IV Ketamine vs. Spravato (Nasal Spray): Which is Right for You?

When I talk to patients in Southlake about Ketamine therapy, I usually see two reactions.

The first is hope. They have read the studies. They know it works for treatment-resistant depression and anxiety.

The second is confusion.

They ask me questions like: "Doc, do I have to get an IV? I heard there's a nasal spray now. Is that the same thing? Does insurance cover it? Which one is better?"

It is a valid confusion because the landscape has changed fast. A few years ago, IV infusions were the only game in town. Now, we have Spravato (Esketamine), which is FDA-approved and covered by many insurance plans.

At Magnolia Functional Wellness, we offer guidance on both because there is no "one size fits all" answer. It depends on your biology, your budget, and your goals.

Let’s break down the science so you can decide which path fits your life.

The Gold Standard: IV Ketamine Infusions

We have to start with the original. Intravenous (IV) Ketamine is what most of the groundbreaking research is based on.

The Pros:

100% Bioavailability: When we put an IV in your arm, 100% of the medication goes into your bloodstream. It doesn't have to pass through your stomach or your nasal sinus. It goes straight to the brain.This gives me, as your doctor, total control. If you are feeling too overwhelmed during the session, I can dial the dose down instantly. If you aren't feeling enough dissociation to get the therapeutic effect, I can bump it up. It is precise.

The Experience: It is a deeper dive. Because the dosing is higher and more direct, the "dissociative" experience—that feeling of detaching from your ego and your problems—is usually more profound with IV. For patients who need a massive "hard reset" on their neural pathways, IV is often the strongest tool we have.

The Cons: It is rarely covered by insurance. It is an investment. And, obviously, it involves a needle. If you have a phobia of needles, this can be a hurdle (though we make it as painless as possible).

The New Contender: Spravato (Esketamine)

Spravato is a brand name for esketamine, which is a chemical cousin of ketamine. It comes in a nasal spray device.

The Pros:

Insurance & Convenience: This is the big one. Spravato is FDA-approved specifically for Treatment-Resistant Depression. That means many insurance plans in Texas will cover it. For patients who need long-term maintenan;ce but can't afford out-of-pocket IVs, this is a lifesaver.It is also needle-free. You sit in our comfortable chair, you administer the spray yourself (under our supervision), and you relax.

The Cons:

Variability: Absorption through the nose can be tricky. If you have a cold, or allergies (which is everyone in Southlake during pollen season), it can affect how much medicine you get. Bioavailability is around 50%, compared to 100% with IV. It is a milder experience. For some, that is a pro. For others who need that deep breakthrough, it might take longer to see results.

Which One Should You Choose?

When you come into Magnolia Functional Wellness, we look at a few factors:

1. Severity: If you are in a crisis, I often recommend starting with IV for the rapid, robust relief. We need to put out the fire fast.
2. Biology: If you have difficult veins or hate needles, Spravato is a beautiful alternative.
3. Finance: We check your insurance benefits. If Spravato is covered, it might be the most sustainable option for you long-term.

The Setting Matters More Than the Method

Here is the secret. Whether you choose IV or Spray, the medicine is only half the equation. The setting is the other half.

You can’t just do this in a cold, sterile room and expect magic. At our clinic, we curate the experience. We have the gravity blankets. We have the noise-canceling headphones with specific playlists designed to guide your brainwaves. We have the integration coaching to help you make sense of what you felt.

Whether it enters through your arm or your nose, the goal is the same: To disrupt the negative loops in your brain and give you a fresh start.

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