Choosing the Best Ketamine Treatment for Your Needs
Ketamine therapy can be life-changing, but figuring out the best way to take it? That’s where things get tricky. IV infusions, injections, or the esketamine nasal spray—each comes with its own benefits, downsides, and logistical hurdles. And if you’re already struggling, sorting through all the fine print can feel like just one more obstacle between you and relief.
That’s why I put together a straightforward, no-nonsense table that lays it all out for you. These aren’t my recommendations; they’re a framework to help you weigh competing priorities and make the best decision for your situation.
Whether your top priority is maximum effectiveness, avoiding needles, or keeping costs down, this table lays it all out clearly. It isn’t a debate about what’s good or bad—it’s about figuring out what’s good, better, or best for you.
The Ketamine Delivery Method Decision Table
Compare Options, Weigh Benefits, and Make an Informed Choice
| If Your Top Priority Is... | Best Choice | Second Best | Not Recommended | Why This Option Works |
|---|---|---|---|---|
| Maximum Effectiveness | IV Ketamine | IM Injection | Spravato | IV ketamine is the most effective, delivers faster and more consistent relief with fewer side effects, allows for tailored dosing, and has a far lower dropout rate among patients. |
| Lowest Cost (Self-Pay) | IM Injection | IV Ketamine | Spravato | IM injections require minimal equipment (a syringe and needle), take only a few minutes to administer, don’t require highly specialized professionals, and don’t need continuous monitoring like IV infusions. |
| Lowest Cost (With Insurance) | IM Injection | IV Ketamine | Spravato | Although injections aren’t covered by insurance, they still cost less than the out-of-pocket costs you’ll pay for Spravato if your insurance covers it. |
| Lowest Cost (With Insurance + Manufacturer Subsidy) | Spravato | None | N/A | Spravado offers a manufacturer subsidy of up to $8,150. You must have insurance that covers Spravato to qualify. |
| Avoiding Needles | Spravato | None | N/A | Spravato is a non-invasive and self-administered nasal spray, making it ideal for needle-averse patients. |
| Fastest Relief | IV Ketamine | IM Injection | Spravato | IV provides the fastest symptom relief, often noticeable during or immediately after the session. |
| Minimal Time Commitment | IM Injection | IV Ketamine | Spravato | IM injections are quick and straightforward, requiring less time than IV or Spravato. |
If you want a deeper understanding, keep reading—I’ve broken down each method in detail so you can make the most informed choice possible.
KETAMINE IV INFUSIONS
How IV Ketamine Infusion Therapy Works
Ketamine is delivered directly into your bloodstream via an IV line, allowing for precise dosing and controlled delivery over a set period of time (usually 40 minutes to an hour). This method ensures rapid absorption and consistent blood levels of the medication throughout the infusion.
Pros:
1. Proven To Be The Most Effective Method
IV infusion is the most researched and widely studied method for ketamine treatment, with systematic reviews and meta-analyses showing it’s three to five times more effective than the esketamine nasal spray, Spravato.
2. Fewer Treatments Needed Than Spravato
Because IV infusion is so much more effective, you don’t need as many treatments to reach remission or substantially improve your symptoms.
3. High Bioavailability
Because the ketamine goes straight into your bloodstream, almost 100% of the dose is available for use by your body. This ensures the most potent and predictable effects.
4. You’re More Likely to Finish IV Ketamine Infusions
You’re less likely to quit IV ketamine because it works faster and feels more effective. The rapid relief and noticeable improvements make it easier for people to stick with treatment compared to the slower and less predictable results of the Spravato nasal spray.
5. Fewer and Milder Side Effects
IV ketamine has fewer and less intense side effects than the nasal spray. That said, side effects for all administration methods are generally mild and temporary.
6. Customizable Dosing in Real Time
A clinician can adjust the dosage during the session to tailor the treatment to your needs. For example, if side effects occur or your response suggests you need more or less, the infusion can be modified immediately.
7. Rapid Onset of Effects
The effects of IV ketamine are usually noticeable during or immediately after the session, making it ideal for those seeking quick relief.
8. Standardized Protocols
Most IV ketamine clinics follow strict protocols based on research, ensuring consistent and predictable results.
9. Lower Cost Than Spravato
Even with insurance, Spravato’s out-of-pocket costs are higher than IV infusions. I know, right?
How I Feel About IV Ketamine
If you haven’t noticed by now—on this page, heck, across the entire site—I sing the praises of IV ketamine like I’m auditioning to be its official spokesperson.
Here’s the thing: I’ve never had an IV infusion. Not once. Never sat in the chair, never had the needle in my arm, never watched the drip do its magic. And yet, if you read what I’ve written, you’d think I’m the unofficial spokesperson for IV ketamine. The irony? I’m totally okay with it—because once you look at the research, it’s almost impossible to argue with the facts.
If it were just a couple of studies, I’d shrug it off. Maybe even chalk it up to a fluke. But it’s not just a handful of data points or someone saying, “Trust me, it’s great.” No, the evidence is stacked higher than a library ladder. We’re talking systematic reviews and meta-analyses—the gold standard for determining what actually works. These aren’t your run-of-the-mill studies; they’re the research equivalent of calling in the Avengers. They combine data from multiple studies, account for biases, and serve up the big picture: IV infusions are three times more effective than Spravato. Not “a little better,” not “arguably superior”—three times. That’s not a small edge; that’s a game-changer.
And it’s not just effectiveness. The precision, the near-perfect bioavailability (almost 100% of the dose hits where it needs to), and the rapid relief—all of it feels like the therapy equivalent of a mic drop. Sure, there are needles involved (which I’m not a fan of), but honestly, when the results are this good, you kind of stop caring about that part.
So yeah, maybe I’m a bit biased toward IV ketamine. And yes, I’ve never tried it myself. But if I sound like I’m banging the drum for it, it’s because the science made me do it. When the research is this compelling, it doesn’t just speak—it practically shouts.
So, if therapy with ketamine IV is so much better, why didn’t I do it? First, because I didn’t know what the advantages were. That’s a big reason why I created this website—to share the kind of information I wish someone had told me. Back then, I didn’t have a clue about the effectiveness of IV ketamine, its near-perfect bioavailability, or how quickly it could work. I wasn’t even asking the right questions because I didn’t know what I didn’t know.
But the second—and far more important—reason is simple: I was broke. Flat-out broke. The kind of broke where “out-of-pocket” meant “out of the question.”
Insurance doesn’t cover IV infusion, and every session would have come straight out of my wallet—a wallet that, at the time, was as empty as my energy for fighting depression. My insurance plus Spravato’s generous subsidy program, was my only realistic option.
Cons of IV Ketamine:
1. Invasive Procedure
Requires the placement of an IV line, which can be uncomfortable for people with needle phobias or hard-to-access veins. This can also increase anxiety for some patients.
2. More Expensive Than Injections
That’s due to the need for specialized equipment and trained staff (including a clinician or anesthesiologist).
3. Commercial Insurance Won’t Cover It
You’ll have to pay 100% of the costs.
4. Medicare & Medicaid Won’t Cover It
You’ll have to pay 100% of the costs.
5. Much More Expensive Than Spravato If You Qualify for the Manufacturer’s Subsidy
Spravato’s manufacturer subsidy of up to $8,150 eliminates most out-of-pocket costs, making IV infusions significantly more expensive.
Intramuscular (IM) Injections
How It Works
Ketamine is injected into a large muscle, such as the upper arm, thigh, or buttocks.
Pros:
1. High Bioavailability
Slightly less than IV but still far more effective than oral or nasal options.
2. Quick and Simple
The injection process is quick and simple—it doesn’t involve setting up an IV line or the delays of the nasal spray, which requires three separate doses with a 5-minute wait between each.
3. Costs Less Than IV
Generally less expensive than IV infusion because it doesn’t require as much equipment.
4. Fewer and Milder Side Effects
Ketamine injections have fewer and less intense side effects than the nasal spray. Again, side effects for all administration methods are generally mild and temporary.
5. Fewer Equipment Requirements
IM injections only require a syringe, needle, and the ketamine solution. Unlike IV infusions, they do not need IV lines, infusion pumps, or other specialized equipment.
6. No Continuous Monitoring Needed
IV infusions require real-time monitoring of vitals (e.g., heart rate, oxygen levels, blood pressure) during the infusion process to adjust dosing and manage potential side effects. IM injections, being a single shot, do not require this level of monitoring.
Cons:
1. Limited Dosing Control
Once injected, the dose cannot be adjusted mid-treatment.
2. Invasive
While quicker than an IV, it’s still not ideal for those uncomfortable with needles.
3. Mild Discomfort
Injections into muscles can cause soreness at the site, particularly with repeated use.
4. Commercial Insurance Won’t Cover It
You’ll have to pay 100% of the costs.
5. Medicare & Medicaid Won’t Cover It
You’ll have to pay 100% of the costs.
6. More Expensive Than Spravato *If* You Qualify for the Manufacturer’s Subsidy
Again, Spravato’s manufacturer subsidy of up to $8,150 eliminates most out-of-pocket costs, making injections more expensive.
Esketamine Nasal Spray (Spravato)
How It Works
A clinically supervised, self-administered nasal spray containing esketamine (a form of ketamine). The process requires three separate doses, with a 5-minute wait between each, all under medical supervision. Find out how esketamine is different than ketamine.
Pros:
1. Non-Invasive
No needles or IV lines are required, making it a great option for needle-averse patients.
2. FDA-Approved
Backed by rigorous research, ensuring safety and effectiveness.
3. Ease of Use
Straightforward process with minimal discomfort.
4. Partially Covered By Most Commercial Health Insurers
Average insurance coverage for Spravato is about 50-60%, leaving you with over $8,000 in out-of-pocket costs unless you qualify for the manufacturer’s $8,150 subsidy. Without both insurance coverage and the subsidy, Spravato is absolutely the most expensive ketamine administration method of all.
5. Covered By Medicare
Medicare Part B covers the esketamine nasal spray cost as it is a physician-administered treatment requiring medical supervision. Out-of-pocket costs depends on your plan. Note: Many clinics won’t take Medicare. Check out my guide on how to get Spravato approved by Medicare.
6. Covered By Medicaid (Depending on the State)
Medicaid generally covers Spravato, but coverage varies significantly by state – some states fully cover it while others don’t cover it at all. Note: Many clinics won’t take Medicaid. Check out my guide on how to get Spravato approved by Medicaid.
Cons:
1. The Least Effective Method of Therapy With Ketamine
Spravato may be less effective than IV or injections, but make no mistake—it’s still a powerful treatment that delivers significant relief.
2. Lower Bioavailability
Only about 40-50% of the medication is absorbed through the nasal tissues, making it less efficient than IV or injection.
3. Limited Medication Form
Only esketamine is available in this method, not full-spectrum (racemic) ketamine, which is more effective.
4. Potential for Irritation
Some users report nasal discomfort or irritation after use.
5. You’re More Likely to Quit the Spravato Nasal Spray
That’s because it works slower and feels less effective compared to IV ketamine. The delayed relief and less noticeable improvements can make it harder for some people to stay committed. HOWEVER. It’s important to note that Spravato is a VERY effective treatment with clinical trials showing significant benefits for those who stick with it.
6. Fewer Clinics Near You
Spravato is subject to a Risk Evaluation and Mitigation Strategies (REMS) program established by the FDA to ensure that the benefits of certain medications outweigh their risks. This means having safety protocols in place, such as certified treatment centers and requiring patients to be monitored for at least two hours after receiving the first spray of Spravato (there are three in total).
This means you shouldn’t assume that every ketamine clinic offers Spravato (though many do). Click here to find the nearest certified Spravato clinic to you.
Spravato Put Me Into Full Remission
For all the praise I’ve heaped on IV ketamine, let me be absolutely clear: the esketamine nasal spray Spravato deserves its place in the spotlight. Yes, IV is more effective—there’s no denying that. The data speaks for itself. But that doesn’t mean the nasal spray isn’t a powerful option. Far from it. I used the spray, and within six weeks, I hit full remission. Full. Remission. Not partial relief, not “feeling a little better”—remission.
Here’s the thing: two truths can exist at the same time. IV ketamine is the gold standard, but the nasal spray isn’t some second-rate option. In fact, it’s leaps and bounds ahead of any traditional antidepressant on the market. It’s not a matter of good versus bad—it’s good, better, best. And the nasal spray firmly sits in the “better” category.
I don’t want my bias for IV to scare anyone off the nasal spray, especially because, for many people, it’s the most realistic option. Without the manufacturer’s subsidy program, I couldn’t have afforded any ketamine treatment, let alone IV. That subsidy gave me access to a life-changing therapy, and for that, I’ll always be grateful.
So, if the esketamine nasal spray is the only thing you can afford, don’t second-guess it. It worked for me, and it can work for you.
ORAL KETAMINE
I don’t provide information on oral forms of ketamine–tablets, capsules, sublingual troches, lozenges, or liquid solutions because they’re less safe, less effective, and far less researched than IV infusions, injections or Spravato.