Spravato vs Ketamine Infusion Therapy: What's the Difference?

When individuals seek innovative options for treating depression that has not responded to traditional medications, two names commonly appear: Spravato® (esketamine) therapy and ketamine infusion therapy. Although both derive from the same underlying compound, there are important differences related to approval status, safety, administration, insurance coverage, and medical oversight that patients should understand before choosing a treatment pathway.

Patients exploring Spravato treatment in Houston frequently ask whether ketamine infusions offer comparable benefits. The answer depends on regulatory standards, access to insurance coverage, and personal medical considerations.

✅ FDA Approval & Regulation

Spravato (Esketamine)

Spravato is the only FDA-approved ketamine-based therapy specifically for the treatment of treatment-resistant depression. It is regulated under a Risk Evaluation and Mitigation Strategy (REMS) program that ensures:

• Administration only in certified medical clinics

• Direct in-office dosing under physician supervision

• Continuous patient monitoring for at least two hours after dosing

• Detailed medical documentation and safety protocols

This structure ensures consistent quality, standardized safety measures, and medical accountability.

Ketamine Infusion Therapy

By contrast, ketamine infusions use compounded racemic ketamine in an off-label capacity. While many clinics provide this service, it is not FDA-approved for depression treatment and is not regulated by REMS requirements. Monitoring standards vary depending on the clinic providing care.

✅ Treatment Administration Differences

Spravato Administration

Spravato is delivered via nasal spray while patients remain under clinic supervision. Treatment protocols follow nationally standardized schedules including:

• Twice-weekly sessions for induction

• Weekly or biweekly maintenance dosing

• Mandatory monitoring after each session

Patients cannot self-administer Spravato at home.

Ketamine Infusions

Ketamine infusion therapy requires placement of an IV line and adminstration of ketamine over a 40–60 minute period. Treatment environments can vary significantly by provider and jurisdiction.

✅ Safety & Medical Oversight

Spravato Safety Standards

Because Spravato is federally regulated:

✅ Blood pressure and vital signs are monitored

✅ Mental status checks are required throughout treatment

✅ Emergency response protocols are standardized

✅ Providers must be REMS-certified

This ensures uniform medical oversight nationwide.

Ketamine Infusion Variable Oversight

Ketamine infusion centers may operate without psychiatric supervision, standardized safety protocols, or insurance compliance oversight. Monitoring may be minimal depending on region and provider type.

✅ Insurance Coverage

Spravato

Spravato therapy is widely covered by insurance when FDA criteria are met.

Commonly accepted plans include:

• Medicare

• Blue Cross Blue Shield of Texas

• United Healthcare

• Aetna

• Cigna / Evernorth

• Tricare

• Ambetter/Superior Health

Insurance coverage significantly reduces out-of-pocket costs for eligible patients.

Ketamine Infusions

Ketamine infusions are rarely covered by insurance and are typically paid out-of-pocket, often costing $350–$800 per session depending on location and clinic fees.

✅ Effectiveness for Depression

Both therapies show promising results for rapid symptom improvement in patients with severe or medication-resistant depression.

However:

✅ Large-scale studies support Spravato’s safety and effectiveness within FDA approval guidelines.➡️ Evidence for ketamine infusions remains less standardized due to off-label use and inconsistent outcome tracking.

✅ Choosing the Right Option

Most patients seeking a medically regulated, insurance-covered solution start with:

Spravato treatment in Houston under licensed psychiatric supervision.

Patients who:

• Do not meet FDA eligibility criteria

• Require immediate same-day access

• Wish to pursue off-label options

may explore ketamine infusion therapy as an alternative after consulting with their treating physician.

✅ Summary Comparison Table

Feature	Spravato	Ketamine Infusions
FDA Approved	✅ Yes	❌ No
REMS Safety Program	✅ Required	❌ None
Administration	Nasal spray in-clinic	IV infusion
Supervision	Psychiatric physician	Variable/clinic dependent
Insurance Coverage	✅ Often covered	❌ Rare
Monitoring	Mandatory 2-hour observation	Variable

✅ Frequently Asked Questions

Who is a better candidate for Spravato?

Patients diagnosed with treatment-resistant depression who have tried two or more antidepressants and qualify through a psychiatric evaluation.

Is ketamine stronger than Spravato?

No. Both contain related compounds. The difference is not about "strength" but rather safety regulation and standardized dosing protocols.

Can I try ketamine first if I want faster access?

Some patients explore ketamine infusion clinics for early access, though these treatments remain self-pay and off-label.

✅ Final Recommendation

For patients looking for:

✅ FDA-approved treatment

✅ Medical supervision and safety standards

✅ Insurance coverage

Spravato therapy remains the gold-standard option for esketamine depression treatment.

Interested patients in Houston can explore eligibility through a consultation for Spravato treatment in Houston at a certified clinic.