If you’ve been researching ketamine-based treatments for depression, you’ve likely come across two options: IV ketamine and Spravato (esketamine). While they’re related compounds, there are important differences that can affect your treatment experience and outcomes.
What’s the Difference?
Ketamine exists as two mirror-image molecules: S-ketamine and R-ketamine. Spravato contains only the S-ketamine form, while IV ketamine (used at Gateway Clinics) contains both forms — known as racemic ketamine. Research suggests that having both isomers may contribute to broader therapeutic effects.
| Feature | IV Ketamine | Spravato (Esketamine) |
|---|---|---|
| Administration | Intravenous (IV drip) | Nasal spray |
| Composition | Racemic (S + R ketamine) | S-ketamine only |
| Dosage Control | Precise, real-time adjustment | Fixed dose increments |
| FDA Status | Approved as anesthetic (1970) | Approved for TRD (2019) |
| Insurance | Typically not covered | May be covered with prior auth |
| Bioavailability | 100% (direct to bloodstream) | ~48% (nasal absorption varies) |
| Setting | Medical clinic, physician-supervised | REMS-certified healthcare setting |
Why Gateway Clinics Uses IV Ketamine
Gateway Clinics chose IV administration for three key reasons:
- Precise dosage control: IV delivery allows Dr. Adam Schenk to adjust the dosing in real-time based on each patient’s response. Nasal spray absorption varies significantly between patients and even between sessions
- 100% bioavailability: Every milligram reaches the bloodstream. With nasal spray, absorption depends on factors like nasal congestion, technique, and mucosal health
- Both ketamine isomers: Racemic ketamine provides both the S and R forms, which may offer complementary therapeutic mechanisms that S-ketamine alone does not
The Insurance Question
One advantage of Spravato is that it may be partially covered by insurance, since it has a specific FDA approval for treatment-resistant depression. IV ketamine is used off-label and is typically not covered.
However, many patients find that the total cost difference is smaller than expected once copays, required concurrent antidepressant prescriptions, and the greater number of Spravato sessions are factored in. Spravato protocols typically require twice-weekly sessions for the first month, while Gateway’s IV protocol is 6 sessions over 3 weeks.
Related: Depression Treatment in Santa Monica: Complete Guide
Related: Ketamine Therapy Cost in Los Angeles: Complete Guide
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Frequently Asked Questions
Is one treatment more effective than the other?
Head-to-head studies are limited, but IV ketamine has a longer track record and broader research base. The 70-80% improvement rate for treatment-resistant depression is based primarily on IV ketamine studies. Both treatments show significant efficacy compared to placebo.
Can I switch from Spravato to IV ketamine?
Yes. If you’ve tried Spravato without adequate results, IV ketamine may still be effective. The different composition (racemic vs. S-only) and delivery method mean your response could differ. Dr. Schenk can evaluate your Spravato history during a free consultation.
Does Gateway Clinics offer Spravato?
Gateway Clinics exclusively offers IV ketamine therapy. We believe IV administration provides the most precise, controllable, and effective treatment experience for our patients.
Ketamine Therapy Near You
Gateway Clinics serves patients from across LA’s Westside from our Santa Monica clinic: