If you’ve been reading about fast-acting treatments for depression, you have probably seen two names: ketamine and Spravato. They are closely related, they work on the brain in a similar way, and Rivendell Health offers both. Where they differ is in how they are approved, how you take them, what happens afterwards, and who pays for them.
Those differences usually decide which one you start with, so this post walks through each of them in turn.
| Ketamine therapy | Spravato (esketamine) | |
|---|---|---|
| What it is | Ketamine, a medication used in anesthesia since the 1970s | Esketamine, one form of the ketamine molecule, as a nasal spray |
| FDA approval for depression | None. Used off-label at low doses | Approved for treatment-resistant depression and for major depression with suicidal thoughts |
| How you take it | An injection given by a nurse in the office, on your provider’s order | Our trained medical staff will assist with self-administration |
| After each dose | Two hours of monitoring in the office | At least two hours of monitoring in the office |
| Insurance | Always self-pay. No insurance plan covers it | Often covered once prior authorization is approved |
Ketamine is made of two mirror-image versions of the same molecule, known as R-ketamine and S-ketamine. Esketamine, the medication in Spravato, is the S version on its own.
Both act on glutamate, the brain’s main signaling chemical, rather than on serotonin the way most antidepressants do. That is a large part of why they can help people who have already tried two or more antidepressants without enough relief, and why some people notice a change within days rather than weeks.
Spravato went through clinical trials for depression specifically. The FDA approved it in March 2019 for treatment-resistant depression, added major depression with suicidal thoughts or behavior in 2020, and in January 2025 approved it as a treatment on its own, without a daily antidepressant alongside it.
Ketamine itself was approved in 1970 as an anesthetic. Its use for depression, PTSD and related conditions is off-label, meaning a provider prescribes it for a purpose the FDA has not reviewed. That is legal and common in psychiatry, and there is a solid body of research behind it for treatment-resistant depression.
The practical effect is on your bill. Insurers generally cover treatments approved for your diagnosis, so Spravato is often covered once your insurer approves a prior authorization request. Ketamine therapy is never covered and is always paid out of pocket, though you can use HSA funds. For our full breakdown by plan, see Does Insurance Cover Ketamine Therapy or Spravato?
You check in, we take your blood pressure, and our trained medical staff help you take the nasal spray yourself. You then stay with us for at least two hours while we monitor your blood pressure and how you’re feeling. The FDA requires that monitoring period, and it is why Spravato can only be given at a clinic certified in its safety program, known as REMS. Rivendell Health is REMS certified.
You cannot drive until the next day, after a night of sleep, so plan a ride for every session. In the first month, sessions are twice a week. From week five they drop to once a week, and after week eight most people come in weekly or every other week depending on how they are doing.
Your provider sets your dose and puts the order in your chart, and a nurse gives the ketamine as an injection. We then monitor you in the office for two hours, the same as with Spravato, until you are cleared to leave. You will need a ride home that day too.
A typical first course is six sessions over about five weeks: two in the first week, then one a week for the next four. When the course is done, your provider looks at how your symptoms have changed and decides with you whether maintenance sessions make sense.
Your provider makes that call with you at your evaluation, and it usually comes down to four things.
Both treatments raise blood pressure for a short time, so your evaluation includes a look at your blood pressure and heart health whichever way you go.
Every patient starts with an evaluation by one of our psychiatric providers, who reviews your diagnosis, the medications you have tried and at what doses, and your medical history. If one of these treatments makes sense, your provider will talk you through the next steps. Depending on your history, that decision does not always happen at the first visit. The same team handles your follow-up and adjusts your other medications along the way.
You can read more about each option on our ketamine therapy and Spravato pages, or call us at (719) 726-6573 to book a consultation.
If you’re in crisis right now, call or text 988, or call 911. We are an outpatient practice, not a crisis service.
Phone: (719) 726-6573
Fax: (719) 698-7879
Email: support@RivendellHealth.com
Location: 1465 Kelly Johnson Blvd. Ste 310
Colorado Springs, CO 80920
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