If you have been reading about ketamine for depression, you have probably come across Spravato too, and it is easy to assume they are the same thing. They are related, but they are not the same treatment, and the difference matters when you are deciding what to ask your provider about.
Is Spravato the Same as Ketamine?
No, they are not the same, although they come from the same family. Ketamine is a medication that has been used for decades as an anesthetic. Ketamine is made up of two mirror-image forms, and esketamine, the active ingredient in Spravato, is one of them. It was developed and studied specifically for depression.
The practical differences are these:
Approval. Spravato is FDA-approved for adults with treatment-resistant depression, and for adults with major depression who are having suicidal thoughts or actions. IV ketamine is FDA-approved as an anesthetic. When clinics use it for depression, that use is off-label.
How it is given. Spravato is a nasal spray you give yourself under supervision. Ketamine infusions go through an IV line.
Where it is given. Spravato can only be given in a clinic certified under the FDA's SPRAVATO REMS program. It cannot be taken home.
Insurance. Because Spravato is FDA-approved for depression, insurance can cover it. Coverage for off-label ketamine infusions is much less common.
Since January 2025, the FDA has also approved Spravato as a standalone treatment for treatment-resistant depression in adults, not only alongside an oral antidepressant, according to Johnson & Johnson's announcement.
To be clear about what BNBA offers: we provide Spravato. We do not offer IV ketamine infusions, and we do not offer ketamine or Spravato for PTSD.
Who Qualifies for Spravato
For treatment-resistant depression, you generally need to have tried two or more antidepressant medications without enough relief. If you are unsure whether that describes you, our guide to how Spravato works for depression explains the clinical picture in more detail.
Spravato is not safe for everyone. People with certain brain or blood vessel aneurysms, a history of certain brain or vascular surgery, or high blood pressure that is not under control may not qualify and need further clinical review first. That is why every Spravato patient at BNBA starts with an evaluation rather than a straight booking.
What Happens Before Your First Treatment
The process at BNBA has a few steps, and knowing them in advance saves frustration:
Clinical evaluation. You meet with one of our licensed clinicians, who reviews your history and decides whether Spravato is appropriate.
Consent. If you qualify, the clinician walks you through the treatment, answers your questions, and you sign consent.
Insurance approval. We contact your insurer for approval. Sometimes this takes a follow-up or an appeal before it is granted, which is normal for this treatment.
Scheduling. Once insurance approves, your first treatment is booked.
Most major insurance plans, including Medicaid, are accepted. You can check which plans BNBA takes on the Massachusetts insurance page.
What a Spravato Appointment Is Actually Like
Each spray takes only seconds, but a dose uses two or three devices with a five-minute rest between each, so dosing takes about 5 to 10 minutes. The rest of the visit is monitoring. You relax in a private room for at least two hours while our team checks on you, including your blood pressure, since a rise in blood pressure is one of the known side effects.
The other common effect is dissociation, a feeling of being detached, dreamy, or disconnected from your surroundings. It usually passes during the monitoring window, which is exactly why the two hours exist.
You cannot drive yourself home. Plan for a family member or friend to pick you up, or book a ride service like Uber. Most people can return to their normal routine, including work, the following day.
How Often You Come In
Spravato is front-loaded, then tapers:
Weeks 1 to 4: two treatments a week
Weeks 5 to 8: usually one treatment a week
Week 9 onward: usually once a week or every two weeks, depending on how you respond
The goal is the least frequent schedule that keeps you well. There is no fixed end date. Some people eventually stop treatment, and others continue with maintenance sessions.
For people coming from Fall River, Taunton, New Bedford or Plymouth, that means about eight trips to our Dartmouth location in the first month, each needing a driver home. It is worth arranging your rides before you start rather than week by week. If Dartmouth is too far, call anyway, because we may be able to help you find a treatment center closer to you.
Spravato or TMS?
Both are options once antidepressants have not been enough, and BNBA offers both. They work differently and ask different things about your schedule. TMS means short daily sessions you can drive yourself to, while Spravato means fewer, longer visits with a ride home. Our comparison of TMS vs Spravato covers the tradeoffs, and our post on TMS therapy near Taunton, Brockton and the South Coast explains what a TMS course looks like here.
If you are having thoughts of suicide right now, call or text 988 to reach the Suicide and Crisis Lifeline, or call 911 in an emergency.
Ready to see if Spravato fits? Call (508) 979-5557 or request an appointment. You can read more about Spravato treatment at BNBA.
Frequently Asked Questions
Can You Drive After Spravato?
No, not on the day of treatment. You need a family member, friend, or ride service to take you home after your two-hour monitoring period. Most people can drive and return to normal activities the following day.
How Long Do You Stay After Spravato?
Stay at least two hours for monitoring. The spray itself takes seconds, but you stay at the clinic while our team monitors you for side effects such as dissociation and higher blood pressure before you leave.
Is Spravato Covered by Insurance?
Often, yes. Because Spravato is FDA-approved for treatment-resistant depression, insurers can cover it, and BNBA accepts most major plans, including Medicaid. Approval sometimes needs a follow-up or appeal, and our team handles that request with your insurer.