Spravato vs Oral Ketamine: A Guide on the Differences
- Pine Ridge Mental Healthcare
- 5 hours ago
- 4 min read
February 27, 2026
If you’ve been researching treatment options for depression, you’ve likely come across both Spravato and oral ketamine. Patients frequently ask:
Is Spravato the same as ketamine?
Which one works better?
Is nasal spray stronger than oral ketamine?
This guide breaks down the difference between ketamine and esketamine, how each works, and how to determine which option may be right for you. You can learn more about how ketamine works for depression in our detailed guide here.
What Is Spravato?
Spravato is the brand name for esketamine, a medication approved by the FDA for treatment-resistant depression and major depressive disorder with suicidal thoughts or behaviors.
Esketamine is derived from ketamine. Ketamine has two mirror-image molecules (R and S). Spravato contains only the S-enantiomer (esketamine), which is believed to be the more active component for mood improvement.
Key Facts About Spravato:
FDA-approved for treatment-resistant depression
Administered as a nasal spray
Must be given in a certified medical clinic
Requires 2-hour monitoring after each treatment
Used alongside an oral antidepressant
Because of safety and monitoring requirements, Spravato is only available through a REMS (Risk Evaluation and Mitigation Strategy) program.
What Is Oral Ketamine?
Ketamine has been used safely in medicine for decades as an anesthetic. In mental health, it is used off-label to treat depression, PTSD, anxiety, and other mood disorders.
Oral ketamine (often prescribed as a troche or lozenge) contains racemic ketamine, meaning it includes both the R and S molecules.
Key Facts About Oral Ketamine:
Used off-label for depression and other mood disorders
Taken orally (often sublingual/dissolvable)
May be administered in clinic or prescribed in structured programs
Contains both R- and S-ketamine
Often more flexible dosing options
Spravato vs Oral Ketamine: Side-by-Side Comparison
Feature | Spravato (Esketamine) | Oral Ketamine |
FDA Approval | Yes (for specific depression diagnoses) | No (off-label use) |
Form | Nasal spray | Oral lozenge/troche |
Active Compound | S-ketamine only | R- and S-ketamine |
Monitoring | Mandatory in-clinic monitoring | Depends on program |
Insurance Coverage | Often covered | Sometimes cash-based |
Flexibility | Structured protocol | More customizable |
What Is the Difference Between Ketamine and Esketamine?
Ketamine is made of two molecular forms:
R-ketamine
S-ketamine (esketamine)
Spravato contains only the S-molecule. Oral ketamine includes both.
Some emerging research suggests R-ketamine may contribute to longer-lasting antidepressant effects, but this area is still being studied. Clinically, both treatments can be effective — the right choice often depends on:
Diagnosis
Severity of symptoms
Insurance coverage
Medical history
Patient preference
Oral Ketamine Treatment vs Esketamine Nasal Spray: Which Works Better?
There is no universal “better.” Instead, the question becomes: Which is better for you?
Spravato may be preferred if:
You want an FDA-approved ketamine therapy option
Insurance coverage is important
You prefer structured in-clinic treatment
Oral ketamine may be preferred if:
You want broader diagnostic flexibility
You need customized dosing
You do not meet strict Spravato criteria
Both treatments work on the glutamate system in the brain, helping promote neuroplasticity — essentially helping the brain form healthier pathways more quickly than traditional antidepressants. If you’re considering ketamine therapy in Oklahoma, a comprehensive evaluation can help determine whether Spravato or oral ketamine is best for you.
Safety Considerations
Both Spravato and oral ketamine can cause:
Dissociation
Temporary blood pressure elevation
Nausea
Drowsiness
This is why proper medical screening and supervision are critical.
At Pine Ridge Mental Healthcare, careful assessment is performed before recommending either treatment to ensure safety and effectiveness.
How Do You Choose?
The decision between Spravato vs ketamine should be collaborative and individualized.
Important factors include:
Previous antidepressant history
Presence of suicidal thoughts
Medical conditions
Accessibility to clinic visits
Financial considerations
The most important question is not which medication is “stronger,” but which approach supports your long-term mental health goals.
Frequently Asked Questions (FAQ)
Is Spravato stronger than oral ketamine?
Not necessarily. They contain different molecular compositions. Effectiveness varies by individual.
Is esketamine the same as ketamine?
No. Esketamine is one part (the S-molecule) of ketamine.
Why is Spravato only given in a clinic?
Because of federal REMS requirements.
Does oral ketamine work as fast as Spravato?
Both can produce rapid antidepressant effects, often within hours to days.
Is one safer than the other?
Both are safe when administered under proper medical supervision.
Final Thoughts
When comparing Spravato vs oral ketamine, the goal is not choosing a brand — it’s choosing a path toward healing.
Both treatments represent a major advancement in depression care, especially for individuals who have not responded to traditional antidepressants.
If you’re exploring ketamine therapy in Oklahoma, the best next step is a comprehensive evaluation to determine which option aligns with your diagnosis, goals, and lifestyle.
Interested in some of our other articles on Ketamine and Spravato?
Treatment For Long-Term Success
At Pine Ridge Mental Healthcare, we’ve found success using a variety of approaches to depression, PTSD, and anxiety. Discussing these approaches with a trusted provider is the first and most important step. Getting your symptoms under control is a key to improving how you feel.
Our mental health team works to reduce your reliance on medications by educating you about the different tools available and how life situations can affect your mood. In addition, we help keep you on track with regular check-ins to monitor how you are doing.
For help managing your health, schedule an appointment online or over the phone at Pine Ridge Mental Healthcare in Owasso, Oklahoma. If you are interested in other services we provide, check out our services page.
This content was written and reviewed by Pine Ridge Mental Healthcare, an outpatient psychiatry clinic in Oklahoma. Treatment decisions are made by licensed psychiatric providers based on individual evaluation.
At Pine Ridge Mental Healthcare, we believe everyone deserves compassionate, personalized care. If you or someone you love is struggling, reaching out for help is a brave and important step.
If you want to explore more about how depression impacts your relationships and find resources to support you, visit Pine Ridge Mental Healthcare.
Pine Ridge Mental Healthcare is here to support you. Call us today: (918) 858-4353
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