Two Paths, One Goal
If you’ve been researching treatments for depression that hasn’t responded to traditional antidepressants, you’ve likely come across multiple options: Spravato (esketamine), ketamine IV infusion therapy, ketamine injections, and sublingual ketamine administration. All options are rooted in the same molecule, but they differ in important ways - how they’re administered, staffing requirements, what they cost, whether insurance covers them, and how they fit into a broader healing plan.
Understanding these differences can help you make an informed decision about which approach is right for you.
What Is Spravato?
Spravato is the brand name for esketamine, a nasal spray manufactured by Janssen (a Johnson & Johnson company). It was first approved by the FDA in 2019 as an add-on to oral antidepressants for treatment-resistant depression, and in January 2025, it received FDA approval as a standalone monotherapy - meaning it can now be prescribed on its own, without requiring a concurrent antidepressant. Spravato is not available at Integrative Soulutions.
Key facts about Spravato:
- Administered as a nasal spray in a certified healthcare setting
- Contains esketamine (the “S” enantiomer of ketamine)
- FDA-approved specifically for treatment-resistant depression and major depressive disorder with suicidal ideation
- Requires a 2-hour monitored observation period after each dose
- Typically administered twice weekly for the first month, then weekly or biweekly
- Covered by most major insurance plans, including Medicare and many commercial insurers
What Is Ketamine Infusion Therapy?
Ketamine infusion therapy uses racemic ketamine - the original form of the molecule that contains both the “S” and “R” enantiomers - that is continuously infused through an intravenous line for the duration of your treatment. It has been used safely as an anesthetic since the 1960s and has been prescribed off-label for depression, anxiety, PTSD, and chronic pain for over two decades. Ketamine IV infusions are not available at Integrative Soulutions.
Key facts about ketamine infusion therapy:
- Administered intravenously (IV) in a clinical setting with nursing monitoring
- Contains racemic ketamine (both S and R enantiomers)
- Used off-label for depression, anxiety, PTSD, OCD, chronic pain, and other conditions
- Sessions typically last 1-2 hours
- Treatment frequency is individualized (often a series of sessions, then maintenance as needed)
- IV infusions can be covered by some insurances - please check with your insurance plan for providers within your network
How Else Is Ketamine Administered?
Due to ketamine’s pharmacology, it can be administered in multiple ways in a clinical setting. At Integrative Soulutions we offer ketamine therapy either through a single intramuscular injection with close monitoring for the duration of your treatment, or with sublingual administration and close monitoring for the duration of your treatment. Like ketamine infusion therapy, this method uses racemic ketamine, which has been used safely as an anesthetic since the 1960s.
Key facts about ketamine administration by intramuscular injection or sublingual absorption:
- Administered with a single injection or under your tongue in a clinical setting with physician monitoring
- Contains racemic ketamine (both S and R enantiomers)
- Used off-label for depression, anxiety, PTSD, OCD, chronic pain, and other conditions
- Sessions typically last 1-2 hours
- Treatment frequency is individualized (often a series of sessions, then maintenance as needed)
- Not covered by insurance plans - cash pay pricing available. However, patients are eligible for sliding scale fees and package discounts if multiple sessions are scheduled
How They Compare
The Molecule
This is perhaps the most important scientific distinction. Spravato contains only esketamine (the S-enantiomer), while traditional ketamine therapy uses racemic ketamine (both S and R enantiomers).
Why does this matter? Emerging research suggests that the R-enantiomer may contribute meaningfully to ketamine’s antidepressant and neuroplasticity effects. Some researchers believe that racemic ketamine’s therapeutic profile may be broader precisely because it engages multiple receptor systems through both enantiomers. The science is still evolving, but this is an active area of investigation.
Administration and Experience
Spravato is self-administered as a nasal spray under medical supervision. The experience is generally milder, with less dissociation than IV ketamine. You spray the medication yourself, then rest in a monitored room for two hours.
Ketamine infusion/injection is administered by a physician. The experience tends to be more immersive, which can be therapeutically valuable. Many patients describe deeper introspective experiences during IV or IM sessions - experiences that, when paired with therapeutic support, can facilitate significant psychological breakthroughs.
What Conditions Are Treated
Spravato is FDA-approved specifically for:
- Treatment-resistant depression (after failing at least two antidepressants)
- Major depressive disorder with acute suicidal ideation or behavior
Ketamine therapy is used off-label for a broader range of conditions:
- Treatment-resistant depression
- Anxiety disorders (generalized, social, panic)
- PTSD and complex trauma
- OCD
- Chronic pain (fibromyalgia, CRPS, neuropathic pain, migraines)
- Suicidal ideation
If your primary concern is depression, both may be appropriate. If you’re dealing with anxiety, PTSD, chronic pain, or other conditions, ketamine therapy offers more flexibility.
Cost and Insurance
This is often the deciding factor for many patients.
Spravato is covered by most major insurance plans. Out-of-pocket costs with insurance typically range from $10-$150 per session, depending on your plan. Without insurance, Spravato can cost $600-$900 per session.
Ketamine IV infusion therapy is rarely covered by insurance when used for mental health conditions. Sessions typically range from $300-$800 depending on the route of administration and level of therapeutic support. However, HSA/FSA funds can usually be applied, and many providers offer superbills for potential out-of-network reimbursement.
Ketamine administration by intramuscular injection or sublingual absorption is not covered by insurance. Sessions at Integrative Soulutions typically range between $350-$500 depending on whether you are a new or returning patient. HSA/FSA funds can usually be applied, and a superbill can be offered for potential out-of-network reimbursement.
Treatment Protocol
Spravato follows a standardized FDA protocol:
- Weeks 1-4: Twice weekly
- Weeks 5-8: Once weekly
- Week 9 onward: Once weekly or every two weeks
- Often continued indefinitely as maintenance
Ketamine therapy protocols are individualized:
- Typically 1-8 sessions based on response
- No requirement to purchase sessions upfront
- Maintenance frequency determined by individual needs
- Can be adjusted based on your specific condition and goals
The Therapeutic Component
This is where our approach at Integrative Soulutions differs from many Spravato-certified clinics.
Spravato administration at most clinics involves spraying the medication, then sitting in a monitoring room for two hours - often with minimal therapeutic engagement. The focus is on medication delivery and safety monitoring.
Ketamine-assisted therapy at our practice embeds every session within a therapeutic framework:
- Pre-session intention setting and preparation
- Physician-supervised administration in a comfortable, curated environment
- Post-session integration to process insights and anchor lasting change
We believe the therapeutic context matters as much as the molecule. Research consistently shows that combining ketamine with psychotherapy produces more durable outcomes than medication alone.
Effectiveness: What Does the Research Say?
Both Spravato and ketamine have demonstrated significant efficacy for treatment-resistant depression.
Spravato clinical trials showed that approximately 65-70% of patients experienced meaningful improvement in depressive symptoms. The 2025 monotherapy approval was based on data showing Spravato was effective even without a concurrent oral antidepressant.
Ketamine research has shown response rates of 60-75% for treatment-resistant depression, with some studies reporting even higher rates when combined with therapy. A landmark study in the New England Journal of Medicine found ketamine to be at least as effective as ECT (electroconvulsive therapy) with fewer side effects.
Head-to-head comparisons are limited, but available evidence suggests comparable efficacy between the two. Some clinicians and researchers have noted that racemic ketamine may have a slight edge for certain patients, potentially due to the R-enantiomer’s additional mechanisms of action.
Side Effects
Both treatments share similar side effect profiles, as they’re based on the same molecule:
Common side effects (both):
- Dissociation (feeling detached from surroundings)
- Dizziness
- Nausea
- Increased blood pressure (temporary)
- Sedation
- Altered perception
These effects are temporary and typically resolve within 1-2 hours after the session. At Integrative Soulutions, we monitor you throughout and don’t discharge you until you’re feeling stable.
Key difference: Many patients report that IV/IM ketamine produces a more pronounced dissociative experience than Spravato’s nasal spray. For some, this deeper experience is therapeutically valuable; for others, a milder experience is preferred.
Which One Is Right for You?
Spravato may be a better fit if:
- Insurance coverage is a primary concern
- You’re specifically dealing with treatment-resistant depression
- You prefer a milder, FDA-standardized treatment experience
- You’re comfortable with a longer-term, protocol-driven approach
- You want an FDA-approved indication for your condition
Ketamine therapy may be a better fit if:
- You’re dealing with anxiety, PTSD, chronic pain, or OCD in addition to (or instead of) depression
- You want a more individualized treatment plan rather than a standardized protocol
- You value the therapeutic component - preparation, intention-setting, integration
- You’ve tried Spravato without adequate results
- You prefer fewer, more intensive sessions rather than ongoing maintenance
- You’re open to a deeper therapeutic experience
It’s also worth knowing:
- Some patients start with Spravato (for insurance coverage) and later transition to ketamine therapy for deeper therapeutic work
- Others begin with ketamine-assisted therapy for an intensive initial phase, then switch to Spravato for maintenance
- The two approaches are not mutually exclusive
Questions to Ask Any Provider
Whether you’re considering Spravato or ketamine therapy, here are questions worth asking:
- What therapeutic support is included? Is there preparation and integration, or just medication administration?
- Who oversees your care? Is a physician involved, or only a nurse practitioner?
- What happens if the first approach doesn’t work? Is there flexibility to adjust?
- How do they handle side effects and safety monitoring?
- What is the total cost, including all associated visits?
Our Approach at Integrative Soulutions
At Integrative Soulutions, we offer ketamine-assisted therapy with a focus on the whole person - not just the molecule. We believe that the most effective treatment combines:
- The right medicine for your specific condition
- A physician who understands your complete health picture
- Therapeutic support that helps you turn neurochemical shifts into lasting life changes
We’re happy to discuss whether Spravato or ketamine therapy makes more sense for your situation. In some cases, we can help you navigate insurance options or connect you with Spravato-certified providers if that’s the better path for you.
Your healing matters more than which door you walk through. We’re here to help you find the right one.
Schedule a consultation to discuss your options, or call us at (503) 662-8186.
Integrative Soulutions provides physician-led ketamine-assisted therapy in Seattle, WA. We serve patients throughout King County, including Bellevue, Kirkland, Redmond, and the greater Puget Sound area.