IV Ketamine vs. Spravato: What's the Difference?

Same family, different medicine

Ketamine is a decades-old anesthetic. The ketamine used in infusion therapy is the racemic form — a mixture of two mirror-image molecules (R- and S-ketamine). Spravato is the brand name for esketamine, which is just the S-half of that molecule, formulated as a nasal spray.

So both come from ketamine, but they are different formulations, given by different routes, and regulated differently.

How each is given

• Spravato (esketamine): a nasal spray self-administered under supervision in a certified healthcare setting. Patients are monitored for about two hours afterward and cannot drive themselves home that day.
• IV ketamine: a controlled intravenous infusion administered and monitored by a clinician, with the dose titrated in real time. Arcane Neuro delivers IV ketamine in your home, with a board-certified CRNA present throughout, under physician oversight.

Approval and coverage

Spravato is FDA-approved — for treatment-resistant depression, and for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior. Because it's approved, it's more often eligible for insurance coverage, but it must be given in a certified setting under a federal safety program (a REMS).

IV ketamine is used off-label for mental-health and pain indications. It is typically private-pay, and protocols can be tailored more flexibly. Importantly, evidence gathered for one route or formulation does not automatically transfer to another.

Dosing, control, and the experience

Because an IV infusion delivers the medication directly into the bloodstream, bioavailability is essentially complete, and the clinician can adjust — or pause — the dose moment to moment based on how you respond. Intranasal absorption is more variable from person to person.

Both can produce dissociative effects during treatment, which is why supervision and monitoring matter in either case.

Which is right for you?

There's no universal answer. The right choice depends on your diagnosis and history, whether insurance coverage is a priority, and whether you'd prefer a certified clinic or a private, in-home setting. A physician should review your situation and screen you before either path — ketamine therapy isn't appropriate for everyone.

If a discreet, closely monitored, in-home experience is what you're after, that's the model Arcane Neuro is built around.