What’s the difference between Spravato® and ketamine?

If you’re struggling with depression that hasn’t improved with traditional interventions, you may have heard about ketamine or Spravato® as newer treatment options. While these therapies are often mentioned together, and they are related, they aren’t the same.

Spravato and ketamine differ in how they’re formulated, delivered, and regulated. Understanding these differences can help you have a more informed conversation with your psychiatrist and feel more confident about your treatment choices.

At NYC Psychiatric Associates, located in the Murray Hill section of Midtown Manhattan, our skilled psychiatrists offer Spravato treatment for patients with treatment-resistant depression (TRD) or major depressive disorder (MDD) with suicidal thoughts or actions. 

Here, we explain the differences between Spravato and ketamine and why we offer the FDA-approved treatment option.

What is ketamine?

Ketamine is an FDA-approved general anesthetic that has been safely used for decades in surgical and emergency medical settings. It’s classified as a dissociative medication that works by altering perception and blocking pain signals.

It works by blocking receptors in the brain that manage the glutamate system and may increase neural connectivity and promote neural plasticity (reorganizing the brain’s structure and function). The effect on the brain is believed to play a role in its rapid reduction of depression symptoms.

Some providers use low-dose ketamine infusions as an off-label treatment for depression. We want to point out that while ketamine is an FDA-approved general anesthetic, it’s not FDA-approved to treat depression.

What is Spravato?

Spravato is an FDA-approved medication that treats TRD and MDD with suicidal symptoms. The active ingredient in Spravato is esketamine, which is one of the two mirror-image molecules that make up ketamine. Traditional ketamine contains both forms, while Spravato only contains esketamine.

Esketamine binds better to the brain receptors than ketamine, making it more effective at lower doses. Its unique properties have been developed, studied, and approved as a medication treatment option for depression.

Spravato vs. ketamine

Although Spravato and ketamine affect similar brain pathways, there are several differences.

Molecular composition

As previously mentioned, ketamine is made up of two molecules, while Spravato contains only one (esketamine). This molecular difference influences potency, dosing, and how consistently the medication affects the brain.

Administration

Spravato is administered as a nasal spray, while ketamine is given as an intravenous (IV) infusion. Both treatments require close medical supervision during treatment, but Spravato is only administered in a certified medical facility that must follow a federally mandated safety protocol.

Dosing and treatment protocols

Spravato also has a standardized dosing and treatment protocol that includes three phases: induction, optimization, and maintenance. As an off-label treatment for depression, there is no set protocol for ketamine infusions, and treatment can vary. 

FDA approval and insurance coverage

Because Spravato is FDA-approved to treat depression, your health insurance is more likely to cover the cost of treatment. Ketamine, on the other hand, is often an out-of-pocket expense.

Side effects and safety considerations

Both Spravato and ketamine are powerful medications and can only be  used under the care of a qualified medical professional. Common side effects include:

• Dissociation
• Dizziness
• Nausea 
• Vomiting
• Headache
• Temporary changes in blood pressure

Side effects may occur during or shortly after treatment and can last several hours. You shouldn’t drive or go back to work after administration.

Because Spravato has undergone extensive clinical trials, its safety and effectiveness for treatment of depression has been closely studied.

Both Spravato and ketamine may provide rapid relief from depression for some people, but it’s not the correct treatment for everyone. A mental health provider who understands your symptoms, medical history, and prior response to treatment is the best person to turn to when considering either treatment.

At NYC Psychiatric Associates, we offer Spravato treatment for patients who qualify and take the time to explain how it works, what to expect, and whether it’s the best choice for you.

Call one of our New York City, New York, offices today or message us to schedule your consultation. We offer same-day appointments so we can help you get relief as quickly as possible.