IV Ketamine vs. Spravato: Understanding the Best Treatment for You

What Is Intravenous (IV) Ketamine?

Ketamine is a powerful anesthetic that was developed initially for surgical procedures. However, over the past decade, its potential as a mental health treatment has garnered significant attention. Clinical research has shown that ketamine has rapid antidepressant effects, with benefits appearing hours after treatment. The treatment is particularly important for treatment-resistant mood disorders, providing relief when other treatments have failed.

Ketamine can be administered in several different ways, including intravenous (IV) infusion, intramuscular (IM) injection, and intranasal spray. In some cases, it may also be prescribed in oral form. The most common method of administration in clinics is IV ketamine, as it allows for precise dosing and fast absorption, providing quicker therapeutic effects.

What Is Spravato?

Spravato, the brand name for esketamine, is a nasal spray that was developed by Janssen Pharmaceuticals as a more targeted form of ketamine for treating depression. While ketamine contains both the R- and S-enantiomers, Spravato is composed exclusively of the S-enantiomer (S-ketamine).

Unlike ketamine, which has a broader range of uses, Spravato is specifically approved for treatment-resistant depression(TRD) and major depressive disorder with suicidality (MDSI). The nasal spray format is designed to be easier and less invasive than the IV ketamine infusions, but it still requires monitoring for side effects during and after treatment.

How Do IV Ketamine and Spravato Work?

Both ketamine and Spravato block NMDA receptors in the brain, which play a role in learning and neuroplasticity. Neuroplasticity  is the brain's ability to reorganize itself, and it's an essential player in treating mood disorders. The process helps repair dysfunctional nerve circuits and supports the development of healthier thought patterns and behaviors.

While both treatments share this mechanism of action, there are some key differences in how they affect the brain. Ketamine, especially when administered intravenously, can produce psychedelic effects, including dissociation, changes in perception, and vivid emotional experiences. These experiences can be therapeutic when paired with psychotherapeutic support, similar to classical psychedelics.

Spravato, on the other hand, interacts more strongly with NMDA receptors and is less psychoactive at therapeutic doses.

Ketamine vs Spravato Treatment Protocol

Ketamine is typically delivered through IV infusions, which provide the most consistent and rapid absorption into the bloodstream. Treatment sessions generally last about 40 minutes, with the effects starting to take hold within a few minutes. Patients are closely monitored for side effects and remain in the clinic for about two hours following treatment to ensure safety. The frequency and number of sessions will depend on a patient's unique condition and how they respond to ketamine. 

Spravato is a nasal spray that patients administer themselves under medical supervision. Each session takes about two hours, including observation time, as side effects can occur soon after administration. The treatment protocol is much less flexible and follows a standard protocol of doses twice weekly for the first four weeks, with maintenance treatments occurring weekly afterward.

Is IV Ketamine or Spravato More Effective?

Both IV ketamine and Spravato have shown promise in treating treatment-resistant depression (TRD), with similar effectiveness. However, IV ketamine may give rise to quicker symptom relief, with improvements typically occurring within hours of treatment. One study found no difference in terms of overall efficacy, but IV ketamine patients required fewer treatments to reach remission.

Safety and Side Effects

Both IV ketamine and Spravato are generally safe when administered by experienced professionals in a clinical setting. However, like all medications, they come with potential side effects.

Common side effects of both treatments can include:

• Dizziness
• Nausea
• Increased heart rate
• Dissociation (feeling detached from one’s body or surroundings)
• Temporary changes in blood pressure

For IV ketamine, the dissociative effects can sometimes be more intense. For some patients, these sensations can feel disorienting or even frightening, while for others, they can lead to valuable insights during the therapy process. Patients may also experience side effects related to the infusion, such as pain at the site of injection.

Spravato, due to its lower dosage, generally leads to milder side effects. However, it may cause nasal irritation  or congestion  in some individuals, as the medication is administered via a nasal spray.

Cost and Insurance Coverage

When considering treatment options, the cost is an essential factor. Spravato, being FDA-approved, is often covered by insurance, making it a more affordable option for many patients. However, coverage may depend on the specific plan, and some individuals may still need to pay a co-pay or meet other out-of-pocket expenses.

IV ketamine, on the other hand, is not FDA-approved for depression, meaning it is less likely to be covered by insurance. While the out-of-pocket cost of ketamine can be higher, many patients find it worth the investment due to the rapid and lasting relief it provides.

At SW Florida TMS & Ketamine Clinic, we work with CareCredit, a health and wellness credit card that provides flexible financing options for ketamine treatment. This allows you to pay for the care you need or desire over time.

Which Treatment Is Right for You?

Choosing between ketamine and Spravato depends on several factors, including the severity of your condition, your preferences for treatment, and cost considerations.

• IV ketamine therapy is an off-label treatment for several different mental health disorders. It offers flexibility with various administration methods and treatment protocols. Its psychoactive effects can give rise to potential psychotherapeutic benefits.
• Spravato is a nasal spray that is only available for people with diagnosed TRD or MDSI. The treatment protocol is more structured, and its insurance coverage makes it a financially viable option.

At our TMS and ketamine clinic in Fort Myers, we provide personalized consultations to help you decide on the best treatment for your needs. Our medication management services will also help track your progress, manage treatment doses and schedules, and explore alternative options. Contact us today to learn more about ketamine and Spravato treatment options and how they can help you achieve lasting relief from depression and other mental health challenges.