Depression treatment has changed more in the past decade than in the preceding several. For much of the twentieth century, antidepressants worked through a single broad mechanism, targeting the monoamine neurotransmitter systems, and patients who did not respond to one drug in this class would typically be offered another. The options were varied in name but similar in mechanism, and for the roughly one third of patients who do not achieve adequate relief from conventional antidepressants, the situation was often one of diminishing returns.
That has begun to change with the development of ketamine-based treatments. Ketamine-assisted therapy and Spravato represent two distinct but related approaches that work through a completely different mechanism from conventional antidepressants, produce effects that are measurably faster, and have shown meaningful benefit for patients who have not responded to prior treatment. This guide explains both options clearly, including what they involve, how they differ, and who they are most likely to help.
For patients in the New York area, Village TMS ketamine therapy offers ketamine-based treatments alongside TMS within a psychiatrically supervised outpatient setting.
What Ketamine-Assisted Therapy Is
Ketamine-assisted therapy, sometimes abbreviated KAT, refers to a treatment model that combines the pharmacological effects of ketamine with concurrent or subsequent psychotherapy. The underlying premise is that ketamine’s effects on the brain, particularly its promotion of neuroplasticity and the strengthening of synaptic connections in regions involved in mood regulation, create an enhanced window for psychological processing and therapeutic work.
In practice, ketamine-assisted therapy involves a psychiatrically supervised ketamine administration session, followed by one or more psychotherapy sessions designed to help the patient process material that arose during the ketamine experience and integrate any insights or shifts in perspective into their broader therapeutic work. The therapist may be present during the administration session, working with the patient as they move through the ketamine experience, or the psychotherapy may occur in a separate session following the infusion.
The research base for ketamine-assisted therapy is less mature than the research on ketamine infusion alone, but early results are promising, particularly for conditions like PTSD and treatment-resistant depression where both the biological and psychological dimensions of suffering benefit from simultaneous attention. Many clinicians who use this model report that the combination produces more durable effects than ketamine alone for patients who engage meaningfully with the psychotherapy component.
What Spravato Is and How It Differs
Spravato is the brand name for intranasal esketamine, developed by Janssen Pharmaceuticals and approved by the FDA in 2019 for treatment-resistant depression and major depressive disorder with acute suicidal ideation. Esketamine is the S-enantiomer of ketamine, meaning it is a more refined version that isolates the pharmacologically active component responsible for ketamine’s antidepressant effects.
Unlike ketamine infusions, which use an off-label formulation developed for anaesthetic use, Spravato is specifically approved for psychiatric indications. It is administered as a nasal spray in a certified healthcare setting, under the supervision of a healthcare provider, and patients are monitored for at least two hours after each dose due to the risk of sedation and dissociation. Patients cannot drive themselves home after a Spravato session.
As the FDA has clarified, Spravato’s benefit and risk profile has been specifically established through clinical trials, in contrast to compounded ketamine nasal spray preparations which have not undergone the same regulatory evaluation. This distinction is relevant for patients choosing between certified Spravato treatment and less regulated ketamine compounding services.
The Spravato dosing schedule involves twice-weekly sessions for the first month, followed by weekly sessions in the second month, and then either weekly or every-two-weeks maintenance dosing depending on the patient’s response. Most patients who respond to Spravato experience initial symptom improvement within the first four weeks of treatment.
Who Is Most Likely to Benefit
Both ketamine-assisted therapy and Spravato are primarily indicated for patients with treatment-resistant depression, defined as inadequate response to at least two antidepressant medications of adequate dose and duration. Both treatments may also be considered for patients with major depressive disorder and acute suicidal ideation, where the rapid onset of effect is clinically significant.
Spravato is particularly well suited to patients who prefer the structure and regulatory oversight of an FDA-approved treatment, who have concerns about the less regulated landscape of ketamine infusion services, or whose insurance plan covers Spravato but not ketamine infusions. Most major commercial insurers and Medicare cover Spravato for qualifying patients, making it more financially accessible for many people than ketamine infusions, which are more frequently paid out of pocket.
Ketamine-assisted therapy tends to be most beneficial for patients who are already engaged in psychotherapy, who have the capacity and willingness to engage with psychological processing alongside the pharmacological treatment, and for whom the integration of new insights into their therapeutic work is a meaningful goal. It is not simply a medicated therapy session but a specific treatment model that works best when the patient is a willing and active participant in both components.
The Practical Reality of Treatment
Both treatments require a commitment of time and attendance that patients should understand before beginning. Spravato’s initial phase involves twice-weekly clinic visits, each of which requires monitoring time on top of the administration itself. Ketamine infusion courses typically involve six infusions over two to three weeks, each lasting approximately 40 minutes plus monitoring time. Ketamine-assisted therapy adds psychotherapy sessions on top of this schedule.
Both treatments also require that patients be accompanied home after each session. Planning the logistics of this in advance, and communicating clearly with your support network about what the treatment schedule involves, is an important practical step before beginning either treatment.
Side effects are broadly similar between the two treatments. Dissociation, dizziness, nausea, and elevated blood pressure during administration are the most common. These effects are transient and resolve within the monitoring period for most patients, but they can be disconcerting for those who have not been prepared for them. A reputable clinic will provide thorough preparation and will have staff available to support patients who find the experience difficult.
Finding Spravato Near You
Spravato must be dispensed and administered in a healthcare setting that is certified in the Spravato REMS programme. This means it is available only at practices that have undergone specific certification, and you cannot obtain it from a standard pharmacy for home use.
When searching for Spravato near me, look for certified practices with psychiatric oversight, experience with the Spravato dosing and monitoring protocol, and the ability to coordinate your Spravato treatment with your broader mental health care. A practice that offers Spravato as part of a comprehensive psychiatric service, rather than as a standalone treatment disconnected from your other care, is better positioned to maximise the benefit of the treatment.
Final Thoughts
Ketamine-assisted therapy and Spravato represent a genuine advance in the treatment of depression, particularly for patients who have not found relief through conventional approaches. They are not interchangeable with each other, and neither is appropriate for everyone. But for the right patient, with the right clinical support, both treatments offer the possibility of relief that has been elusive through other means.
A thorough evaluation with a psychiatrist experienced in ketamine-based treatments is the essential first step in determining whether either option is right for you.
Disclaimer: This article is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing any treatment for mental health conditions.
