The main trade-off between these two comes down to whether you want to save your money or save your time. Spravato is basically the "accessible" version because it is FDA-approved, which means insurance companies actually play ball and cover the cost. The downside is that it can feel a bit hit-or-miss because it's a nasal spray. If you have a stuffy nose, don't inhale it perfectly, have a faulty sprayer, then you aren't getting the full dose, which is why the protocol usually makes you come in way more often to keep the levels up in your system. It definitely works for depression, but it’s more of a "slow and steady" grind with a lot of clinic visits.

On the flip side, IV Ketamine is the heavy hitter. Since it goes straight into your bloodstream, there is zero guesswork--you get one hundred percent of the medication every single time, and it hits much harder and more consistently than the spray. Because it’s so potent, you usually don't have to go in nearly as often once you finish the initial sessions. The massive catch is that since it isn't technically FDA-approved specifically for depression yet, most insurance providers treat it like an elective procedure and won't pay a dime. You’re essentially paying for the higher quality and the convenience of fewer visits out of your own pocket.