Spravato vs ketamine: which is right for you?

The short version

Spravato is FDA approved for depression and is covered by insurance. Generic ketamine is not approved for depression, is used off label, and is almost always cash pay. Both work through the same receptor and both produce a rapid response in a similar share of patients. See the coverage hub, the Spravato hub, and the coverage checker.

Side by side

| | Spravato | IV or IM ketamine | |---|---|---| | FDA approval for depression | Yes | No (off label) | | Insurance coverage | Most plans, with prior authorization | Rarely | | Typical patient cost | $10 to $250 per session insured | $350 to $850 per session cash | | Route | Nasal spray, self-administered | Infusion or injection by a clinician | | Monitoring | 2 hours, REMS certified clinic | 1 to 2 hours, clinic policy | | First-month schedule | 8 sessions | 6 sessions | | Oral antidepressant required | Usually, by insurers | No |

When Spravato makes more sense

You have insurance that covers it, you meet the criteria, and you want a treatment with a defined maintenance path that your plan will keep paying for.

When ketamine makes more sense

You do not meet Spravato's insurance criteria (for example, bipolar depression), your plan denies Spravato, you want the flexibility of dose adjustment, or a nearby ketamine clinic is far cheaper than your Spravato out-of-pocket cost.

Find clinics

Many clinics offer both. See Spravato centers by state and ketamine clinics by state, or use the coverage checker.