Spravato vs. Ketamine: What Is the Difference?

What each one is

Spravato is esketamine, one mirror-image half of the ketamine molecule, formulated as a nasal spray and approved by the FDA for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior. Ketamine used for depression is racemic ketamine, typically given intravenously and prescribed off-label — meaning the use is not an FDA-approved indication.

How it is given

• Spravato: self-administered nasal spray in a certified healthcare setting.
• Ketamine: most often an intravenous infusion, sometimes intramuscular.

Supervision and monitoring

Spravato is only available through the Spravato REMS program, which requires a certified setting, an on-site clinician and at least two hours of observation after each dose. Ketamine infusion protocols vary between clinics because there is no comparable single national program for the off-label use.

Insurance

Because Spravato carries an FDA-approved indication, many plans cover it after prior authorization. Off-label ketamine infusions are frequently not covered and are often paid out of pocket.

Which one is discussed here

Thinking Therapeutics is a REMS-certified Spravato treatment center in Mason, Ohio. We do not offer ketamine infusions. If you are weighing the two, we are glad to talk through what the difference would mean for your situation.

This article is general information, not medical advice. Eligibility and dosing are decided during an individual evaluation with Nikki Ruoss, APRN, PMHNP-BC, a board-certified psychiatric mental health nurse practitioner.