Spravato vs. Ketamine Infusions for Depression in Connecticut: The Difference in Plain Terms

Search for ketamine therapy in Connecticut and you will find two very different things sold under one name: IV ketamine infusions at private clinics, and Spravato (esketamine) nasal spray at certified medical offices. Both are used for depression that has not responded to antidepressants. They are not the same treatment, and the differences matter for safety, cost and insurance. New Horizon Behavioral Health in West Hartford offers Spravato. Here is why.

Approved versus off label

Ketamine itself is an FDA-approved anesthetic. Using it intravenously for depression is off-label prescribing: legal and common, but not FDA approved for that purpose and not governed by any federal safety program. Esketamine, one of the two mirror-image forms of ketamine, was approved by the FDA as Spravato for treatment-resistant depression in adults. It can be used alone or with an oral antidepressant. That approval is the root of every other difference below.

Where and how it is given

Spravato is a nasal spray you administer yourself, in a healthcare setting certified under the Spravato REMS, with a clinician present. You stay for at least two hours of monitoring after every dose, your blood pressure is checked before dosing and about 40 minutes after, and you may not drive until the next day after a restful sleep. Those rules are not optional and every certified office follows them.

IV ketamine is given through a vein over roughly 40 minutes, with monitoring practices that vary from clinic to clinic because no REMS applies.

Insurance and cost

Because Spravato has an FDA indication, insurers have a defined coverage pathway for it. Many commercial and Medicare plans cover it, nearly always with a prior authorization that documents which antidepressants you tried, at what dose, and for how long. New Horizon assembles that record and files the authorization before you are scheduled. The evaluation that decides candidacy is billed as a psychiatric visit, and each dosing session is billed separately.

IV ketamine for depression is usually paid out of pocket, because there is no approved indication to bill against.

The schedule

Spravato follows the schedule on the FDA label: twice weekly for weeks one through four, once weekly for weeks five through eight, then weekly or every two weeks from week nine on. Your prescriber sets the dose, 56 mg or 84 mg, and confirms the interval based on your response. Infusion schedules are set clinic by clinic.

Risks

Spravato carries a boxed warning for sedation, dissociation, respiratory depression, abuse and misuse, and suicidal thoughts and behaviors. Dissociation, dizziness, nausea and a rise in blood pressure are the common session-day effects. Contraindications include aneurysmal vascular disease, arteriovenous malformation, a history of intracerebral hemorrhage, and hypersensitivity to esketamine or ketamine. IV ketamine shares most of the pharmacology and the same cardiovascular cautions.

Why New Horizon chose Spravato

The approval, the monitoring requirement and the insurance pathway all line up behind esketamine. That lets a West Hartford outpatient practice offer it alongside the therapy and medication management most patients keep during treatment, in one chart.

Whether Spravato is right for you is decided at a clinical evaluation, not online. Read the full comparison on the Spravato page or request an evaluation.

New Horizon Behavioral Health
10 Princeton St, Ste N, West Hartford, CT 06110
Phone: (860) 838-8799
By appointment, Monday through Friday. In person only. Adults 18 and over.
In a crisis, call or text 988, or call 911.