Spravato vs Ketamine Infusion: Which Is Right for You?
Both treatments offer hope for treatment-resistant depression, but they differ significantly in FDA approval, insurance coverage, administration, and cost.
Last updated: March 2026 | Medically reviewed by Dr. Morium Chowdhury, MD
Quick Answer
Spravato (esketamine) is FDA-approved for treatment-resistant depression and covered by most insurance plans (90%+). Ketamine infusions are off-label, rarely covered by insurance, and cost $400-800 per session out-of-pocket. For most patients, Spravato is the more accessible and affordable option.
Side-by-Side Comparison
| Factor | Spravato® (Esketamine) | Ketamine Infusion |
|---|---|---|
| FDA Approval | Yes (2019) | No (Off-label) |
| Insurance Coverage | 90%+ plans cover | Rarely covered |
| Cost per Session | $0-100 with insurance | $400-800 out-of-pocket |
| Administration | Nasal spray (self-administered) | IV infusion (nurse-administered) |
| Session Duration | ~2 hours | ~1-2 hours |
| Treatment Frequency | 2x/week (4 weeks), then maintenance | Varies by provider |
| REMS Program | Required (safety monitoring) | Not standardized |
| Approved For | TRD, MDD with suicidal ideation | Off-label for depression |
What Is Spravato?
Spravato (esketamine) is an FDA-approved nasal spray derived from ketamine. It was approved in 2019 specifically for treatment-resistant depression (TRD) and in 2020 for major depressive disorder with suicidal ideation. As an FDA-approved medication, it's covered by most commercial insurance plans, Medicare, and Medicaid.
Spravato must be administered at a certified REMS (Risk Evaluation and Mitigation Strategy) facility under medical supervision. Patients self-administer the nasal spray while being monitored for at least 2 hours.
What Is Ketamine Infusion?
Ketamine infusion therapy delivers ketamine intravenously (through an IV). While ketamine itself is FDA-approved as an anesthetic, its use for depression is considered "off-label" — meaning doctors can prescribe it, but it's not specifically approved for this purpose.
Because it's off-label, insurance companies rarely cover ketamine infusions for depression. Patients typically pay $400-800 per session out-of-pocket, with most needing 6+ sessions for the initial treatment course.
Cost Comparison
Spravato with Insurance
$0 - $100
per session (after insurance)
- ✓ Covered by 90%+ of commercial plans
- ✓ Medicare Part B coverage
- ✓ Medicaid coverage (with prior auth)
- ✓ Manufacturer copay assistance available
Ketamine Infusion
$400 - $800
per session (out-of-pocket)
- ✗ Rarely covered by insurance
- ✗ 6+ sessions typically needed
- ✗ Total cost: $2,400 - $4,800+
- ✗ Maintenance sessions extra
Effectiveness: How Do They Compare?
Both Spravato and ketamine infusions show similar effectiveness for treatment-resistant depression. Studies indicate:
- Spravato: 70% response rate in clinical trials; 27% remission rate at 8 weeks
- Ketamine: Similar response rates in studies (60-70%), though data is less standardized
- Both: Rapid onset — many patients notice improvement within 24-48 hours
Which Treatment Should You Choose?
Choose Spravato If:
- ✓ You have health insurance (most plans cover it)
- ✓ You want an FDA-approved treatment
- ✓ You prefer nasal spray over IV
- ✓ Cost is a concern
- ✓ You want standardized safety monitoring (REMS)
Consider Ketamine Infusion If:
- • Spravato hasn't worked for you
- • You have significant nasal/sinus issues
- • You prefer IV administration
- • You can afford out-of-pocket costs
- • A specific ketamine protocol is recommended by your doctor
Frequently Asked Questions
Is Spravato the same as ketamine?
Not exactly. Spravato contains esketamine, which is the 'S' form (enantiomer) of ketamine. It's chemically related but formulated specifically as a nasal spray for depression treatment.
Why is Spravato covered by insurance but ketamine isn't?
Spravato went through FDA clinical trials and received approval specifically for depression treatment. Ketamine infusions use the drug 'off-label,' which insurance companies typically don't cover.
Can I switch from ketamine to Spravato?
Yes, many patients transition from ketamine infusions to Spravato, especially when they discover insurance coverage. Discuss with your psychiatrist about the best approach.
How quickly do both treatments work?
Both can provide relief within 24-48 hours for some patients. This rapid onset is what makes ketamine-based treatments revolutionary compared to traditional antidepressants that take 4-6 weeks.
Are there any conditions where one is clearly better?
For most patients with treatment-resistant depression, Spravato is the practical first choice due to FDA approval and insurance coverage. Ketamine infusions may be considered if Spravato is ineffective or contraindicated.
Ready to Explore Spravato Treatment?
As a certified Spravato provider in Lilburn, GA, we help patients navigate insurance coverage and start treatment quickly.