Spravato® and IV Ketamine: Are They the Same?

Dr. Karen Giles and Dr. Cecilia Kwong at Atlanta-based Breakthru Psychiatric Solutions provide innovative treatments for those struggling with mental health disorders. Two of our most advanced options for treatment-resistant depression are Spravato® and IV ketamine, which work differently from traditional antidepressants.

Even though Spravato and IV ketamine share similarities, such as their use for treatment-resistant depression, they have distinct differences you should know about before deciding to undergo therapy. Here’s a look at how each works, who they can help, and what sets them apart.

How Spravato works

Spravato is the brand name for esketamine, a refined form of ketamine you take via nasal spray. Unlike traditional antidepressants that target serotonin, norepinephrine, and dopamine, Spravato works on your glutamate system.

The main benefit of Spravato is that it delivers faster results and facilitates better communication between your brain cells, which can alleviate depression symptoms within hours rather than weeks.

At Breakthru Psychiatric Solutions, we typically use Spravato as an augmentation to oral antidepressants in cases of treatment-resistant depression or major depressive disorder with suicidal ideation.

Spravato must be administered in a doctor’s office under the supervision of a licensed provider like Dr. Giles or Dr. Kwong. You undergo treatments twice weekly for four weeks, then taper to weekly visits. The treatment delivers rapid relief for many patients who haven’t found success with traditional therapies.

Key facts about Spravato:

FDA-approved for treatment-resistant depression
Works by increasing glutamate to encourage neuroplasticity
Requires in-office administration under supervision
Covered by insurance with prior authorization

Our Breakthru Psychiatric Solutions patients often notice improvement after three to eight treatments.

How IV ketamine works

IV ketamine sends ketamine directly into your bloodstream. Like Spravato, it targets your glutamate system to enhance brain cell communication. However, unlike Spravato, which is a nasal spray, IV ketamine requires a needle-based infusion.

IV ketamine is an effective treatment for moderate-to-severe depression, anxiety, bipolar depression, and PTSD. It’s ideal for acute symptoms because it acts quickly. Unlike Spravato, IV ketamine is not FDA-approved for depression treatments, so it isn’t covered by insurance.

During your IV ketamine therapy, you sit in a relaxed environment while receiving the infusion, which takes 40–60 minutes. Side effects, such as mild nausea or dizziness, often subside quickly. We start you with an induction phase of two to three weekly treatments over two to three weeks.

Key facts about IV ketamine:

Not FDA-approved for mental health use (off-label use only)
We customize infusions to each patient
Offers fast-acting relief for various mood disorders
More flexible than Spravato for patients with unique needs

It’s best to follow a maintenance protocol after your initial sessions.

What do Spravato and IV ketamine treat?

We primarily use Spravato and IV ketamine for treatment-resistant depression, but each has specific indications:

Spravato:

Ideal for treatment-resistant depression
FDA-approved for major depressive disorder with suicidal ideation

IV ketamine:

Applicable for major depressive disorder, anxiety, bipolar depression, PTSD, and OCD
Used alongside primary psychiatric care for eating disorders

At Breakthru Psychiatric Solutions, Dr. Giles and Dr. Kwong work closely with you to determine which treatment might better fit your condition and lifestyle.

Who is an ideal candidate?

Before recommending Spravato or IV ketamine, we weigh your health history, condition, symptoms, and circumstances. Each treatment has distinct characteristics that suit some people better than others.

Spravato candidates

Patients who haven’t seen results with oral antidepressants or traditional therapy often find success with Spravato. It is a good option if you’re looking for an FDA-approved, insurance-covered alternative.

However, its in-office protocol may not be a good match if you have strict time constraints.

IV ketamine candidates

If you need a highly flexible treatment for depression or other mood disorders, you may find IV ketamine preferable. It’s especially helpful for severe symptoms that need quick intervention.

However, since it isn’t FDA-approved for mental health treatments, cost may be a consideration.

Comparing treatment experiences

Each treatment experience differs, so consider the method of administration and the treatment duration.

Spravato administration

Self-administered nasal spray in-office
Requires supervision for two hours after treatment
Frequency starts at two visits per week for four weeks

IV ketamine administration:

Delivered through an IV line by our trained professionals
Infusion duration is 40-60 minutes
Initial treatments occur more frequently (two to three times per week)

Dr. Giles and Dr. Kwong can help you evaluate your options. Call Breakthru Psychiatric Solutions in Sandy Springs or Alpharetta, Georgia, or book an appointment online to learn more.