If you’ve spent time researching ketamine therapy, you’ve probably run into the same question most patients ask: “What’s the difference between IV infusion and SPRAVATO — and which one is right for me?”
The honest answer is: it depends on your diagnosis, your insurance coverage, and a conversation with a physician who knows your history. And that’s exactly what this guide is for.
At Charleston Ketamine Center, Dr. Richard L. Bowen has guided thousands of patients through this decision. Below is a straight-talk breakdown of how these two treatments compare — including the clinical evidence, the costs, and the factors that actually drive the choice.
How Both Treatments Work
Ketamine IV infusion therapy and SPRAVATO® (esketamine) are both forms of ketamine-based treatment, and they share the same fundamental mechanism: they target NMDA receptors in the brain. This is a completely different pathway than traditional antidepressants, which primarily affect serotonin.
Because ketamine works on the brain’s glutamate system, it can reach patients who haven’t responded to SSRIs, SNRIs, or other standard psychiatric medications. And unlike most antidepressants — which can take weeks to produce results — ketamine-based treatments may begin working within hours to days for some patients.
But the two treatments differ significantly in how they’re delivered, who they’re approved for, and how they’re covered by insurance. Understanding those differences is the first step in making an informed decision.
Ketamine IV Infusion Therapy: Clinical Evidence and Flexible Reach
IV infusion therapy delivers ketamine directly into the bloodstream through an intravenous drip. This method gives your physician precise, real-time control over dosing — which is one reason it carries the deepest clinical evidence of any ketamine treatment available, with research published by Mayo Clinic, Cleveland Clinic, and the Journal of Clinical Psychiatry.
What to Expect at CKC
At Charleston Ketamine Center, the standard protocol for depression and anxiety is six one-hour infusions over two weeks, provided in a private, calm, monitored setting. This is usually followed by another single one-hour infusion two weeks later. At this time, most patients are started on low-dose at-home Ketamine lozenges. With the lozenges, patients then get infusions on a monthly basis for the next few months, then on an as needed basis thereafter.
For chronic pain conditions — including Complex Regional Pain Syndrome (CRPS) and peripheral neuropathy — treatment involves four-hour infusions on four consecutive days, with further sessions based on your individual response.
During an infusion, most patients experience a calm but unique state. Full cognitive function typically returns within 20 to 30 minutes after the session ends. You will need a driver, as motor function may take longer to fully normalize.
Conditions IV Infusion May Help
Pricing at CKC:Depression and anxiety infusions are $400 per session. Pain infusions are $850 per four-hour session. Advance Care Card and CareCredit financing are available. |
SPRAVATO®: FDA-Approved and Insurance-Covered
SPRAVATO is the brand name for esketamine, a nasal spray form of ketamine developed by Janssen Pharmaceuticals. Unlike IV ketamine — which is used off-label for depression — SPRAVATO received FDA approval specifically for treatment-resistant depression (TRD) and for major depressive disorder (MDD) with active suicidal ideation.
That FDA approval matters for a very practical reason: insurance covers it. Most major insurance plans cover SPRAVATO for patients with qualifying diagnoses — making it accessible to people for whom out-of-pocket IV infusion costs are prohibitive.
What to Expect With SPRAVATO
SPRAVATO is available only through clinics certified in the FDA’s REMS (Risk Evaluation and Mitigation Strategy) program. This requires careful patient screening, structured dosing protocols, and in-office monitoring at every session — no exceptions.
Each session involves self-administering the nasal spray under physician supervision, followed by a required two-hour monitoring period in the office.
Insurance note:Coverage varies by provider and policy. CKC’s team can assist with benefit verification and prior authorization before treatment begins. |
Which Is More Effective? The Honest Answer.
We believe patients deserve a straight answer: according to a 2021 peer-reviewed study, IV ketamine is clinically more effective than SPRAVATO for treating depression.
That’s an important fact — and it’s one we share with every patient, because physician-guided care means being honest about what the evidence actually shows.
That said, SPRAVATO still provides meaningful benefits for many people living with treatment-resistant depression. And for patients who cannot access IV ketamine due to cost, SPRAVATO may be the treatment that changes their life. Effectiveness is not only about which drug performs better in a study — it’s about which treatment a patient can actually access, afford, and complete.
Risks and Considerations
As with any medical treatment, both options carry risks that should be discussed with your physician before starting.
This is one of the most important reasons to seek ketamine treatment from a physician-supervised clinic: the risks that exist can be effectively managed when a qualified medical team is overseeing every step.
When to Talk to a Physician
Ketamine therapy may be worth discussing with a physician if you:
If you are currently in crisis, please contact the Suicide and Crisis Lifeline by calling or texting 988 before pursuing any elective treatment options.
The Right Choice Starts With a Physician Conversation
There is no universal answer to whether IV infusion or SPRAVATO is the right choice — and anyone who tells you otherwise isn’t giving you the full picture. The right treatment depends on your diagnosis, your history with other medications, your insurance situation, and your goals for care.
Some patients are ideal candidates for SPRAVATO because insurance removes a major financial barrier. Others — particularly those with complex pain conditions or a history of failed psychiatric treatments — may see better outcomes with IV infusion therapy. Some patients use both, at different points in their treatment journey.
At Charleston Ketamine Center, Dr. Bowen offers a free phone or in-person consultation to help you understand your options clearly, without pressure. Both our Charleston and Columbia locations are ready to see you.
Kaia Roman
mindbodygreen.com
February 9, 2021
I’ve shared a lot about my quest to quell anxiety over the years, including in my book, The Joy Plan. Thankfully, daily practices such as mindfulness, meditation, exercise, and a healthy diet have helped me tremendously.
But, like the majority of people in these crazy times, I found that my regular practices fell painfully short during this past year. Throwing a divorce into the mix with a pandemic propelled my negative mental feedback loop into overdrive. I found myself unable to sleep, focus, or even think clearly; I was desperate to find the “off” switch.
I told my friend Zappy Zapolin, known in celebrity circles as the “Psychedelic Concierge to the Stars,” (with clients like Lamar Odom and Michelle Rodriguez) about my struggles, and he had one word for me. It definitely wasn’t a word I was expecting: ketamine.
Although I had some vague concept of ketamine as a club drug, I had no idea about its extensively studied application for anxiety, depression, PTSD, and addiction. After diving into the literature, I understood that medical ketamine treatments are legal and not to be confused with the crystallized form of ketamine that is snorted through the nose.
I was most impressed by the 2012 findings at the Yale School of Medicine that many people with chronic depression experience immediate relief after even small amounts of medical ketamine.
This is likely in part because ketamine inhibits the NMDA receptors in the brain, which contributes to its effectiveness as a painkiller and gives the drug its dissociative properties. At a low dose, ketamine appears to induce neurogenesis—new growth of neurons and synapses in the brain—creating an ideal landscape for the creation of new neural pathways. These new neural pathways make it easier to create new ways of thinking and behaving. This is why the medical aspect of ketamine treatments is so essential: A health professional needs to be there to help you navigate this new mental landscape.
In depression and other mental health conditions, brain firing patterns are disordered, and evidence suggests that ketamine-assisted therapy can help restore them. Scientists have pointed to a region in the brain that records all the stress you’ve had in your entire life, called the lateral habenula. When this mechanism gets to a certain tipping point, it goes into a “burst” mode and shuts down the area responsible for dopamine production (no dopamine feels like crap). According to a more recent study in Nature, ketamine blocks this bursting activity, acting like a light switch that turns dopamine production back on instantly.
This is why ketamine-assisted therapies can provide relief from stress and anxiety almost immediately—though there is some question about how long these effects last.
After doing my research and hearing a number of success stories from friends, I decided to give a series of ketamine treatments a try to see for myself.
As much as I wanted relief from anxiety, it still wasn’t easy for me to justify using synthetic medicine. I usually opt for the natural, plant-based option whenever possible. However, I must admit, with each treatment, I experienced new levels of clarity, energy, and inner calm. The results increased in the days and weeks that followed.
While ketamine is not classified as a hallucinogenic, it is a psychedelic (a substance capable of producing profound experiences of reality). A high dose of ketamine puts you to sleep, but at a low dose, you enter a dreamlike state that induces an expanded perspective.
The ideal treatment protocol for depression, based on several studies at Yale, is a series of six sessions over two weeks. Since I don’t have clinical depression but do struggle with anxiety, I decided to have four treatments over two weeks in a clinic. I was later able to beta test an at-home (but clinically sanctioned) program that uses oral ketamine, which was much easier to do during these times of social distance.
My ketamine experience felt like a journey through my own mind, where I encountered beautiful visuals and accessed difficult areas of my life from a new angle. It was as if I was floating outside my body, leaving my habitual state of mind behind, and opening myself to new possibilities.
In my opinion, one of the biggest benefits of ketamine, compared to traditional pharmaceutical antidepressants and anti-anxiety medications, is that it only stays in the body for hours—rather than altering brain chemistry every day. After the treatment, I was so present that I could have gone back to normal activities 15 minutes later.
However, the insights and new perspective that I had while on ketamine stayed with me. In the weeks that followed, I was also able to slip into deeper meditation more easily—which I attribute to ketamine’s potential ability to help calm rumination and a wandering mind.
I tried ketamine during a time when psychedelic-assisted therapies are gaining more traction, funding, and credibility in American medical spaces.
The FDA has granted “breakthrough therapy” status to various psilocybin and MDMA research programs, fast-tracking their potential rollout. mindbodygreen featured psychedelic assisted-therapy as one of their major wellness trends to watch this year, and the Cleveland Clinic has called ketamine a “Top-10 medical breakthrough” for its antidepressant effect.
This attention comes at a poignant time: Last month, the CDC reported that a whopping 41% of U.S. adults suffered from anxiety in December 2020; this was compared to only 11% in January to July of 2019. In the Household Pulse Survey, 37% of U.S. adults said they felt hopeless more than half of the time in October 2020; that number soared to over 50% for adults under 30. Unfortunately, experts say that these mental health reverberations are likely to persist long after the pandemic is behind us.
At times like this, we need all the help we can get. And while not a miracle cure, ketamine—when administered in a safe, medical setting—was one such helpful treatment for me.
If you’re interested in learning more about ketamine-assisted therapy, listen to our conversation with Gita Vaid, M.D. on the mindbodygreen podcast.
