IV and IM Ketamine vs. Spravato (esketamine)

If you've been searching for options beyond traditional antidepressants, you've probably come across two names: ketamine and Spravato. They're related, but they are not the same treatment. Here is a plain-language comparison to help you understand the differences and prepare questions for your provider.

Although we don’t currently offer Spravato, we’re happy to discuss whether it may be a better fit for you.

The short answer

Spravato (esketamine) is an FDA-approved nasal spray for certain types of depression. IV and IM (intramuscular) ketamine are forms of generic ketamine, which is FDA-approved as an anesthetic and used off-label for mental health and pain conditions. Both work on the brain's glutamate system rather than the serotonin pathways targeted by most antidepressants, but they differ in the medication itself, how it's delivered, who it's approved for, and how it's paid for.

What is Spravato?

Spravato is a nasal spray containing esketamine, one of the two mirror-image molecules that make up ketamine. The FDA approved it in 2019 for treatment-resistant depression, and its approval has since expanded to include depressive symptoms in adults with major depressive disorder and suicidal thoughts. Because it is an approved medication for depression, many insurance plans cover it when criteria are met. Spravato is only available through a restricted safety program (REMS). Patients selfadminister the spray under supervision in a certified healthcare setting and are monitored for at least two hours afterward. You cannot drive until the next day after a restful night's sleep.

What are IV and IM ketamine?

These treatments use ketamine itself (a mix of both molecules) given by a medical provider.

• IV ketamine is delivered through an IV line over about an hour. Because it goes directly into the bloodstream, the dose can be adjusted during the session.

• IM ketamine is given as an injection into the muscle. Sessions are shorter, and it is a good option for some patients who prefer to avoid an IV.

Both are considered off-label when used for depression, anxiety, PTSD, or chronic pain. Off-label means a licensed provider may legally prescribe an approved medication for a purpose the FDA has not specifically reviewed. This is common across medicine, but it does mean that insurance coverage is usually limited, and many patients pay out of pocket.

How do I know which is right for me?

There is no single answer. A few things to consider:

• Your diagnosis. Spravato is approved specifically for depression. If you are seeking help for anxiety, PTSD, or chronic pain, those uses are off-label for either form.

• Delivery and dosing. Some people prefer the precision of an IV or the simplicity of an injection. Others prefer a nasal spray.

• Cost and coverage. Insurance may make Spravato more affordable up front, while IV and IM ketamine are typically self-pay.

• Your medical history. Blood pressure, heart conditions, a history of psychosis, and substance use can all affect which treatment is safe.

• Logistics. Treatment schedules, visit length, and the availability of providers in your area matter, particularly in a region where options are limited.

Direct comparisons between these treatments are still limited, and researchers continue to study them. We can't tell you that one is better than the other for everyone. Responses vary from person to person.

Safety to know about

Both forms of ketamine can cause temporary side effects such as dissociation (feeling detached or dreamlike), dizziness, nausea, and increased blood pressure. Spravato carries a boxed warning for sedation, dissociation, breathing problems, misuse potential, and suicidal thoughts. Neither treatment should be started without a screening that reviews your medical history and current medications, and neither is a replacement for ongoing mental health care.

Talk to someone who can look at your whole picture

Choosing a treatment is a personal decision that is best made with a qualified medical provider. If you're considering ketamine therapy, we're happy to talk through your history, answer your questions, and tell you plainly whether IV or IM ketamine makes sense or whether another option may serve you better.

Call us at 208-607-8401 or text 208-271-3800 to schedule a consultation.

This article is for educational purposes only and is not medical advice. Ketamine used for conditions such as depression, anxiety, PTSD, and chronic pain is off-label. Individual results vary. If you are in crisis, call or text 988 or go to the nearest emergency room.