Spravato vs IV Ketamine for Depression: Typical Number of Sessions

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How Many IV Ketamine or Spravato Treatments You May Need (Typical vs Higher-Need)

Here’s a direct comparison of what schedules often look like early on. The exact plan can vary by provider, response, and whether you need longer maintenance.

The headline difference is the burden of visits. IV is usually front-loaded and then tapers. Spravato stays on a structured weekly/every-other-week rhythm much longer. That affects time off work, transportation planning, scheduling load, cost, and overall treatment experience.

*Higher-need totals like 35+ often mean weekly maintenance continues for longer and/or treatment extends beyond six months.

Spravato’s FDA Schedule vs Typical Real-World Session Counts

Spravato starts on a structured schedule: 8 sessions in Month 1 (twice weekly) and 4 sessions in Month 2 (weekly). After that, maintenance is typically weekly or every other week depending on response. That’s why the FDA-labeled schedule is often summarized as 21 sessions in six months, but in real-world care a typical patient ends up closer to about 25 sessions in that same period, and higher-need cases can reach 35+.

IV Ketamine Has No Single Protocol: Typical vs Higher-Need Infusion Counts

IV ketamine has no single FDA-approved depression schedule, so providers adjust the pace based on response and whether maintenance is needed. A common pattern is front-loaded dosing (often 6–8 infusions in the first month), then a taper. For planning, many people land around ~11 total infusions in the first six months, while higher-need / harder-to-treat cases can reach ~18+ (and a smaller subset continues beyond that).

Takeaway

For planning purposes, a typical patient often lands around ~11 IV infusions (higher-need ~18+). For Spravato, the FDA schedule is often summarized as 21 sessions, but typical real-world totals are closer to ~25 (and higher-need cases can reach ~35+), because maintenance can stay weekly longer.

Why Does Spravato Require More Treatment Sessions Than IV Ketamine?

When you compare 25+ Spravato sessions to 11-18 IV ketamine sessions, you’re looking at more than just numbers—you’re seeing two fundamentally different approaches to the same goal. This gap isn’t arbitrary. It exists because of specific biological differences and regulatory realities that directly affect how these treatments work in your body and how doctors can administer them.

#1: Spravato’s Lower Absorption Means You Need More Doses to Treat Depression

IV ketamine delivers 100% of the medication directly into your bloodstream. Every molecule goes exactly where it needs to go—no detours, no waste. Like having a direct flight to your destination versus multiple connections. This is partly why my synthesis of 33 systematic reviews shows that about 30% of IV ketamine patients go into remission after just 1 or 2 infusions.

Spravato’s nasal spray only gets 25-50% of the medication where it needs to go. The rest is either swallowed (where it’s largely destroyed by your digestive system) or doesn’t penetrate the nasal tissues effectively. This dramatically lower bioavailability means you need more frequent doses to reach and maintain therapeutic levels in your brain.

Think of it this way: If you’re trying to fill a bathtub, IV ketamine is like using a firehose that pours directly into the tub. Spravato is more like using a garden sprinkler—it still works, but you need to run it longer and more often to get the same result.

#2: FDA Rules Lock Spravato Into a Fixed Schedule—Unlike IV Ketamine, Which Doctors Can Adjust

Spravato’s 21-session protocol (25+ in real-world clinical care) wasn’t designed because that’s what most patients actually need. It’s what the FDA approved based on the clinical trials Johnson & Johnson ran to get their product to market.

Spravato comes in just two fixed doses—56mg and 84mg—regardless of your body size or individual needs. A 250-pound man and a 140-pound woman might receive the exact same dose, with no ability to fine-tune based on body weight or sensitivity.

IV ketamine, however, uses weight-based dosing (typically 0.5mg per kilogram of body weight), allowing for precise customization. Your provider can even adjust the dose during your infusion if you’re experiencing side effects or not responding as expected—something impossible with pre-packaged nasal sprays.

These trials used a specific schedule: 8 sessions in month one, 4 in month two, and 9 spread across months three through six. Once approved, this became the “official” protocol—regardless of how quickly individual patients improve or how long their relief lasts between sessions.

In contrast, IV ketamine’s schedule reflects medical reality, not regulatory requirements. Since it’s used off-label, doctors can adjust the frequency based on how you actually respond:

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  If you reach substantial improvement after 6 sessions, your doctor might space out further sessions or reduce their frequency

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  If your relief lasts 3 weeks between doses, you don’t need to come in every 2 weeks just because a protocol says so

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  If you’re not responding after 8-10 sessions, your doctor can recommend stopping rather than continuing on a predetermined path

#3: IV Ketamine Doses Can Be Personalized—Which Helps You Feel Better in Fewer Sessions Than Spravato

Spravato follows a recipe—the same ingredients, same cooking time, same temperature for every dish. IV ketamine adjusts the ingredients based on how you’re doing—more salt if needed, less time in the oven if it’s cooking faster than expected.

This personalization is a key reason why IV ketamine often requires fewer total sessions. When each dose is optimized for your body weight and adjusted based on your unique response, you may reach therapeutic levels more efficiently than with standardized dosing.

This isn’t about which approach is “better”—both can be effective. But understanding why these schedules differ helps you make an informed choice about which treatment rhythm might better fit your life, your response pattern, and your recovery needs.

#4: IV Ketamine Starts Working Sooner Than Spravato

One of the most compelling advantages of IV ketamine is how quickly it works compared to nasal esketamine. Studies routinely show that almost 30% of patients achieve remission after 1 or 2 infusions. For patients with severe depression, waiting weeks for relief is not an option. IV ketamine often begins to reduce symptoms within hours or days after the first infusion.

In contrast, esketamine usually takes several treatments over multiple weeks to show meaningful improvements. The immediacy of IV ketamine’s effects makes it a life-saving option for those in crisis, particularly patients at risk of suicide.

Beyond its speed, IV ketamine also offers a more tolerable experience for many patients. In the studies included in this review, severe side effects were less common with IV ketamine than with esketamine. This means fewer people will drop out compared to patients using Spravato.

#5: IV Ketamine Has Two Active Molecules—Spravato Uses Just One

Think of IV ketamine as a full symphony: layered, balanced, and rich. Spravato is a solo act—powerful, but missing half the sound. The difference comes down to chemistry.

IV ketamine is a racemic mixture, containing both R-ketamine (arketamine) and S-ketamine (esketamine). These enantiomers interact differently with the brain. S-ketamine acts quickly by blocking NMDA receptors and increasing glutamate. R-ketamine may go further—enhancing neuroplasticity, offering longer-lasting relief, and causing fewer dissociative side effects.

Spravato contains only S-ketamine. That means it delivers fast symptom reduction, especially in suicidal patients, but may not offer the same durability or neural repair as R-ketamine.

By combining both enantiomers, IV ketamine provides rapid improvement and potentially longer-term stabilization—often with fewer total sessions. Spravato can still be life-changing. But without R-ketamine, it may need more frequent dosing to match the same depth and staying power.

Takeaway

IV ketamine offers superior bioavailability, faster onset, flexible dosing, dual-molecule benefits, and personalized scheduling compared to Spravato’s fixed protocol.

How Spravato’s Higher Session Counts Impact Your Time, Logistics & Resources

See how schedules can differ month-by-month, and what those differences mean for your calendar, rides, and time away from work or family.

Note: Onsite time varies by clinic and route. Many people plan roughly ~1 hour 40 minutes onsite for IV/injection visits and ~2 hours 15 minutes onsite for Spravato (including the required observation time), not counting travel or ride logistics.

How Spravato’s Higher Session Count Changes Your Weekly Life

The difference between a typical IV course (~11 sessions) and a typical Spravato course (~25 sessions) is not just a number. It can mean 14 more clinic days in the first six months, plus a longer stretch of weekly scheduling. Even compared to a higher-need IV course (~18 sessions), Spravato is still often more appointments to coordinate.

#1: More Rides to Plan

Both treatments typically require a ride home after each visit. With IV ketamine, many people arrange around ~11 rides (or ~18+ in higher-need cases). With Spravato, a typical first-six-month plan is closer to ~25 rides, and some people continue into longer maintenance beyond that.

If rideshare is part of your plan, the difference can be real. Example: at $25–$35 per ride, 14 additional rides is roughly $350–$490 in extra transportation costs over six months.

#2: More Total Time Onsite

Spravato requires a fixed post-dose observation period, so the visit length is less flexible. Over ~25 sessions, that adds up to a lot of hours spent onsite. IV visits can still take time, but the total number of visits is often lower and the schedule often tapers sooner.

#3: More Ongoing Disruption to Your Work and Family Week

Spravato’s maintenance rhythm (weekly or every other week) can stay “on the calendar” longer, even after the initial ramp-up. IV ketamine is often more front-loaded, with fewer visits later if you respond well. That can mean fewer recurring interruptions in Months 3–6 for some IV patients, while Spravato may continue at a steady pace.

#4: More Scheduling Headaches

More appointments means more opportunities for scheduling conflicts. If your clinic has limited slots, or your job has unpredictable hours, a ~25-visit plan can be harder to keep on track than a typical IV course.

Takeaway

Compared with a typical IV course (~11 visits), a typical Spravato course (~25 visits) usually means more clinic days, more rides, and more ongoing calendar disruption. The gap can shrink in higher-need IV cases (~18+), but Spravato is still often the heavier scheduling load.

What You’ll Spend More Of With Spravato: Time, Rides, and Days Off Work

This side-by-side comparison shows what the session count difference can mean in real life.

How Does Scheduling ~25 Spravato Sessions vs. ~11 IV Ketamine Treatments Impact Your Work and Family Life?

Looking at the numbers above, here’s what these differences can mean if you are balancing treatment with work, family, and other responsibilities.

Why Does Spravato Add So Much More Onsite Time Compared to IV?

The biggest difference is the combination of more visits plus a longer, fixed observation window. A typical Spravato plan (~25 visits) often adds up to roughly ~56 onsite hours, compared with roughly ~18 onsite hours for a typical IV plan (~11 visits). That is time pulled from work, family, and basic recovery routines.

How Many Sick Days (or Half-Days) Might You Need?

With ~25 schedule disruptions versus ~11, the practical impact can look like:

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  More conversations with employers about medical leave or flexible scheduling

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  More catching up on missed work

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  Harder scheduling around important meetings or deadlines

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  More total days where the treatment appointment becomes the main event of the day

For people with limited time-off benefits, the additional visits can mean using sick days you may need later in the year.

Can You Find Transportation for That Many Visits?

Neither treatment typically allows same-day driving, so every session usually requires transportation. With ~25 rides versus ~11 rides:

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  You will need to ask friends or family for rides more often

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  If using rideshare, transportation costs can rise fast

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  More coordination and advance planning for each appointment

For people without a strong support network, transportation can become the hidden constraint that determines what treatment is actually doable.

What About Childcare?

If childcare is part of the equation, the difference in total onsite hours can be the difference between “manageable” and “barely possible.” A typical Spravato plan can mean dozens of additional hours of coverage compared with a typical IV course.

Does a Heavier Appointment Calendar Increase Missed Sessions?

More appointments means more chances for life to collide with the schedule. If you are already stretched thin, a ~25-visit plan simply creates more points of failure than an ~11-visit plan.

Takeaway

Typical planning is ~11 IV sessions versus ~25 Spravato sessions in the first six months. That difference can cascade into more rides, more time onsite, more days impacted, and more scheduling stress.