Spravato is a form of ketamine (called esketamine) that is FDA-approved for depression, often covered by insurance, and given in a monitored medical setting. For most adults with treatment-resistant depression, that makes it the better-supported place to start. Traditional ketamine, usually given by IV, is used off-label and is typically paid for out of pocket. At Revival Psychiatry in Mesa, we offer Spravato treatment, and this guide will help you work out whether it fits your situation.
Ketamine has been used in medicine since 1970, first as an anesthetic. Its molecules come in two mirror-image forms, called R and S. Standard ketamine contains both. Spravato contains only the S form, which is why it’s called esketamine.
In the early 2000s, researchers noticed that low doses of ketamine could lift severe depression within hours or days, much faster than typical antidepressants. That discovery led to Spravato, a nasal spray the FDA approved in 2019 for adults whose depression hasn’t responded to other treatments.
“When patients ask if Spravato is ‘real’ ketamine, I tell them it’s a close cousin. It’s the same family, but refined, tested in large clinical trials, and approved by the FDA specifically for depression. That matters to a lot of people, and it mattered to me when I decided to bring it into our practice.” – Erin Jones, FNP, PMHNP, Founder of Revival Psychiatry
Form: Ketamine is usually given as an IV infusion. Spravato is a nasal spray you self-administer with staff nearby.
FDA status for depression: Ketamine is off-label. Spravato is FDA-approved.
Where you receive it: Ketamine varies by clinic. Spravato must be given in a certified treatment center.
Insurance: Ketamine is rarely covered. Spravato is often covered.
Monitoring: Both require observation afterward. For Spravato, it’s a required safety step of at least two hours.
Because Spravato is a regulated prescription medication, it comes with a safety program. You take each dose in the clinic, and we check your blood pressure and how you’re feeling before, during, and after. Off-label ketamine has no single standard for dosing or monitoring, so quality can differ a lot from one provider to another.
Cost is often the deciding factor. Spravato sessions are roughly $600–$1,200 before insurance, depending on your plan. Many people pay far less with coverage. IV ketamine, by contrast, is billed per infusion and is rarely covered by insurance, so the out-of-pocket cost tends to add up over a course of treatment. We can help you check your insurance benefits before you commit to anything.
Spravato follows a set schedule. Most people come in twice a week for the first four weeks and weekly for weeks five through eight. After that, visits drop to weekly or every-other-week. Plan on about two hours per visit, since the observation time is part of the treatment. IV ketamine schedules vary by clinic, since there’s no single approved protocol, so the number and spacing of infusions can differ from one provider to the next.
Your journey starts with a psychiatric evaluation. We review your history, your past medications, and your goals. If Spravato looks like a good match, your first session takes place in a calm, comfortable room. You use the spray yourself while our team monitors you. Afterward, you rest until you’re cleared to go home with a ride.
“The first visit is mostly about reassurance. People are nervous about the unknown, so we walk through every step. By the second session, most patients tell me they know exactly what to expect.”– Erin Jones, FNP, PMHNP
Spravato may be worth discussing if you:
Have major depression that hasn’t improved after at least two antidepressants
Are dealing with depression along with suicidal thoughts
Need faster relief than traditional medication usually offers
Can attend in-person visits and arrange a ride afterward
Certain conditions, like uncontrolled high blood pressure or specific blood vessel problems, may make Spravato unsafe. That’s one reason the screening visit matters. If your symptoms overlap with depression, anxiety, or PTSD, we’ll look at the full picture rather than a single diagnosis.
Spravato is effective, but it isn’t effortless. Common side effects include dizziness, nausea, sleepiness, a temporary rise in blood pressure, and a floaty, “detached” feeling called dissociation. These effects usually peak within the first hour and fade by the end of the visit. You can’t drive until the next day, after a good night’s sleep.
“I never want anyone surprised by how they feel in the room. If we talk about the side effects ahead of time, they’re much easier to handle, and our team is right there the whole time.” – Erin Jones, FNP, PMHNP
Spravato is usually paired with an oral antidepressant, and the FDA also approved a stand-alone option in 2025. Either way, ongoing medication management helps keep your whole plan safe and steady. Many patients also find that therapy helps them make the most of the mental space that opens up after treatment.
Ketamine’s early fame was on the battlefield. It was developed in 1962 and later used in the Vietnam War because it doesn’t slow breathing, unlike many anesthetics. Its use for mood came decades later.
The spray device is surprisingly small. Each single-use device holds 28 mg and delivers two sprays, one per nostril. Your dose is two or three devices, with a short rest between each.
Time can feel strange. Many patients say a two-hour visit felt like twenty minutes, or that minutes stretched out. It’s a normal effect, and it fades.
Music can shape the experience. Many people bring headphones and a calming playlist, and a quiet, softly lit room helps set a peaceful tone.
Your brain may build new connections. Animal studies suggest ketamine helps neurons form new connections within hours, which scientists link to its fast effects on mood.
It’s on a global essential list. The World Health Organization includes ketamine on its List of Essential Medicines, though for anesthesia, not depression.
Try asking yourself a few honest questions:
Have I already tried two or more antidepressants without enough relief?
Do I want a treatment that’s FDA-approved and monitored?
Will my insurance help with the cost?
Can I commit to a regular schedule for the first two months?
If you’re answering yes to most of these, Spravato is likely a strong option to explore. If you’re unsure, that’s normal. No one should have to guess.
“The best treatment isn’t the trendiest one. It’s the one you can do safely and stick with. I’d rather spend an hour understanding your story than rush you into anything.” – Erin Jones, FNP, PMHNP
You don’t have to figure this out alone. When you’re ready, book a consultation, and we’ll go over your history, your options, and what to expect. You can also meet our team to see who will be caring for you. We welcome patients from across the Valley, including Chandler, Gilbert, Tempe, and Scottsdale. Call us at (480) 613-8162 to get started.
Disclaimer: This blog post is for educational purposes only and is not medical advice. It does not create a provider-patient relationship. Treatment decisions should be made with a qualified healthcare provider who knows your medical history. Spravato is not right for everyone. If you are in crisis or having thoughts of harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911 immediately.
About the Author
Erin Jones
