Spravato vs. Ketamine Infusions: Which Is Better for Treatment-Resistant Depression?

Is Spravato Better Than Ketamine Infusions for Depression Treatment?

Many patients with treatment-resistant depression are faced with a difficult decision: Should I choose Spravato or IV ketamine infusions? While both therapies originate from the same compound, there are important differences in administration, side effects, cost, insurance coverage, and safety that can help determine the best choice for your needs.

At Axis Integrated Mental Health, we believe Spravato offers several advantages that make it the better option for most patients. Here's why.

How Spravato and IV Ketamine Work Differently

Spravato (esketamine) and ketamine affect the brain in similar ways by targeting the NMDA receptor, stimulating glutamate release, and promoting neuroplasticity. However, Spravato is a more selective isomer and has recently been FDA-approved not just as an add-on therapy but as a standalone treatment for treatment-resistant depression (TRD).

IV ketamine is used off-label, meaning it's not FDA-approved for depression. While it can be effective, it lacks the rigorous oversight and safety infrastructure that accompanies Spravato.

Ease of Administration: Nasal Spray vs. IV Line

Spravato is self-administered as a nasal spray under clinical supervision. No needles, no IVs. This is a big relief for many patients who experience anxiety around invasive procedures.

Ketamine infusions require an intravenous line, continuous monitoring, and a more intensive setup. This can be a deterrent for patients uncomfortable with needles or clinical equipment.

Safety and Abuse Risk: Why Spravato Wins

Spravato is available only through certified treatment centers that participate in the FDA Risk Evaluation and Mitigation Strategy (REMS) program. Patients are supervised for at least two hours post-treatment, and the drug cannot be taken home.

IV ketamine has no such federal oversight. This opens the door to potential overuse or misuse, especially at clinics without psychiatric oversight.

Side Effects: A Gentler Experience with Spravato

Both treatments can cause dissociation and dizziness, but IV ketamine has more intense side effects such as nausea, vomiting, injection site pain, and temporary hallucinations.

Spravato, by contrast, typically causes only mild nasal discomfort, fatigue, or a sense of floating. Many patients describe it as a "guided mental journey" compared to the more jarring experience of ketamine infusions.

Insurance and Affordability: A Clear Advantage for Spravato

Spravato is covered by most major insurance companies, including Medicare, Medicaid (in many states, including Colorado), Anthem/BCBS, Aetna, Cigna, and United Healthcare.

Additionally, patients with commercial insurance may be eligible for the Spravato Savings Card, which can reduce costs to as low as $10 per visit. This program can contribute over $8,000 annually toward deductibles and copays.

On the other hand, ketamine infusions are never covered by insurance due to their off-label status. Patients typically pay hundreds of dollars out-of-pocket per session.

You can read more about Spravato costs and Ketamine costs on our website for more details.

FDA Approval and Long-Term Viability

Spravato is the only ketamine-derived therapy approved by the FDA as both an add-on and a standalone treatment for TRD. This distinction gives Spravato an edge in safety, credibility, and insurance support.

IV ketamine, though effective in some cases, remains off-label and unregulated. While it may work faster in some cases, it also carries more clinical and financial risks.

Efficacy Studies: What the Research Says

A Cambridge study published in CNS Spectrums showed that Spravato and ketamine had similar remission rates, but ketamine required fewer treatments to achieve a response.

Other research suggests Spravato is just as effective, especially when used consistently and paired with other therapies like oral antidepressants or TMS.

Spravato vs. TMS: Why You Don’t Have to Choose Just One

TMS (Transcranial Magnetic Stimulation) and Spravato both promote neuroplasticity, but through different mechanisms. TMS uses magnetic pulses to stimulate underactive brain regions, while Spravato enhances glutamate signaling and synaptic growth.

At Axis, we've seen the best outcomes when patients use both together. It's not a competition—it's a combination.

A Unique Perspective: What Real Patients Say

One of our patients recently shared:

Hearing stories like these reminds us why expanding access to FDA-approved, insurance-covered treatments is so important.

How to Get Started with Spravato at Axis

If you're struggling with depression that hasn’t improved after multiple medications, Spravato may be a great fit. At Axis Integrated Mental Health, we provide:

• Free benefits verification to see if your insurance covers Spravato
• Comprehensive psychiatric evaluation to assess eligibility
• A certified REMS clinic and highly trained staff

You don’t have to figure this out alone. Let us help you take the next step toward recovery.

Still wondering, "Is Spravato better than ketamine infusions?" For many patients, the answer is yes, because safety, affordability, and accessibility matter just as much as symptom relief.

Ready to explore your options? Contact Axis Integrated Mental Health by calling us at 720-400-7025 or book with us online.

People Also Ask

1. Is Spravato covered by Medicaid or Medicare in the state of Colorado?
2. How does Spravato compare to IV Ketamine in terms of side effects?
3. Why is Spravato only available at certified clinics?
4. Can Spravato be combined with TMS therapy for better results?
5. Is Spravato as effective as IV Ketamine for treatment-resistant depression?