Spravato vs IV Ketamine for Depression: Typical Number of Sessions and Timeline

By Michael Alvear, Health Author & Independent Researcher

My research is published on these scholarly platforms:

Last Updated: November 13, 2025

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How Many IV Ketamine or Spravato Treatments You’ll Need in the First 6 Months

Here’s a direct comparison of what to expect in the first six months—the timeframe when most patients either reach remission, achieve substantial symptom relief they find satisfactory, or discontinue treatment due to lack of response.

Most patients receive 11-18 IV ketamine sessions over six months, while Spravato’s FDA-approved protocol involves 21 sessions during the same period. This isn’t just a number—it’s a significant difference in time commitment, work disruption, transportation needs, scheduling burden, cost, and overall treatment experience.

Spravato’s Structured 21-Session Treatment Schedule

The Spravato protocol follows a structured schedule: 8 sessions in month one (twice weekly), 4 sessions in month two (weekly), and 9 sessions in months three through six (every other week). Though this is the standard FDA-approved approach, your doctor may adjust this based on your response.

IV Ketamine’s Flexible 11-18 Session Approach

IV ketamine follows a more flexible pattern: typically 6-8 sessions in the first month, about 4 sessions in month two, then 4-6 sessions spread across months three through six. This schedule can be tailored based on your individual response, often resulting in fewer total sessions for many patients.

Takeaway

Most patients need 11-18 IV ketamine sessions or 21 Spravato treatments over six months, with both methods frontloaded in the first month and tapering down if you respond well.

Why Does Spravato Require More Treatment Sessions Than IV Ketamine?

When you compare 21 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 rigid 21-session protocol 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.

Adding to this inflexibility, 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 More Sessions Impact Your Time, Logistics & Resources

See exactly how ketamine treatment schedules compare over six months, and what these differences mean for your life, schedule, and recovery.

Note: IV ketamine sessions typically last 1-1.5 hours total (including preparation and recovery), while Spravato requires a mandatory 2-hour observation period after administration regardless of how quickly you feel ready to leave.

How Spravato’s Increased Number of Treatments Affect Your Weekly Schedule and Recovery Journey

The difference between 11-18 IV ketamine sessions and 21 Spravato sessions isn’t just about numbers—it’s about the practical reality of fitting treatment into your life while managing depression. You may need up to 10 more treatments with Spravato compared to IV ketamine. That means:

#1: More Rides to Plan—and More Time Asking for Favors or Paying for Trips

Both treatments require someone to drive you home afterward. With IV ketamine’s schedule, you’ll need to arrange 11-18 rides over six months. Spravato requires coordinating 21 separate trips.

This difference means either asking the same person to commit to more days (potentially straining relationships) or paying for more ride services. In urban areas where rideshare costs average $25-35 per trip, this could add $75-$105 to your total Spravato treatment cost compared to IV ketamine’s lower end.

#2: Spending Twice as Much Time in the Clinic as IV Ketamine

Spravato’s FDA-approved protocol requires a full 2-hour observation period after each dose—even if you feel completely fine after 30 minutes. This is non-negotiable at certified Spravato providers.

IV ketamine’s monitoring period is typically shorter and more flexible, often 20-30 minutes after the infusion ends. This means each Spravato session claims roughly half a workday, while IV sessions might allow you to return to some activities sooner.

#3 More Disruption To Your Family and Work Week

The regularity of Spravato’s biweekly schedule in months 3-6 creates predictability—you’ll know exactly when you need to be at the clinic. This consistency can make planning easier but requires ongoing time commitments regardless of your improvement.

IV ketamine’s decreasing frequency means potentially fewer disruptions to your work schedule in later months, but the schedule may change based on your response, requiring more flexibility.

#4: More Scheduling Headaches—Especially If Your Clinic Has Limited Availability

More total appointments means more potential scheduling conflicts. Spravato’s 21-session requirement can be particularly challenging if your local clinic has limited availability or if you have a job with unpredictable hours.

Some patients report that the additional appointments required for Spravato meant having to schedule further in advance or compromise on preferred appointment times—a factor worth considering if you have limited scheduling flexibility.

Takeaway

Spravato’s rigid 21-session protocol with 2-hour monitoring periods creates twice the time commitment, transportation needs, and work disruptions compared to IV ketamine’s 11-18 flexible sessions.

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

This side-by-side comparison reveals what the session count difference actually means for your life, schedule, and recovery journey.

How Does Scheduling 21 Spravato Sessions vs. 11 IV Ketamine Treatments Impact Your Work and Family Life?

Looking at the numbers above, you might wonder what these differences really mean for someone balancing treatment with work, family, and other responsibilities. Let’s break down the practical impact these stark contrasts could have on your recovery journey.

Why Does Spravato Require Triple the Clinic Hours Compared to IV Ketamine Treatment?

The most dramatic difference is in total time commitment—Spravato requires 42 hours in a clinic versus 14 hours for IV ketamine. That’s an extra 28 hours—almost two full waking days of your life spent in treatment over six months. If you’re working full-time, this means either using more personal days or arranging for more half-days off. For someone juggling multiple responsibilities, those extra hours represent time away from family, work projects, or personal activities.

How Many Sick Days Will You Need for Ketamine Therapy Throughout a Complete Treatment Course?

With 21 total work disruptions versus 11, Spravato requires nearly twice as many schedule adjustments. This could mean:

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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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  Potential career impact if frequent absences become noticeable

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  Harder to schedule around important meetings or deadlines

For professionals with limited time-off benefits, the 10 additional days could mean using sick days you might need later in the year.

Can You Find Transportation for Twice as Many Ketamine Treatment Sessions Over Six Months?

Neither treatment allows you to drive yourself home, so each session requires transportation assistance. With Spravato’s 21 rides versus IV ketamine’s 11:

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  You’ll need to ask friends or family for rides twice as often

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  If using rideshare services, you’ll spend an additional $300 on transportation alone

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  More coordination and advance planning for each trip

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  Potential transportation fatigue if regularly relying on the same people

For those without a strong support network, this increased transportation demand can become a significant obstacle to consistent treatment.

How Much Does Childcare for Ketamine Treatment Sessions Cost When Comparing Spravato vs. IV Options?

Parents face perhaps the most significant logistical challenge. Spravato requires 52 hours of childcare coverage compared to IV ketamine’s 21 hours—a 148% increase. This means:

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  Finding reliable childcare for more than double the time

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  Potentially higher childcare costs (an extra 31 hours of care)

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  More disruption to children’s routines

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  Added coordination with caregivers, schools, or after-school programs

For single parents or those with limited childcare options, these extra hours can create substantial stress and financial strain.

Will More Frequent Ketamine Appointments Increase Your Risk of Missing Treatment Sessions?

More required sessions means more opportunities for life to interfere with your treatment schedule. With 21 appointments versus 11:

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  Higher likelihood of scheduling conflicts with work, travel, or family events

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  More rescheduling and coordination with the clinic

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  Potential treatment interruptions if multiple sessions need postponement

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  Greater mental energy spent managing a more demanding treatment calendar

Consistency matters for ketamine therapy effectiveness, so these scheduling challenges could potentially impact your treatment outcomes.

Takeaway

Spravato’s 10 additional sessions create a cascading impact: 91% more work disruptions, doubled clinic time, increased transportation needs, and 148% more childcare demands compared to IV ketamine’s minimum protocol.

FAQs On How Many Ketamine Sessions You’ll Need

Compare the number of treatments, schedules, and time commitments for IV ketamine infusions versus Spravato nasal spray

Can Ketamine End Your Depression?

See definitive rates for IV ketamine, injection, Spravato (esketamine), and oral/sublingual. Based on my summary of 33 systematic reviews and meta-analyses, published in scholarly libraries like Zenodo and Google Scholar.

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How Much Will Spravato Really Cost You?

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Based on your deductible, copay, coinsurance, and out-of-pocket max for accurate results

These evidence summaries highlight key points about Spravato (esketamine nasal spray) and IV ketamine treatment schedules, dosing, response rates, and safety, with direct links to the clinical trials, drug labels, and practice policies used to write this page.