You have tried more than one antidepressant, waited for each one to work, and still do not feel like yourself.
Now you are looking at other options—and the names start to blur together.
IV ketamine. Esketamine. SPRAVATO®. Nasal spray. Infusion therapy.
They are sometimes discussed as though they are interchangeable. They are not.
IV ketamine and SPRAVATO® are distinct treatments that may be considered for eligible adults with treatment-resistant depression. They involve different medications, follow different regulatory pathways, and are administered in different ways.
At Claritiv Health, IV ketamine infusion therapy is our cornerstone interventional treatment. We also want you to understand how it differs from SPRAVATO® so you can have a more informed conversation about your care.
The right question is not which treatment is “better” for everyone.
It is which option—if either—makes sense for you.
The Most Important Difference: They Are Not the Same Medication
IV ketamine uses ketamine administered directly into a vein.
SPRAVATO® contains esketamine and is administered as a nasal spray under supervision in a certified healthcare setting.
Ketamine contains two molecular forms that are mirror images of one another. Esketamine is one of those molecular forms, but SPRAVATO® is its own prescription medication with specific FDA-approved indications, dosing requirements, safety rules, and administration procedures.
That distinction matters.
SPRAVATO® should not be called ketamine, ketamine nasal spray, intranasal ketamine, or a form of ketamine therapy. It is a distinct FDA-approved esketamine nasal spray.
How Do IV Ketamine and SPRAVATO® Work?
Both treatments affect the brain’s glutamate system, which plays a role in communication and adaptability between brain cells.
That differs from the primary pathways targeted by many conventional antidepressants, which commonly act on serotonin, norepinephrine, or dopamine.
Researchers continue to study the full processes involved in both treatments. Their effects appear to involve activity at NMDA and AMPA receptors, along with changes related to communication between brain cells.
That shared area of research does not make the treatments identical.
The medication, route of administration, regulatory status, treatment schedule, and evidence base differ. Those differences need to be considered alongside your diagnosis, medical history, previous treatments, and goals.
How Are They Administered?
IV Ketamine Infusion Therapy
IV ketamine is administered directly into a vein in a medically monitored setting.
At Claritiv Health, an infusion generally lasts 40 to 60 minutes. You remain conscious and able to communicate with us throughout treatment.
We monitor your blood pressure, heart rate, and oxygen level while you receive the medication. After the infusion, you remain with us for approximately 20 to 30 minutes while the immediate effects begin to wear off.
Our standard induction course consists of six infusions over approximately two to three weeks. If treatment is helpful, maintenance infusions may later be considered according to your response and ongoing needs.
SPRAVATO®
SPRAVATO® is administered with a nasal spray device in a certified healthcare setting.
The patient uses the device under the supervision of a healthcare professional. SPRAVATO® is not taken home or used independently outside the certified treatment setting.
Patients are monitored for at least two hours after administration because of risks that include sedation, dissociation, respiratory depression, and changes in blood pressure.
SPRAVATO® is also subject to a Risk Evaluation and Mitigation Strategy, or REMS. Treatment settings and pharmacies involved in dispensing it must meet federal program requirements designed to support safe administration and monitoring.
What Is Each Treatment FDA-Approved For?
The regulatory difference between these treatments is one of the clearest.
IV Ketamine
Ketamine is FDA-approved as an anesthetic.
Its use for depression, including treatment-resistant depression, is off-label. That means the medication is being used for a purpose that is not included in its FDA-approved labeling.
Clinicians may use approved medications off-label when they determine that doing so is medically appropriate. But the distinction should always be explained clearly.
IV ketamine is not FDA-approved for depression.
SPRAVATO®
SPRAVATO® is FDA-approved for specific depressive indications.
It is approved for treatment-resistant depression in adults as a standalone medication or in conjunction with an oral antidepressant.
It is also approved, together with an oral antidepressant, for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior.
That second indication does not mean SPRAVATO® has been shown to prevent suicide, eliminate suicidal thoughts, or replace emergency evaluation and care.
FDA approval also does not mean SPRAVATO® is automatically appropriate for every adult with depression. Treatment still requires screening, evaluation, informed consent, and ongoing monitoring.
Who May Be Considered for Treatment?
Both treatments may enter the conversation when depression has not improved enough with conventional care, but candidacy is not determined by one symptom or a medication count alone.
We need to understand:
- Your current diagnosis
- Which medications you have tried
- The doses and length of those trials
- Whether you experienced a partial response
- Which side effects occurred
- Your psychiatric and medical history
- Your current medications
- Your substance-use history
- Your previous treatment experiences
- What meaningful improvement would look like for you
We also need to consider whether the diagnosis still fits.
Depressive symptoms can occur in both major depressive disorder and bipolar disorder, but those conditions require different clinical considerations. Anxiety, trauma, sleep problems, medication effects, substance use, and medical concerns may also influence how depression appears and responds to treatment.
We do not choose a treatment before understanding the full picture.
Does One Work Faster Than the Other?
Both IV ketamine and SPRAVATO® have been studied as rapid-acting approaches for difficult-to-treat depression.
Some people who respond may notice changes earlier than they did with conventional antidepressants. But the research does not support promising a specific timeline for either treatment.
Direct comparisons remain limited.
Some studies and research reviews have found broadly similar response or remission outcomes. Others have suggested possible differences in speed, the number of treatments needed, or overall response. Study designs, patient populations, dosing, and outcome measurements vary.
That makes it difficult to declare one treatment universally superior.
Your response also cannot be predicted from a study average.
We will not tell you that one option is guaranteed to work faster or better.
How Does the Treatment Experience Differ?
The route of administration shapes much of the experience.
With IV ketamine, the medication enters the bloodstream through an IV while we manage its administration throughout the infusion. You remain in a private treatment suite, and we monitor you during the session and recovery period.
With SPRAVATO®, the patient uses the nasal spray device under supervision. Absorption occurs through the nasal passages, and federal safety requirements call for at least two hours of monitoring afterward.
Both treatments can cause temporary effects such as:
- Dissociation or a sense of detachment
- Dizziness
- Nausea
- Sedation or sleepiness
- Changes in perception
- Increased blood pressure
- Difficulty with balance or coordination
The intensity and combination of effects can vary by person and treatment session.
Neither experience should be treated casually. Both require screening, medical supervision, transportation planning, and time to recover.
Can You Drive After Treatment?
No. You will need transportation home after either treatment.
After IV ketamine at Claritiv Health, you should not drive, operate machinery, or make major decisions for 24 hours.
After SPRAVATO®, patients should not drive or operate machinery until the next day after a restful sleep.
Plan for treatment days to be quieter days. Do not assume you can receive either medication and immediately return to driving, demanding work, or responsibilities that require your full alertness.
How Do the Treatment Schedules Compare?
The schedules are different.
At Claritiv Health, our standard IV ketamine induction course consists of six infusions over approximately two to three weeks. If treatment is helpful, maintenance infusions may be considered every two to eight weeks based on individual response and ongoing need.
SPRAVATO® follows a structured schedule established in its prescribing information. For treatment-resistant depression, it is generally administered more frequently during the first four weeks. Treatment becomes less frequent during later phases when continued care is clinically appropriate.
The exact schedule may vary according to the indication, response, tolerability, and prescribing plan.
Neither treatment should continue on autopilot.
We look at symptom changes, daily functioning, side effects, durability of improvement, and how treatment fits into the rest of your care.
What About Insurance and Cost?
Coverage can differ because the treatments have different regulatory status.
IV ketamine for depression is an off-label treatment and is generally provided as a self-pay service. Claritiv Health’s current payment information states that IV ketamine infusion therapy is not typically covered by insurance.
Because SPRAVATO® is FDA-approved for specific indications, some insurance plans may provide coverage when their medical-necessity and authorization requirements are met.
Coverage is not guaranteed. Benefits, prior-authorization rules, deductibles, copays, and treatment requirements vary by plan.
The financial difference may matter, but it should not be the only factor. Clinical appropriateness, treatment availability, time commitment, medical history, and your previous response to care also matter.
You should understand the expected cost before committing to treatment.
Is One Treatment Safer?
Neither treatment is risk-free, and safety cannot be reduced to a simple ranking.
Both can cause dissociation, dizziness, nausea, sedation, perceptual changes, and increases in blood pressure. Both are controlled substances and require careful screening for potential risks.
SPRAVATO® carries boxed warnings related to sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors. Its REMS requirements are part of how those risks are managed.
IV ketamine does not have an FDA-approved psychiatric indication or a labeled depression protocol. Safe off-label treatment depends on careful patient selection, medical oversight, monitoring, appropriate administration, and follow-up.
Your medical history, cardiovascular health, medications, substance-use history, and other factors may influence which option—if either—is appropriate.
Safety begins with evaluation, not assumptions.
Why Does Claritiv Position IV Ketamine as the Cornerstone?
IV ketamine is Claritiv Health’s cornerstone interventional treatment.
It allows us to administer the medication directly through an IV, monitor treatment closely, and individualize care according to the patient’s history and response.
That does not mean IV ketamine is automatically better for every person.
SPRAVATO® offers an FDA-approved option for treatment-resistant depression with a structured federal safety program. For some patients, its regulatory status, potential insurance pathway, or treatment format may be important considerations.
Our position is not that every patient should receive the same service.
Our position is that treatment should follow a careful psychiatric evaluation and an honest discussion of the available options.
Can IV Ketamine and SPRAVATO® Be Used Interchangeably?
No.
You should not assume that you can move between IV ketamine and SPRAVATO® as though only the delivery method has changed.
They are distinct medications with different administration procedures, regulatory requirements, schedules, and clinical considerations.
Any change from one treatment to another requires a new clinical decision. That decision should consider why the first treatment was stopped, whether it helped, which side effects occurred, and what the evidence supports for your situation.
Do not change treatment plans based on online comparisons alone.
How Do We Decide What to Discuss?
We begin with a psychiatric evaluation.
We look at what you have tried, what is still affecting your life, and what you need from care now. We explain the potential benefits, limitations, risks, logistics, and regulatory differences without turning the conversation into a sales pitch.
You may be a candidate for IV ketamine.
Another treatment may be worth discussing.
Another part of your care may need attention first.
Or interventional treatment may not be the right next step.
We will tell you honestly.
Interventional Depression Care in Jackson, Tennessee
When you have already tried more than one treatment, choosing what comes next can feel like another burden placed on your shoulders.
You should not have to sort through conflicting claims alone.
At Claritiv Health, we provide private, comprehensive mental health care for adults in Jackson and across West Tennessee. We bring psychiatric evaluation, medication management, Talk Therapy, and interventional care together under one roof.
IV ketamine and SPRAVATO® are not interchangeable, and neither is right for everyone.
The next step is not choosing a treatment from a comparison chart.
It is understanding your full story.
Book a private consultation with Claritiv Health to begin the conversation and ask about current treatment availability.
This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Ketamine is FDA-approved as an anesthetic; its use for depression is off-label. SPRAVATO® is a distinct FDA-approved esketamine nasal spray for specific depressive indications. Eligibility, availability, and treatment recommendations depend on an individualized clinical evaluation.
Works Cited
Bahji, A., Vazquez, G. H., & Zarate, C. A., Jr. (2021). Comparative efficacy of racemic ketamine and esketamine for depression: A systematic review and meta-analysis. Journal of Affective Disorders, 278, 542–555.
McIntyre, R. S., Rosenblat, J. D., Nemeroff, C. B., Sanacora, G., Murrough, J. W., Berk, M., Brietzke, E., Dodd, S., Gorwood, P., Ho, R., Iosifescu, D. V., Lopez Jaramillo, C., Kasper, S., Kratiuk, K., Lee, J. G., Lee, Y., Lui, L. M. W., Mansur, R. B., Papakostas, G. I., … Stahl, S. (2021). Synthesizing the evidence for ketamine and esketamine in treatment-resistant depression: An international expert opinion on the available evidence and implementation. American Journal of Psychiatry, 178(5), 383–399.
Singh, B., Kung, S., Perez-Vega, M. E., Lapid, M. I., Croarkin, P. E., & Bobo, W. V. (2023). Comparative effectiveness of intravenous ketamine and intranasal esketamine in clinical practice among patients with treatment-refractory depression. Journal of Clinical Psychiatry, 84(2), 22m14548.
U.S. Food and Drug Administration. (2024). Understanding current use of ketamine for emerging areas of therapeutic interest.
U.S. Food and Drug Administration. (2026). SPRAVATO® prescribing information.