Both work on the same underlying mechanism. Both have evidence behind them for treatment-resistant depression. They are not interchangeable, and the choice usually comes down to four things: coverage, dose control, how fast you need a response, and access.
The short version
- Spravato is FDA-approved intranasal esketamine, given in a certified treatment center, and more often covered by insurance.
- IV ketamine is used off-label for depression, with significant clinical data behind it, and the dose can be individualized infusion by infusion.
Why NeoMedicine leans toward IV
“At NeoMedicine we focus more on IV ketamine, because of my clinical experience with intravenous administration, the flexibility to individualize the dose, and the research supporting it as a rapid antidepressant.”
Dose flexibility is the practical difference. A nasal spray comes in set strengths. An infusion can be adjusted for you, during the infusion, by the physician watching your monitors. Here is how a monitored infusion works.
The honest part about speed
There is evidence suggesting IV ketamine may provide a faster response. There is not conclusive evidence that it is superior overall. Dr. De La Hoz says that directly rather than dressing it up, which is unusual in this corner of medicine and worth noticing.
How the decision actually gets made
“Ultimately the treatment should depend on the patient’s clinical needs, prior response to treatment, risks, and access to care.”
On insurance specifically:
“More than the insurance company, it depends on the plan the patient has and their medical history.”
So a blanket answer about whether your carrier covers it is not useful. What matters is your plan, what you have already tried, and what is documented. If you are paying out of pocket, here is what IV ketamine costs.
A rough way to think about it
If cost is the binding constraint and your plan covers Spravato, Spravato is the sensible starting point. If you have had a partial response to a set dose, or you have tolerated some treatments poorly and need the dose managed closely, IV has the advantage. If you have tried neither and have no strong constraint, the evaluation should decide it, not a webpage.
What the evaluation covers
Diagnosis, treatment history, current medications, contraindications, and what you can realistically access and afford. At the end of it you get a recommendation and a reason, not a menu. The evaluation is the first step for IV ketamine at NeoMedicine.
Frequently asked questions
Spravato is esketamine, one of the two mirror-image forms of the ketamine molecule, delivered as a nasal spray. It is FDA-approved for treatment-resistant depression. IV ketamine uses the racemic form and is given off-label for depression.
Both require medical supervision. Ketamine can affect blood pressure, perception and consciousness, which is why NeoMedicine screens patients carefully and monitors throughout treatment with EKG, oxygen saturation and blood pressure.
It happens. Prior response to one is part of what gets reviewed at evaluation when deciding the other.
$525 per infusion. The induction course is six infusions, so $3,150 for the initial series. The eligibility call is free.
Book a free eligibility call at NeoMedicine Institute, Doral. 786-264-2999.
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