The Thrive Journal · Advanced care
IV Ketamine vs Spravato®: cost, insurance, and how to choose
By Jay Borrego, DNP, PMHNP-BC, CRNA · Written and clinically reviewed by the author · Published September 2026 · Last clinical review: September 3, 2026 · Coral Gables, FL
They come from the same molecule
Ketamine is made of two mirror-image molecules. Spravato® is esketamine — the patented S-half — FDA-approved as a nasal spray for treatment-resistant depression and used on its own or with an oral antidepressant (the current label allows either for TRD). IV ketamine uses the complete molecule, infused slowly with weight-based dosing that can be adjusted in real time. Both are given in a monitored medical setting; neither is take-home.
The cost question, answered directly
Spravato® is often covered by insurance because it's FDA-approved — many patients pay a specialist copay per visit. IV ketamine for depression is an off-label use of an FDA-approved anesthetic, so it's self-pay — at Let's Thrive the full series price is quoted in writing at your consultation, with financing available and superbills provided for out-of-network reimbursement.
How people actually choose
Insurance-first patients usually start with Spravato®. Patients who want maximum dosing precision — or who didn't respond fully to esketamine — often choose IV. Some do both across their treatment course. The honest answer is that a consultation should decide it: your history, your cardiovascular picture, your prior medication trials, and your goals. At our practice both options live under one roof, delivered by a clinician dual-trained in psychiatry and anesthesia, so the recommendation isn't biased by what we're able to offer.
One more thing worth knowing: either way, a ride home is required, side effects like dissociation and blood-pressure changes are usually temporary, and results in trials — while sometimes rapid — are never guaranteed for an individual. Any clinic that promises otherwise is selling, not treating.
Read more on our IV Ketamine & Spravato® page, including the full side-by-side comparison and an honest fit filter.
This article is educational and not a substitute for an evaluation. Individual results vary.
References
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Spravato® (esketamine) Prescribing Information. Janssen Pharmaceuticals. Current label (monotherapy or with an oral antidepressant for TRD).
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Anand A, et al. Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression (ELEKT-D). N Engl J Med. 2023;388(25):2315-2325.
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Popova V, et al. Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in TRD (TRANSFORM-2). Am J Psychiatry. 2019;176(6):428-438.
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Sanacora G, et al. Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders. JAMA Psychiatry. 2017;74(4):399-405.