Ketamine-Assisted Psychotherapy vs. Spravato: What Is the Difference?

Spravato and ketamine-assisted psychotherapy both use a form of ketamine to treat depression. They are different treatment models, and the difference is not a technicality. One is a medication protocol with monitoring. The other is psychotherapy with a medicine inside it.

Spravato is the brand name for esketamine, a nasal spray derived from ketamine. The FDA approved it in 2019 for treatment-resistant depression alongside an oral antidepressant, and in 2025 as a standalone treatment for TRD. It is the only form of ketamine with FDA approval for depression.

Because of that approval, Spravato runs under a federal safety program. You take it at a certified treatment center, under supervision, and stay for about two hours of monitoring afterward. There is no take-home use. Sessions typically start twice weekly and taper over time. Psychotherapy is not part of the protocol, though some centers offer it separately.

The practical consequence of FDA approval: most commercial insurance plans, and often Medicare and Medicaid, cover Spravato.

Ketamine-assisted psychotherapy (KAP) uses generic ketamine, prescribed off-label, inside a structured psychotherapy process. At LuminaThera that means medical and psychological screening, preparation sessions, supported experiential sessions with a therapist present, and integration work afterward. The medicine opens a window. The therapy is what walks through it.

Off-label prescribing is legal and common in medicine, but it means insurance rarely covers the treatment. KAP is typically private-pay. Our pricing is published on our Costs & Access page, which is not the norm.

The medicine. Spravato is esketamine by nasal spray, FDA-approved for TRD. KAP uses generic ketamine, IM or sublingual, prescribed off-label and considered experimental.

The session. A Spravato visit is self-administration plus about two hours of monitored observation. A KAP session is a supported experiential session with a therapist present throughout.

The therapy. Psychotherapy is not part of the Spravato protocol. In KAP it is the core of the model: preparation before, presence during, integration after.

The cost. Spravato is usually covered by insurance. KAP is private-pay, with pricing published up front.

Spravato may fit better when insurance coverage is decisive, when a medication-centered approach is the goal, or when a psychiatrist is already managing care and wants an approved protocol.

KAP may fit better when you want the experience held inside psychotherapy, when previous medication-only approaches have not reached what you are working on, or when preparation and integration matter to you as much as the medicine session itself.

Some people do well with one, some with the other, and some try both at different points.

Not currently. We practice ketamine-assisted psychotherapy today, and if that ever changes, we will say it here plainly. If Spravato sounds like the better fit now, certified centers operate in central Ohio, and your psychiatrist or primary care provider can refer you. If you are weighing the two, a consult is a fine place to think it through. We will tell you plainly if we think another door is the better one for you.

Sources: FDA esketamine approval and labeling (2019; monotherapy 2025); Spravato REMS program requirements; Sanacora et al., A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders, JAMA Psychiatry (2017).