This blog compares Spravato (esketamine nasal spray) and IV ketamine as treatment options for depression, particularly treatment-resistant depression. It outlines key differences in administration, safety, side effects, insurance coverage, cost, and effect.
If you’ve been researching alternatives to antidepressants, you’ve probably come across ketamine and esketamine. You might even be wondering: “Esketamine vs ketamine—are they the same thing?” Short answer: not exactly. While they’re closely related, the way they’re administered, monitored, and covered by insurance can vary significantly.
In this guide, we’ll break down the differences between ketamine infusions and Spravato (esketamine), explain what’s covered by insurance, how long each treatment lasts, how much they cost, and which option might be right for you.
What Is the Difference Between Esketamine and Ketamine?
Ketamine is a well-known anesthetic that has been used off-label for depression for over two decades. Esketamine, on the other hand, is a refined version of ketamine—essentially one “half” of the ketamine molecule—that was developed and FDA-approved under the brand name Spravato™ to treat treatment-resistant depression and major depressive disorder with suicidal thoughts.
Is Spravato Covered by Insurance?
Yes, Spravato (esketamine) is FDA-approved and covered by most major insurance plans in Colorado. Unlike traditional ketamine infusions, which are considered off-label and often not reimbursed, Spravato is widely accessible thanks to insurance coverage.
How Much Does Spravato Cost?
Without insurance, a course of Spravato treatment can cost several thousand dollars—but most patients don’t pay the full price. The Spravato With Me Savings Program can bring your out-of-pocket costs down dramatically—often as little as $10 per treatment if you qualify. Read our article for more information about how much Spravato costs.
What Will Your Insurance Cover for Spravato Treatment?
Use our free Spravato cost calculator to get a rough estimate on Spravato treatment. Or, book a free financial consultation with our team to check your coverage and ask any additional questions.
At your appointment, we’ll tell you:
- What your insurance plan requires to cover treatment
- Your estimated out-of-pocket cost
- What you can expect from treatment including time commitments, when you might to start feeling better, and other options.
Ask our team about payment plans, alternative payments, and more on your call.
Get Your Spravato Ketamine Therapy Total Estimate
Important: This is an estimate only, not a guarantee or full benefits investigation. Actual costs depend on your specific plan and claim processing. You are not required or encouraged to book services with Axis based upon this calculator. The calculator is provided as a certain mental and behavioral health concerns.
How Much Does Ketamine Cost?
Ketamine infusions, which are not FDA-approved for depression, are typically not covered by insurance. Patients often pay $350–$500 per infusion, and a full course can cost $3,000–$5,000 or more. You can read more about how much ketamine infusions cost in our deep dive article.
Spravato vs Ketamine Infusions: Pros and Cons
| Feature | Spravato (Esketamine) | Ketamine Infusions |
| FDA Approval | ✅ Yes (for depression) | ❌ No (off-label use only) |
| Insurance Coverage | ✅ Most insurance plans | ❌ Usually out-of-pocket |
| Route of Administration | Nasal spray in a clinic setting | Intravenous infusion in a clinical setting |
| Cost | Often as little as $10 with savings program. $8,150 per year granted to commercially insured patients towards the cost of medication to cover deductibles and out-of-pocket expenses. | $350–$600 per session |
| Setting | Supervised in a certified clinic | Medical office or clinic |
| Monitoring Requirements | 2 hours of observation per visit | Varies; often 1–2 hours |
| Can You Use at Home? | ❌ No—Spravato must be administered in-clinic | ❌ No—infusions require a monitored setting |
| Duration of Effects | 1–2 weeks between maintenance doses after induction | 1 week or more, but varies by individual |
| Success Rate | ~50-70% after 6–8 weeks for treatment-resistant depression | ~50-80% reported improvement, though varies widely |
| Ease of Access | Requires a certified Spravato treatment center | Many clinics offer infusions, but fewer are regulated |
Want a deeper dive into how these compare? Read our full guide: https://www.axismh.com/post/which-is-better-ketamine-infusions-vs-spravato
How Long Does Each Treatment Last?
Both treatments typically begin with a more intensive phase and then taper into maintenance.
- Spravato:
- Initial phase: 2 treatments/week for 4 weeks
- Second Month: 1 treatment/week for 4 weeks
- Maintenance: Depends on patient response
- Duration of benefit: Many patients report long-term stability with regular use
- Ketamine Infusions:
- Initial phase: 6 infusions over 2–3 weeks
- Maintenance: As needed—some people do monthly infusions
- Duration of benefit: Varies widely, often 1–2 weeks per infusion
Can You Use Spravato or Ketamine at Home?
No. Both Spravato and ketamine infusions must be administered under supervision. With Spravato, you’re monitored for 2 hours post-treatment in a certified clinic due to safety regulations. Ketamine also requires post-infusion observation due to potential dissociation or sedation. While other forms of ketamine (e.g. lozenges or compounded ketamine) are available for home use, we highly discourage patients from at-home ketamine for safety reasons. In fact, some states want to ban at-home ketamine use.
Success Rates: Which Is More Effective?
Both treatments are considered highly effective for people with treatment-resistant depression, though individual response varies.
According to a recent study and previous research, there is no difference in efficacy between Ketamine infusions vs. Spravato. Side effects were also equal. In another study from Cambridge, published in The Journal of Clinical Psychiatry, it was noted that “Intravenous ketamine and intranasal esketamine showed similar response/remission in TRD patients but the number of treatments required to achieve response/remission was significantly lower with Ketamine infusions vs. Spravato.” One thing to note is that many of these studies are not done in real-world settings where patients have to pay for treatment. In our experience, we’ve found that when people are paying $350-$650 out-of-pocket for each treatment, it can be challenging to stay on treatment. Ketamine is not a miracle cure that “cures” depression. Like a mental health med, it’s necessary to stay on it to stay in remission.
Can You Build a Tolerance to Ketamine or Esketamine?
Yes, you can develop some level of tolerance to ketamine or esketamine, but that doesn’t mean the treatment has stopped working.
A 2023 review in PubMed Central explains that while ketamine tolerance (requiring higher doses over time to sustain the same psychedelic effect) is a physiological adaptation, it’s often associated with daily or frequent dosing, not typical in controlled depression therapy. Notably, data from multiple long-term studies of Spravato (intranasal esketamine) show that antidepressant effectiveness is maintained in real-world clinical use, with no evidence of diminishing response. We have now successfully treated patients for years with Spravato and many have reduced or eliminated their traditional antidepressants and continue to use Spravato as a standalone treatment.
In other words, experiencing some tolerance or less of a psychedelic effect doesn’t mean the medication isn’t working. In the same way that ADHD medications don’t make you high, but they still work for individuals with ADHD, having a psychedelic experience is not necessary for Spravato to work. Through proper dosing schedules—such as spaced-out maintenance doses—and medical supervision, many patients continue to benefit from ketamine or esketamine over extended periods.
What Do Real Patients Say About Spravato Treatment?
Curious about ketamine therapy from those who’ve actually lived it? This free ebook is packed with real stories, hard-earned tips, and honest insights from patients who’ve walked the path. Learn what worked, what surprised them, and what they wish they knew before starting treatment. Whether you’re considering ketamine or already on the journey, their voices can guide yours. Download now and get real advice from real people.
Final Thoughts: Which Is Right for You?
If you’re deciding between esketamine vs ketamine, consider the following:
- If you need insurance coverage, prefer a regulated treatment, and want long-term support, Spravato is likely the better option.
- If you want more flexible scheduling and are paying out of pocket, ketamine infusions may appeal more, but come with fewer safeguards and less coverage.
At Axis Integrated Mental Health, we offer Spravato treatments in Denver, Boulder, and Adams and Jefferson Counties, and we’re here to walk you through every step – from insurance approvals to tracking your progress.
Ready to Begin Ketamine Therapy?
Take our Spravato qualification quiz to see if you are a good candidate for treatment.
Or book an appointment with a board-certified provider to get started on your recovery.
FAQs
1. Where can I get ketamine therapy in the Denver metro that accepts insurance?
If you are searching for ketamine therapy in the Denver metro, the most insurance-friendly option is usually Spravato, the FDA-approved esketamine nasal spray for treatment-resistant depression. Axis Integrated Mental Health offers Spravato treatment for patients in Denver, Boulder, Westminster, Adams County, Jefferson County, and surrounding Colorado communities, with insurance support from benefits verification through prior authorization.
2. Is Spravato the same as ketamine therapy?
Spravato is related to ketamine, but it is not the same as an IV ketamine infusion. Spravato contains esketamine, one part of the ketamine molecule, and is given as a nasal spray in a certified clinic. IV ketamine uses racemic ketamine through an infusion and is generally used off-label for depression.
3. Who qualifies for Spravato treatment in Denver?
Spravato may be appropriate for adults with treatment-resistant depression, typically meaning depression that has not improved after trying at least two antidepressants. It is also approved, with an oral antidepressant, for depressive symptoms in adults with major depressive disorder and acute suicidal thoughts or behavior. A psychiatric evaluation is needed to confirm whether Spravato is clinically appropriate and safe for you.
4. What should I expect during a Spravato appointment?
During a Spravato appointment, you self-administer the nasal spray under medical supervision in a certified clinic. Your care team checks your vitals, monitors you during the session, and observes you for about two hours afterward. Because you cannot drive after treatment, you should arrange transportation home. Watch the patient testimonials or check out the free resources at our new patient center to learn more.
5. Are at-home ketamine lozenges the same as Spravato or IV ketamine?
No. At-home ketamine lozenges or compounded ketamine are different from both Spravato and IV ketamine. Spravato must be administered in a certified clinic under REMS safety rules, and IV ketamine is also given in a monitored clinical setting. Axis strongly discourages unsupervised at-home ketamine because dissociation, sedation, blood pressure changes, and other safety issues require medical oversight.
