Rethinking IV Ketamine and Spravato

A patient once sat across from me and said, “I can’t do this anymore.”

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She had already tried ten medications — ten rounds of hope, side effects, and waiting — and still woke up under the same heavy cloud. She wasn’t asking for a miracle, just something that could help this week, not maybe months from now.

That’s often when IV ketamine can feel like a lifeline. It can feel like someone cracked open a window in a room that’s been shut for years.

When you see that kind of shift, you start to wonder how many more people could feel this kind of relief if they had a clear way to begin. Earlier this year, one more door opened: the FDA approved Spravato (nasal esketamine) as a monotherapy for treatment-resistant depression. For patients who couldn’t tolerate an oral antidepressant — or simply didn’t want to add one — this was a breakthrough that turned “maybe someday” into “I can start now.”

It’s Not Just Medical — It’s Personal

Choosing between IV ketamine and Spravato isn’t just a medical decision — it’s an emotional one. It happens while juggling work, family, finances, needle fears, and the very real question: “Do I even have the energy to begin right now?”

The best plan is the one you can actually begin and sustain. Perfection is the enemy of progress — and untreated depression is what does the most harm.

IV Ketamine: The Customizable Path

Best when speed and flexibility matter most.

• Rapid effect: IV ketamine goes directly into the bloodstream, reaching the brain quickly so relief can come fast.
• Real-time adjustment: The infusion can be paused or titrated up or down on the spot, which means side effects can be managed right away — making treatment both safer and more comfortable.
• Customized protocol: Because IV ketamine isn’t FDA-approved for depression, we aren’t locked into a single rigid schedule. We can tailor dose and frequency to your needs and progress, which can feel empowering for patients who’ve felt powerless with past treatments.
• Flexible scheduling: insurance-free scheduling allows us to move forward without waiting on insurance authorizations.
• PTSD, anxiety, and chronic pain: Insurance barriers do not limit IV ketamine for patients struggling with these other conditions.

Context: IV ketamine for depression is considered off-label. We always screen carefully and monitor closely during and after treatment.

Spravato: The Covered, Needle-Free Path

Best when predictability, coverage, and structure help you take the first step.

• Insurance support: FDA approval for Treatment Resistant Depression (TRD) means most major insurers have coverage pathways.
• Needle-free: Intranasal dosing is ideal for patients with needle anxiety or difficult IV access.
• Built-in guardrails: The FDA has approved a dosing schedule and requires at least two hours of monitoring after each dose.

The Real Win: Getting Unstuck

There’s no single “right” choice — only the one you can start and keep going with. Many patients move between the two: some begin with Spravato to make starting possible, then switch to IV for more flexibility; others start with IV for a fast lift, then stay on Spravato because insurance makes it sustainable. The goal isn’t to pick the “better” option — it’s to get unstuck and moving forward.

Hope Starts with Motion

Depression already steals enough time. The perfect moment doesn’t exist — but a good-enough one might. Taking that first step, even if it’s not perfect, is what begins to give you your life back. Schedule a consultation with Clarus Health to learn if you qualify for ketamine therapy.