IM Ketamine vs. Spravato: Which One Is Right for You?

What is the difference between IM ketamine & Spravato? If you’re exploring treatment options for treatment-resistant depression (TRD), you’ve likely come across intramuscular (IM) ketamine and Spravato (esketamine nasal spray). Both are innovative alternatives to traditional antidepressants, but they differ in important ways.

Here’s a quick breakdown of the key differences:

• Administration: IM ketamine is given as an injection into the muscle, while Spravato is a nasal spray self-administered under medical supervision.
• Speed of Relief: IM ketamine often works within hours or days, whereas Spravato’s effects typically build over multiple sessions.
• Insurance Coverage: Spravato is FDA-approved and more likely to be covered by insurance, while IM ketamine is considered off-label and is usually paid out of pocket.

If you’re wondering about the difference between Spravato and ketamine, or debating Spravato vs. ketamine for depression, this guide will break down everything you need to know.

What Is Ketamine Therapy?

Ketamine was originally developed as an anesthetic but has been found to have powerful antidepressant effects at lower doses. It works by affecting the brain’s glutamate system, promoting neuroplasticity and allowing for the formation of new neural pathways.

Unlike traditional antidepressants, which increase serotonin levels over weeks or months, ketamine provides rapid relief, often within hours or days. This makes it an effective option for individuals who have not responded to standard treatments.

Is Spravato Ketamine?

A common question people ask is: Is Spravato ketamine?

Yes and no. Spravato (esketamine) is chemically similar to ketamine but is not the same thing.

• Ketamine contains two mirror-image molecules: S-ketamine and R-ketamine.
• Spravato (esketamine) is only the S-ketamine molecule, meaning it is a more refined version of ketamine.

Esketamine was developed specifically to treat treatment-resistant depression and received FDA approval in 2019, whereas traditional ketamine infusions are still considered off-label for depression treatment.

So while Spravato is derived from ketamine, it is a different drug in terms of composition, dosing, and administration.

How Are IM Ketamine and Spravato Administered?

One of the biggest differences between Spravato vs. ketamine therapy is how the treatment is given.

IM Ketamine (Intramuscular Ketamine)

• Given as an injection into the muscle, usually the thigh or upper arm.
• Administered in a clinical setting under medical supervision.
• Effects start within minutes and last for several hours.
• Sessions typically last 60-90 minutes including observation time.
• Usually involves a series of six initial treatments over 2-3 weeks, followed by maintenance treatments as needed.

Spravato (Esketamine Nasal Spray)

• Taken as a nasal spray, self-administered under supervision at a certified medical facility.
• Requires two sessions per week for the first month, then weekly or biweekly maintenance treatments.
• Takes two hours per session due to required medical monitoring.
• Must be used alongside a traditional antidepressant, as per FDA guidelines.

Both treatments require medical supervision due to possible side effects like dissociation, dizziness, and increased blood pressure. However, IM ketamine has a faster onset of action compared to Spravato.

Spravato vs. Ketamine for Depression: Which One Works Faster?

For those seeking the most rapid relief, IM ketamine may be the better option.

• IM Ketamine: Many patients report improvement within hours or days of their first or second treatment. Studies show that 50-70% of patients experience rapid symptom relief.
• Spravato: Because Spravato is taken twice weekly for four weeks before switching to maintenance treatments, symptom relief tends to be more gradual in comparison (although still more rapid than most traditional depression treatments). Most patients experience improvements after 2-4 weeks.

If you’re experiencing severe depression or suicidal thoughts, IM ketamine’s fast-acting effects may be preferable. However, Spravato may be a good choice for those who prefer a slightly slower, regulated approach.

Side Effects & Who Should Avoid Each Treatment

Both IM ketamine and Spravato work by affecting glutamate, an important neurotransmitter involved in mood regulation. Because of their similar mechanisms of action, they share several common side effects, including:

Shared Side Effects

• Dissociation – A feeling of detachment from reality, often described as a “floating” or “dream-like” sensation.
• Dizziness or lightheadedness – Common shortly after administration.
• Increased blood pressure – Both treatments can cause temporary spikes in blood pressure, requiring monitoring.
• Fatigue or drowsiness – Some patients experience tiredness following treatment.

However, there are key differences between the two treatments when it comes to side effects and who should avoid them.

Side Effects Unique to IM Ketamine

• Nausea is less common, but when it occurs, it is usually mild and can be prevented with anti-nausea medication.
• Rapid onset and shorter duration – IM ketamine’s effects begin within minutes and wear off within a few hours.
• More flexibility in dosing – Since ketamine is administered by injection, providers can adjust the dose to manage side effects. 

Who Should Avoid IM Ketamine?

You should avoid IM ketamine therapy if you:

• Have high or unstable blood pressure
• Have schizophrenia or another psychotic disorder
• Have a history of substance misuse
• Are pregnant or nursing
• Are younger than 16 years old

Side Effects Unique to Spravato

• Higher risk of nausea and vomiting – Many patients report feeling nauseous after using Spravato, sometimes requiring anti-nausea medication.
• Nasal discomfort – Because Spravato is a nasal spray, some patients experience irritation, congestion, or an unpleasant taste in the mouth.
• More frequent treatments – Since Spravato requires twice-weekly sessions for the first month, some patients find that side effects persist longer due to frequent exposure.

Who Should Avoid Spravato?

You should not receive Spravato (esketamine nasal spray) if you:

• Have ever had a brain bleed
• Have an arteriovenous malformation (an abnormal tangling of blood vessels)
• Have an aneurysm or similar blood vessel disease
• Have a history of substance misuse
• Are pregnant or nursing
• Are younger than 18 years old

Which Treatment Has More Manageable Side Effects?

While both treatments have mild and temporary side effects, IM ketamine tends to cause fewer issues with nausea and doesn’t involve nasal irritation. However, because Spravato is FDA-approved, it may be a better option for those who need insurance-covered treatment and don’t mind the slightly more gradual relief timeline.

Cost & Insurance: Which One Is More Affordable?

Spravato: More Likely to Be Covered by Insurance

Since Spravato is FDA-approved for treatment-resistant depression, many insurance plans cover some or all of the costs. However, insurance may require proof that the patient has already tried multiple antidepressants without success.

Typical costs for Spravato without insurance:

• $700 – $1,500 per treatment
• $5,000 – $10,000 for the first month

With insurance, patients may only pay a small copay depending on their plan.

IM Ketamine: Often an Out-of-Pocket Expense

IM ketamine is not yet FDA-approved for depression, which means many insurance providers do not cover it.

Typical costs for IM ketamine without insurance:

• $400 – $800 per session
• $3,000 – $6,000 for an initial treatment series

Some clinics, including Anew Therapy Utah, accept CareCredit or Health Savings Accounts (HSA/FSA) to help with costs.

Which One Should You Choose?

Choosing between Spravato vs. ketamine therapy depends on several factors, including:

• If you need fast relief: IM ketamine may be better, as it works within hours or days.
• If you want insurance coverage: Spravato is more likely to be covered by insurance.
• If you prefer fewer treatments: IM ketamine typically requires fewer sessions than Spravato.
• If you want a nasal spray instead of injections: Spravato may be preferable.
• If you want more flexibility in treatment plans: IM ketamine can be customized more easily.

Both treatments are effective for treatment-resistant depression, and the best choice depends on your personal needs, medical history, and budget.

Final Thoughts: Choosing the Right Treatment for You

Deciding between IM ketamine and Spravato comes down to your individual needs—whether you prioritize faster relief, insurance coverage, or a specific treatment experience. Both options offer hope for those struggling with treatment-resistant depression, and the right choice depends on what works best for you.

At Anew Therapy Utah, we offer both IM ketamine and Spravato, providing safe, effective, and compassionate care to help you find lasting relief. Our expert team is here to answer your questions, address your concerns, and guide you toward the best treatment for your needs.

Anew Therapy is recognized as the best ketamine clinic in Utah for safe, effective mental health care. Schedule your free intake appointment today