Spravato and ketamine are closely related medications, but they are not the same treatment. Both affect the brain’s glutamate system, yet they differ in formulation, administration, FDA-approved uses, and how treatment is provided. Understanding these differences can help people with difficult-to-treat depression have a more informed conversation with their healthcare provider.
Spravato is the brand name for esketamine, a specific form of ketamine administered as a prescription nasal spray. It is FDA-approved for adults with treatment-resistant depression and for depressive symptoms in adults with major depressive disorder accompanied by acute suicidal ideation or behavior, with an oral antidepressant for the latter indication.
At Scottsdale TMS & Spravato, patients receive Spravato under direct medical supervision. Before each session, the team reviews the patient’s current condition, mood, and vital signs. The nasal spray is then administered in a dedicated treatment setting, followed by approximately two hours of monitoring.
Ketamine is the broader medication from which esketamine is derived. FDA-approved ketamine products are primarily used as injectable anesthetics for surgical and diagnostic procedures. Ketamine itself is not FDA-approved to treat psychiatric disorders, although clinicians may use it off-label for certain psychiatric conditions.
Unlike Spravato, ketamine treatment for depression may involve intravenous or intramuscular administration, depending on the clinical approach. Because psychiatric ketamine use can be off-label, the specific protocol, setting, dosing, and monitoring requirements can differ between providers.
This distinction is important when comparing the two treatments.
The medications are chemically related, but their treatment pathways are different. Spravato contains esketamine, the S-enantiomer of ketamine, while traditional ketamine contains both the S- and R-enantiomers.
The most noticeable differences involve formulation and regulatory status:
These differences can affect how patients receive treatment and what safety procedures are involved.
Both medications have been studied for their potential effects on depression, but FDA approval should not be confused with identical treatment evidence or indications.
Spravato was specifically developed and evaluated as a nasal formulation for psychiatric treatment. Its approved use includes treatment-resistant depression in adults. The medication works as an NMDA receptor antagonist and can influence glutamate signaling in the brain.
The Scottsdale TMS & Spravato program describes Spravato as an option for adults who have not responded adequately to at least two prior antidepressant trials. The practice also notes that some patients may experience meaningful symptom improvement relatively quickly.
Response varies from person to person, so treatment decisions should be based on an individual psychiatric evaluation rather than assuming one medication will work better for everyone.
Spravato has specific FDA safety requirements. Because esketamine can cause sedation, dissociation, and temporary changes in blood pressure, patients must remain under observation after administration. The Spravato REMS requires treatment to occur in a certified healthcare setting, with monitoring for at least two hours.
Ketamine treatment also requires appropriate medical oversight, particularly because it can cause changes in consciousness, blood pressure, and perception. However, the monitoring process depends on the specific clinical protocol and setting.
With Spravato, these safety procedures are built directly into the FDA-required treatment program.
Choosing between Spravato and ketamine depends on factors such as your diagnosis, treatment history, medical conditions, previous response to antidepressants, and treatment goals.
Dr. Michael Vines and Our Team at Scottsdale TMS & Spravato can evaluate your individual circumstances and explain whether Spravato may be appropriate for your depression care. The practice also offers integrated options such as medication management, psychotherapy, and TMS when clinically appropriate.
Although Spravato and ketamine are closely related, they have important differences. Spravato is esketamine nasal spray with specific FDA-approved psychiatric indications and must be administered through the Spravato REMS under medical supervision. Ketamine is FDA-approved primarily as an anesthetic, while its use for psychiatric conditions is generally off-label.
Understanding these distinctions can help you discuss your options with a qualified provider. Scottsdale TMS & Spravato provides supervised esketamine treatment and personalized psychiatric care for eligible patients.
Dr. Vines has practiced psychiatry in Arizona for for over 25 years and has experience working with diverse populations that include children, adolescents, adults, geriatrics, SMI patients, and the chemically dependent.
August 30, 2026
