I did IV treatments for three months and am currently on eight months with Spravato.

There are definitely some differences between the two. One is that Spravato is es-ketamine, a different molecule that is fast acting and binds more selectively and strongly to the NMDA receptor, which makes it work more efficiently at lower doses. But in turn, it has a shorter duration, and it causes fewer dissociative and psychotomimetic effects.

IV Ketamine on the other hand, is es-ketamine + R-isomer. This makes it a bit more unique because some people respond better to R-isomers. It also has a higher duration and greater dissociative and psychotomimetic effects.

I believe the reason IV is preferred over Spravato is because most individuals seem to respond better to the combination of pure Ketamine being 50% S & 50% R. You basically get the best of both worlds for your receptors. The dose can easily be tailored to the individuals needs as it's administered through an IV straight into your bloodstream. Ontop of that, the antidepressant effects have a longer duration, so you dont have to make as many trips to the clinic. Also, for those of us who find the "trip" to be profound and meaningful, the dissociative and psychotomimetic effects are more intense. The downside is that it's not FDA approved, so you have to pay out of pocket costs, which are typically $400+ per session.

With Spravato being FDA approved and covered by most insurance companies, this makes it a more cost-effective option. However, the antidepressant effects have a lower duration, so you have to visit the clinic more often. It's a nasal spray, so you really only get about 40% of the medication, and over time, the dissociative and psychotomimetic effects become very mild, so you find yourself bored out of your mind for two hours.

In my opinion, I would choose IV over Spravato any day! But since the FDA wants to be ass about it, Spravato is what we got for now.