Ketamine vs esketamine: how they differ
Ketamine is a racemic mixture of two mirror-image molecules, S-ketamine (esketamine) and R-ketamine. Esketamine binds the NMDA receptor more strongly, so a lower dose produces a similar effect. Spravato is esketamine formulated as a nasal spray and approved for depression; generic ketamine is the racemic mixture approved as an anesthetic and used off label.
Updated · Checked by the Covered Mind editorial team against cited sources
Key facts
- Last checked:
- Sources listed: 1
- Reading time: About 1 minute
- Spravato dose: 56 or 84 mg fixed
- Spravato cash price: $850 to $1,500 per session
- Ketamine cash price: $350 to $850 per infusion
| Fact | Value |
|---|---|
| Last checked | |
| Sources listed | 1 |
| Reading time | About 1 minute |
| Spravato dose | 56 or 84 mg fixed |
| Spravato cash price | $850 to $1,500 per session |
| Ketamine cash price | $350 to $850 per infusion |
What differs in practice
Check Spravato and ketamine coverage in the coverage checker and read coverage rules by insurer. Common questions about coverage and billing are answered on the Spravato overview.
| Esketamine (Spravato) | Racemic ketamine | |
|---|---|---|
| Route | Nasal spray | IV, IM, oral, nasal (compounded) |
| Dose | 56 or 84 mg fixed | Weight based, adjustable |
| Where | REMS certified clinic, 2-hour observation | Any clinic, clinic policy |
| Evidence | Large placebo-controlled trials | Many smaller controlled trials, mostly IV |
| Head-to-head | Small trials find comparable response; IV ketamine may act slightly faster | |
| Insurance | Covered with prior authorization | Not covered |
| Cash price | $850 to $1,500 per session | $350 to $850 per infusion |
| Oral antidepressant | Required by most plans | Optional |
For OCD, read Ketamine therapy for OCD and Spravato for OCD.
Which works better?
The few direct comparisons show similar response rates. IV ketamine may produce a faster initial response; esketamine has the larger evidence base and regulatory backing. For most people the deciding factors are coverage, cost and logistics, not efficacy.
Which to choose?
If your plan covers Spravato and you meet its criteria, it costs a fraction of ketamine out of pocket. If you do not qualify (bipolar depression, no oral antidepressant, prior authorization denied), or a ketamine clinic is far cheaper for you, racemic ketamine is a reasonable alternative offered by many of the same clinics.
See Spravato, ketamine therapy, and the coverage checker. Read Ketamine therapy: the complete guide and Spravato: the complete guide.
Related reading: Side effects and safety: Spravato, ketamine and TMS and Driving and monitoring rules for Spravato and ketamine.
Related
Checked by the Covered Mind editorial team · · Editorial policy
Cite this
Covered Mind. "Ketamine vs esketamine: how they differ." https://www.coveredmind.com/compare/ketamine-vs-esketamine. Last checked Sep 1, 2026.
This site provides general information about insurance coverage and treatment options. It is not medical advice, not a guarantee of coverage, and not a substitute for talking with a clinician or your health plan.