How Spravato & Ketamine Work
A plain explanation of two rapid-acting treatments for depression that hasn't responded.
On this page
ketamine and Spravato
What actually are they?
Both are rapid-acting treatments for depression, given in-clinic and overseen by a psychiatrist. They work on a different brain system to standard antidepressants, which is why they can help when other medication hasn't, and why they can work in days rather than weeks. Spravato (esketamine) is a nasal spray. Ketamine is given by infusion or injection. Neither is something you take home; both are delivered in a calm, monitored room.
How it works
What they actually do
Standard antidepressants act on serotonin, and take several weeks to build up. Ketamine and esketamine work differently: they act on glutamate, the brain's most common signalling chemical, and the NMDA receptor. That's thought to help the brain rebuild connections involved in mood, which is why a response can come within one to two weeks rather than months.
It doesn't work for everyone. Your psychiatrist reviews how you've responded after the first few treatments before planning any further.
THE DIFFERENCE
Spravato & ketamine aren't the same thing
Spravato
esketamine
FDA-approved specifically for treatment-resistant depression.
May be covered. We'll tell you where you stand on your call.
Fixed doses, set by the approved protocol.
Ketamine
generic
By injection or infusion, in-clinic.
FDA-approved for anesthesia. For depression it's used off-label, on the strength of extensive research.
Not covered for the treatment of depression.
More flexible, adjusted by your psychiatrist.
Which one fits depends on your history, your goals, how each is given, and what your insurance allows. Rather than have you weigh that up from a webpage, your psychiatrist talks it through and helps you choose.
WHAT TREATMENT LOOKS LIKE
Your course, start to finish
No surprises. Here's the shape of it.
Evaluation
A full psychiatric evaluation confirms you're a candidate, checks your history and blood pressure, and determines which of the two treatments fits. Your psychiatrist talks you through what to expect.
In the room
You're in a calm, private room, monitored by clinical staff throughout. The experience can feel unusual for a short while- an altered sense of time or a feeling of detachment- and then settles before you leave. You'll need someone to drive you home.
Follow-up
Your psychiatrist reviews how you're responding and adjusts the plan, including whether ongoing maintenance treatments make sense for you.
AN ADDED OPTION
Ketamine-assisted therapy
Ketamine can be combined with therapy. At Confluence Psychiatry, therapy can be added to ketamine treatment. This involves preparation prior to the treatment and integration sessions after the treatment. It isn't required, and your psychiatrist will talk through whether it suits you.
Is it safe?
Safety, plainly
Both are given in-clinic precisely so you're monitored the whole time. The short-lived effects people notice most are dizziness, nausea, a temporary rise in blood pressure, and the dissociative feeling described above - all of which are watched for and settle before you go home. Because of that, you can't drive yourself and will need a ride.
It isn't right for everyone. Before anything is booked, we check carefully for things like uncontrolled high blood pressure, a history of psychosis, or an active substance misuse - and if it isn't the right treatment for you, we'll say so.
Being straight with you
Before you start
Approval
Spravato is FDA-approved for treatment-resistant depression. Ketamine is off-label: research-backed, but not approved for it.
Insurance
Doesn't cover ketamine. Spravato may be covered.
Getting home
You can't drive after a session, so arrange a ride.
It doesn't work for everyone. We'd rather say that before you start.
Keep reading
Where to go next
The honest way to find out
A short conversation settles it. On a free 10-minute call, a psychiatrist talks through what you've tried and whether ketamine or Spravato is worth pursuing for you - with no obligation to book anything.
