Millions of Americans suffer from major depression. The National Institute of Mental Health (NIMH) reports that an estimated 21 million adults 18 or older suffered from at least one episode of major depression in 2021. This is 8.3% of the adult population in the country.
Depression is commonly treated by a combination of antidepressant medications and therapy, which is effective for many people. However, some people suffer from treatment-resistant depression and experience minimal improvement from traditional medications and therapeutic approaches.
Two drugs, including intravenous ketamine and Spravato nasal spray, have shown promise for helping people whose depressive disorders don’t respond to other treatments. Before you seek treatment using either of these medications, it’s important to understand the differences between them. Here is some information about intravenous ketamine versus Spravato nasal spray and their differences from the compassionate New Jersey professionals at Oasis Mental Health Centers.
What Is Ketamine vs. Spravato?
Ketamine is a painkiller and anesthetic that has been used in the U.S. for more than five decades. Over time, doctors noticed that ketamine has antidepressant effects in addition to being a reliable anesthetic and painkiller. Chemically, ketamine is comprised of two isomers, including S-ketamine and R-ketamine. Ketamine is administered intravenously.
Spravato is the name brand drug for S-ketamine. Unlike ketamine, it doesn’t contain the R-ketamine isomer. Unlike IV ketamine, Spravato is administered as a nasal spray.
Both of these drugs have been shown to have good antidepressant effects and work for treatment-resistant depression. While they have similar effects, there are some differences to explore.
Differences Between Ketamine vs. Spravato
You should understand the differences between IV ketamine and Spravato so that you can make an informed choice. Both of these drugs work similarly, but they do have the following distinctions:
1. FDA Approval
Ketamine is not approved as a treatment for depression by the U.S. Food and Drug Administration (FDA). Instead, ketamine is only FDA-approved as a drug to induce and maintain general anesthesia. While therapeutic interest in ketamine infusions as a treatment for depression has surged over the past decade, any use of it for this purpose is off-label.
By contrast, Spravato nasal spray has been approved by the FDA for treatment-resistant depression. It was originally approved in 2019 for use in combination with other antidepressant drugs. However, the FDA expanded its approval in January 2025 as a monotherapy, so it can now be taken without other antidepressant medications.
2. Insurance Coverage
Since ketamine for depression hasn’t been approved by the FDA, it also isn’t covered by most insurance companies for that purpose. Ketamine infusions can quickly become expensive since people must undergo them two to three times per week.
Since Spravato has been FDA-approved to treat depression, most insurance companies cover it. People also take it much less frequently than intravenous ketamine. The common dosing schedule for Spravato is:
- Twice per week for the first four weeks
- Once per week or every two weeks thereafter
- Potential to eventually taper off completely
Since people take Spravato less frequently and can have it covered by insurance, its cost can be significantly lower than IV ketamine.
3. Ease of Administration
Ketamine must be administered intravenously in a clinical setting. Oral ketamine isn’t effective because it wears off too quickly. Ketamine infusions are longer-acting to provide relief.
Spravato is only available as a nasal spray. It can only be administered in a clinical setting because of its potential side effects and risk of abuse. Many people find that scheduling time for Spravato treatments is much easier to handle than tri-weekly ketamine infusions though.
4. Risk of Abuse
Both ketamine and Spravato are Schedule III controlled drugs, which means they carry the potential for abuse. Since both are administered in clinical settings, the potential for abuse can be minimized. However, ketamine can be easier for people to get on the streets since it also has veterinary applications. Spravato is always administered in a clinical setting to ensure people can’t abuse it.
5. Efficacy
Both intravenous ketamine and Spravato have demonstrated their potential as effective treatments for treatment-resistant depression. A recent study found there isn’t a difference in how well these two drugs work for depression treatment. A second study published by the Cambridge University Press also found that intravenous ketamine and Spravato were equally effective. However, the researchers noted that intravenous ketamine required significantly fewer treatments compared to Spravato.
It’s important to note that both of these studies had small sample sizes. Additional research is needed to determine the differences in efficacy between the two drugs.
6. Side Effects
Both IV ketamine and Spravato nasal spray have similar side effects, including the following:
- Dissociation
- Drowsiness
- Nausea and vomiting
- Blurred vision
- Increased blood pressure
- Numbness
- Altered taste
Intravenous ketamine can also cause injection site inflammation. While both drugs have similar side effects, Spravato’s have been reported to be milder than intravenous ketamine and primarily occur in the clinic immediately after administration.
Get Help From Oasis Mental Health Centers
If you live in New Jersey and are struggling with major depression with little relief despite receiving therapy and traditional antidepressants, there is hope. Our team of caring professionals at Oasis Mental Health Centers can help you determine whether IV ketamine or Spravato nasal spray might be appropriate and which might be the right choice for you. To learn more, call us today to schedule a confidential appointment.
References
[1] https://www.nimh.nih.gov/health/statistics/major-depression
[2] https://www.fda.gov/drugs/news-events-human-drugs/understanding-current-use-ketamine-emerging-areas-therapeutic-interest-06272024
[3] https://www.jnj.com/media-center/press-releases/spravato-esketamine-approved-in-the-u-s-as-the-first-and-only-monotherapy-for-adults-with-treatment-resistant-depression
[4] https://www.psychiatrist.com/news/study-intravenous-ketamine-vs-intranasal-esketamine/
[5] https://www.cambridge.org/core/journals/cns-spectrums/article/comparative-effectiveness-of-intravenous-ketamine-and-intranasal-esketamine-in-realworld-setting-among-patients-with-treatment-refractory-depression/F331E788C869F0FC81DF82DA35449776
