How Spravato & Ketamine Works
Houston Mind & Brain offers both Spravato (esketamine) and intranasal racemic ketamine therapies as part of an integrated, physician-led program. Both treatments act on the brain’s glutamate system and help restore neuroplasticity, but they differ in formulation, regulatory status, and how they are delivered. We’ll explain how each works, how they are different, and what to expect if you’re considering one of these options.
What is Spravato?
Spravato is a prescription intranasal formulation of esketamine (the S-enantiomer of ketamine) that is FDA-approved for adults with treatment-resistant depression and for certain patients with major depressive disorder with acute suicidal thoughts/behavior. Spravato is only dispensed in certified clinics under a REMS (Risk Evaluation and Mitigation Strategy) program because of its dissociative and blood-pressure effects.
What Is Ketamine?
“Ketamine” refers to the older, well-studied molecule used as an anesthetic that, at low psychiatric doses, can rapidly reduce depressive symptoms. Houston Mind & Brain offers intranasal racemic ketamine (IV, IM and oral formulations may be used in other clinics).
Unlike Spravato (esketamine), which is FDA-approved, intranasal racemic ketamine is used off-label in psychiatric care. At Houston Mind & Brain, it is administered within a structured, medically supervised treatment program.
Regulatory Status
Spravato = FDA-approved for TRD and depressive symptoms with acute suicidal ideation or behavior.
Intranasal ketamine = Used off-label in the treatment of depression.
Formulation & Route
Spravato = Single- enantiomer (esketamine) intranasal formulation with an FDA-approved protocol.
Intranasal ketamine = Racemic formulation (a mixture of two enantiomers) used intranasally.
Delivery & Documentation
Spravato = Administered in REMS-certified clinics with required monitoring and documentation.
Intranasal Ketamine = While not subject to REMS, administered with comparable clinical monitoring and documentation protocols.
Who Might Be Helped By These Treatments?
These therapies are most often considered when standard treatments (multiple antidepressant trials and psychotherapy) have not provided adequate relief, commonly described as treatment-resistant depression. There are also options for patients needing rapid symptom reduction (including severe suicidal thoughts) or for people who prefer non-traditional approaches. Your clinician will evaluate medical history, psychiatric history, and current medications to determine the safest, most effective option.
Safety & Side Effects
Short-term effects commonly reported include:
- Dissociation or altered perception.
- Dizziness, nausea, sleepiness, or transient increases in blood pressure.
- Headache and transient, mild cognitive symptoms for some patients.
Serious risks & safeguards:
- We screen carefully for medical issues (cardiovascular disease, uncontrolled hypertension, pregnancy, substance use concerns, or psychosis) and evaluate seizure risk where relevant.
- Spravato requires REMS certification and 2-hour observation after dosing; ketamine dosing involves similar in-clinic monitoring tailored to the specific case and protocol. Patients cannot drive the same day after these treatments. Houston Mind & Brain documents informed consent and medical monitoring in every program.
What to Expect During Treatment
We review your psychiatric/medical history, current medications, and treatment goals. Safety screening and informed consent are documented.
Comprehensive Consultation
We discuss Spravato vs. ketamine options, the expected schedule (induction/optimization/maintenance for Spravato, or induction/maintenance for ketamine protocols), and whether KAP is appropriate.
Treatment planning
Spravato is self-administered in clinic with a required observation window (commonly ~2 hours). Ketamine dosing is performed with medical supervision and an observation protocol. You’ll be monitored for vitals and mental status.
In-clinic dosing & observation
For KAP, psychotherapy follows dosing. For Spravato/ketamine programs, routine follow-ups and coordination with medication/therapy/TMS are standard so gains are consolidated and safety is monitored.
Integration & Maintenance
Cost & Insurance
Spravato
Many insurers cover Spravato when clinical criteria are met; Houston Mind & Brain assists with benefits verification and prior authorization. Because of REMS and the in-clinic model, Spravato sessions include medication, observation, and clinical supervision in the billing plan.
Ketamine
Intranasal racemic ketamine is often delivered off-label, and billing can vary; clinics commonly publish self-pay estimates for medication + observation + clinician time. Houston Mind & Brain publishes cash rates for supervision and observation as a conservative proxy and provides written estimates after benefits checks.
Frequently Asked Questions
Will I be able to drive after Spravato or ketamine?
No - because dissociation and sedation can occur, patients must arrange safe transport home and may not drive the same day. Houston Mind & Brain will confirm specifics for your protocol.
How quickly will I notice improvement?
Many patients report improvement within hours to days after Spravato or ketamine dosing; sustained benefit typically requires a course of treatments and integration with therapy or other supports. Individual results vary.
Is one option better than the other?
Not universally. Spravato is an FDA-approved, labeled intranasal option with REMS oversight; racemic ketamine protocols are off-label and can be delivered via different routes. Choice depends on clinical history, urgency of symptoms, prior treatments, patient preference, and safety considerations. Houston Mind & Brain’s team will help you choose the best option.
Learn More. Feel Better.
How TMS Works
Learn how physician-led TMS targets specific brain circuits involved in depression and OCD
Compare Treatments
Learn how TMS, accelerated TMS, Spravato, ketamine, medication, and psychotherapy differ
Is TMS Right For Me
Learn whether TMS could be the right treatment for your depression or OCD - and what to expect
We Accept Insurance and Make Care Affordable
We accept most major plans for FDA-cleared treatments (including standard TMS and Spravato). We verify benefits, manage prior authorization, and provide a written estimate before treatment so there are no surprises.
Do you accept Medicaid?
No - we accept Medicare but do not accept Medicaid. If you have questions about coverage, call our team and we’ll help.
Will my insurance cover TMS?
Many commercial plans cover standard TMS when medical-necessity criteria are met. Accelerated/fast-track TMS is often self-pay. We verify benefits and submit prior authorization on your behalf.
What if I’m out of network?
This is uncommon because we are credentialed with most plans. If needed, we can provide a superbill for out-of-network reimbursement.
How do I get a written estimate?
Request a free 20-minute expert call. We’ll run a benefits check, explain likely coverage, and send a written estimate of patient responsibility before any treatment.
Can I get sliding scale pricing for TMS?
Yes. We offer sliding scale pricing for eligible patients and can provide a written cost estimate before treatment. To be considered, we’ll ask for proof of income, such as tax documents.
At this time, sliding scale pricing is not available for Medicare patients or for accelerated TMS protocols.
Integrated Care That Delivers Results
Research-informed care that integrates medication management, psychotherapy, TMS, and Spravato/ketamine into a coordinated treatment plan. Treatments are thoughtfully sequenced and monitored within a structured clinical model to support safety, consistency, and meaningful outcomes.
Why Choose Houston Mind & Brain?
MD-led, research-informed brain health - advanced treatments, personalized plans, and practical insurance support.
Insurance Help & Clear Pricing
30+ Years MD Led Psychiatry
Accelerated TMS & Fast Track Paths
Clinical Research & Outcomes Tracking
Integrated Treatment Options
Spravato, Ketamine & KAP Programs
Hear From Our Patients
100+ Five Star Reviews. Real Stories. Real Recovery.
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