravato a more targeted, single-form version of ketamine therapy.
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 can cover the cost of Spravato™. Prior authorization is required 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 PTSD 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™ has recently been approved as a Monotherapy by the FDA and does not require actively being on an anti-depressant. |
| Length of Appointment | Between 90 and 120 Minutes | 2 and 1/2 Hours |
New Pathways has over a decade of experience treating treatment-resistant patients with ketamine. With a simple nasal spray application, Spravato offers patients another option for treating their major depressive disorder and suicidal ideation that we’re ready to help guide you through at every stage.
Do antidepressants feel like they are merely treating surface-level symptoms?
Have medications and counseling left you feeling like nothing works for you?
Schedule a free phone consultation with the experienced team at New Pathways Clinic and see if Spravato could be right for you.
