Understanding Your Options
Spravato vs. Ketamine for Depression: How They Compare
By Dr. Stacey Forbes, DNP, APRN, PMHNP-BC
Key Takeaways
- Spravato (esketamine) is an FDA-approved nasal spray for treatment-resistant depression, given under a REMS safety program.
- Ketamine (usually IV or intramuscular) is used off-label for depression and isn’t FDA-approved for that use.
- Both require in-person administration and monitoring — neither can be dosed at home or over telehealth.
- Which fits depends on your history, insurance/cost, and clinical picture; an evaluation determines candidacy.
Spravato and ketamine are related but not identical. Both can help depression that hasn’t responded to standard antidepressants, but they differ in FDA status, how they’re given, and cost.
What Spravato (esketamine) is
Spravato is esketamine, a nasal-spray form derived from ketamine. It’s FDA-approved for treatment-resistant depression and for depressive symptoms in adults with major depressive disorder and acute suicidal ideation. Because of its REMS safety program, it must be administered and monitored in a certified healthcare setting.
What ketamine is
Ketamine is an older anesthetic used off-label for depression, typically as an IV infusion or intramuscular injection. It’s not FDA-approved specifically for depression, though there’s substantial clinical experience with it.
Key differences
- FDA approval: Spravato is approved for TRD; ketamine is off-label
- Delivery: Spravato = nasal spray; ketamine = usually IV/IM
- Setting: both require in-person, monitored administration — not telehealth or at-home
- Cost/coverage: Spravato is sometimes covered by insurance for approved uses; ketamine is often cash-pay
How care works here
Willow & Stone provides the telehealth evaluation, treatment planning, and integrative care around these treatments, and coordinates in-person dosing logistics. Dr. Forbes helps determine whether Spravato or another option is the right fit based on your history.
Common Questions
Is Spravato just ketamine?
Spravato is esketamine, one of the two mirror-image molecules that make up ketamine. It’s FDA-approved and delivered as a monitored nasal spray, whereas ketamine is used off-label, usually by IV or injection.
Can I get either treatment at home or by telehealth?
No. Both require in-person administration and monitoring at a certified site. Telehealth is used for evaluation, planning, and follow-up.
Which one is right for me?
It depends on your treatment history, clinical picture, and cost/coverage. An evaluation with Dr. Forbes determines candidacy and the best path.
Sources & Further Reading
Explore Related Care
Learn how Dr. Stacey Forbes, DNP, PMHNP-BC, approaches Spravato (Esketamine) at Willow & Stone — integrative, cash-pay telehealth care. Book a consultation →
Dr. Stacey Forbes, DNP, APRN, PMHNP-BC
Board-certified Psychiatric-Mental Health Nurse Practitioner and founder of Willow & Stone Integrative Mental Health. Nearly two decades of clinical experience; integrative, root-cause psychiatry via telehealth. Licensed in Texas & New Mexico.
About Dr. Forbes →