Esketamine vs Ketamine. Are They the Same Thing?

Esketamine vs. Ketamine Infusions. Which is better?

This blog compares Spravato (esketamine nasal spray) and IV ketamine as treatment options for depression, particularly treatment-resistant depression. It outlines key differences in administration, safety, side effects, insurance coverage, cost, and effect

If you’ve been researching alternatives to antidepressants, you’ve probably come across ketamine and esketamine. You might even be wondering: “Esketamine vs ketamine—are they the same thing?” Short answer: not exactly. While they’re closely related, the way they’re administered, monitored, and covered by insurance can be very different.

In this guide, we’ll break down the differences between ketamine infusions and Spravato (esketamine), explain what’s covered by insurance, how long each treatment lasts, how much they cost, and which option might be right for you.

What Is the Difference Between Esketamine and Ketamine?

Ketamine is a well-known anesthetic that has been used off-label for depression for over two decades. Esketamine, on the other hand, is a refined version of ketamine—essentially one “half” of the ketamine molecule—that was developed and FDA-approved under the brand name Spravato™ to treat treatment-resistant depression and major depressive disorder with suicidal thoughts.

Spravato Treatment in Colorado

At Axis Integrated Mental Health, we are proud to be Colorado’s top-certified Spravato clinic. Our providers have helped hundreds of patients begin their healing journey using FDA-approved esketamine treatments, fully covered by most insurance plans.

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Is Spravato Covered by Insurance?

Yes—Spravato (esketamine) is FDA-approved and covered by most major insurance plans, including Medicaid. Unlike traditional ketamine infusions, which are considered off-label and often not reimbursed, Spravato is widely accessible thanks to insurance coverage.

How Much Does Spravato Cost?

Without insurance, a course of Spravato treatment can cost several thousand dollars—but most patients don’t pay the full price. The Spravato With Me Savings Program can bring your out-of-pocket costs down dramatically—often as little as $10 per treatment if you qualify. Read our article for more information about how much Spravato costs.

How Much Does Ketamine Cost?

Ketamine infusions, which are not FDA-approved for depression, are typically not covered by insurance. Patients often pay $350–$500 per infusion, and a full course can cost $3,000–$5,000 or more. You can read more about how much ketamine infusions cost in our deep dive article.

Spravato vs Ketamine Infusions: Pros and Cons

Feature	Spravato (Esketamine)	Ketamine Infusions
FDA Approval	✅ Yes (for depression)	❌ No (off-label use only)
Insurance Coverage	✅ Most insurance plans, including Medicaid	❌ Usually out-of-pocket
Route of Administration	Nasal spray in a clinic setting	Intravenous infusion in a clinical setting
Cost	Often as little as $10 with savings program. $8,150 per year granted to commercially insured patients towards the cost of medication to cover deductibles and out-of-pocket expenses.	$350–$600 per session
Setting	Supervised in a certified clinic	Medical office or clinic
Monitoring Requirements	2 hours of observation per visit	Varies; often 1–2 hours
Can You Use at Home?	❌ No—Spravato must be administered in-clinic	❌ No—infusions require a monitored setting
Duration of Effects	1–2 weeks between maintenance doses after induction	1 week or more, but varies by individual
Success Rate	~50-70% after 6–8 weeks for treatment-resistant depression	~50-80% reported improvement, though varies widely
Ease of Access	Requires a certified Spravato treatment center	Many clinics offer infusions, but fewer are regulated

Want a deeper dive into how these compare? Read our full guide: https://www.axismh.com/post/which-is-better-ketamine-infusions-vs-spravato

How Long Does Each Treatment Last?

Both treatments typically begin with a more intensive phase and then taper into maintenance.

Spravato:

Initial phase: 2 treatments/week for 4 weeks
Second Month: 1 treatment/week for 4 weeks
Maintenance: Depends on patient response
Duration of benefit: Many patients report long-term stability with regular use

Ketamine Infusions:

Initial phase: 6 infusions over 2–3 weeks
Maintenance: As needed—some people do monthly infusions
Duration of benefit: Varies widely, often 1–2 weeks per infusion

Can You Use Spravato or Ketamine at Home?

No. Both Spravato and ketamine infusions must be administered under supervision. With Spravato, you’re monitored for 2 hours post-treatment in a certified clinic due to safety regulations. Ketamine also requires post-infusion observation due to potential dissociation or sedation. While other forms of ketamine (e.g. lozenges or compounded ketamine) are available for home use, we highly discourage patients from at-home ketamine for safety reasons.

Success Rates: Which Is More Effective?

Both treatments are considered highly effective for people with treatment-resistant depression, though individual response varies.

According to a recent study and previous research, there is no difference in efficacy between Ketamine infusions vs. Spravato. Side effects were also equal. In another study from Cambridge, published in The Journal of Clinical Psychiatry, it was noted that "Intravenous ketamine and intranasal esketamine showed similar response/remission in TRD patients but the number of treatments required to achieve response/remission was significantly lower with Ketamine infusions vs. Spravato."

Final Thoughts: Which Is Right for You?

If you're deciding between esketamine vs ketamine, consider the following:

If you need insurance coverage, prefer a regulated treatment, and want long-term support, Spravato is likely the better option.
If you want more flexible scheduling and are paying out of pocket, ketamine infusions may appeal more—but come with fewer safeguards and less coverage.

At Axis Integrated Mental Health, we offer Spravato treatments in Denver County, Boulder County, and Adams and Jefferson Counties, and we’re here to walk you through every step—from insurance approvals to tracking your progress.

Ready to Begin?

Take our Spravato qualification quiz to see if you are a good candidate for treatment.

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