Spravato, IV ketamine and ketamine troches are three ways of using ketamine-family medicines for depression and related struggles. They differ in FDA status, setting, cost, insurance coverage and how much therapy comes with them. This guide is for anyone trying to choose among them.
SomaVerse offers one of the three: compounded sublingual ketamine troches inside a program of ketamine-assisted psychotherapy (KAP). We don’t offer Spravato or IV infusions. That gives us a stake in the question, so we’ve tried to write the comparison we’d want a friend to read: plain about the evidence, plain about money, and clear about when another option is the better fit.
If you finish this page still unsure, that’s normal. A free 15-minute consult is a good place to talk it through, and we’re glad to help you think it through even if you end up somewhere else.
You might be reading this because…
- Your psychiatrist mentioned Spravato and you want to know how it compares with the ketamine you’ve read about.
- You’ve noticed IV ketamine clinics around Lawrence and Overland Park and wondered why prices vary so much.
- Your insurance might cover one option but not another, and you want to understand the trade-off.
- You’ve tried several antidepressants and you’re weighing next steps for treatment-resistant depression.
- You’re drawn to the idea of therapy with ketamine, not just a medication appointment.
- You’re already receiving Spravato or IV ketamine and wondering whether integration support would help.
Three ways to receive ketamine, in plain terms
Spravato is a brand-name nasal spray containing esketamine. It’s FDA-approved for treatment-resistant depression (TRD) in adults, and since January 2025 it can be used on its own or alongside an oral antidepressant. You give yourself the spray in a certified clinic and stay for at least two hours of observation.
IV ketamine is racemic ketamine (the original anesthetic drug) given through a drip, usually over about 40 minutes in a clinic chair. It’s used off-label for depression and is often given as a series of several infusions over two or three weeks. Most infusion clinics focus on the medicine itself, with therapy offered separately, if at all.
Ketamine troches are small compounded tablets that dissolve under the tongue or in the cheek. Like IV ketamine, they’re racemic ketamine used off-label. At SomaVerse, troches are always part of a program: a medical evaluation, preparation with a therapist or guide, the dosing session in office at any of our three offices, and integration afterward. Learn more on our ketamine troche therapy page.
Esketamine vs. ketamine: is it the same medicine?
Close, but not identical. Ketamine molecules come in two mirror-image forms, called S and R. Ordinary (racemic) ketamine is a 50/50 mix of both. Esketamine is just the S form, which binds the NMDA receptor more strongly, so it’s given in smaller amounts.
Esketamine was developed and patented as a nasal spray, studied in large company-sponsored trials, and approved by the FDA in 2019. Racemic ketamine has been an FDA-approved anesthetic for decades, and its use for depression grew out of academic research, not a drug-approval program. That’s why one carries an FDA indication for depression and the other is prescribed off-label.
Route matters too. An IV delivers essentially all of the dose straight into the bloodstream. A nasal spray absorbs well but less completely. A troche absorbed through the lining of the mouth delivers only about 20–30% of the dose, with wide variation from person to person, so effects build more gradually and tend to feel gentler.
Which is more effective: Spravato, IV or troches?
Honestly, IV ketamine has the strongest trial evidence for depression. A 2021 meta-analysis of 24 trials found larger response and remission rates for racemic (mostly IV) ketamine than for intranasal esketamine. That comparison was indirect, across separate studies rather than head-to-head, so it isn’t the final word.
Spravato has something the others don’t: large, rigorous trials designed for FDA review, and an approved label. For someone with treatment-resistant depression, that regulatory track record and the insurance coverage that follows from it are real advantages.
Evidence for oral and sublingual ketamine is earlier-stage. A 2026 meta-analysis of eight small randomized trials found oral ketamine reduced depression more than placebo in the short term, with moderate certainty. A separate 2026 review of at-home, telehealth-supported sublingual ketamine rated the certainty of that evidence as very low. Research on ketamine paired with psychotherapy is promising but still mostly observational. We think you deserve to know that before you choose.
What each option costs, and what insurance covers
Cost is often the deciding factor, so here it is directly. At SomaVerse a single troche dose is $90, and the Individual Ketamine Healing Package is $480 for six sessions, including the prescription, a Journey Box, medical monitoring and a preparation session. Bundled programs with therapy, guide sessions, medical visits and integration groups run $1,325–$1,650. Eligible medical and therapy visits can often be billed to insurance; the ketamine itself, guides and groups are self-pay. Full details are on our pricing page.
IV infusions often cost $350–$700+ per infusion, and a typical starting series includes several of them. IV ketamine for mental health is generally self-pay.
Spravato is often covered by commercial insurance after prior authorization, usually once you’ve tried at least two antidepressants. Your share depends on your plan’s copays and deductible. If you have good coverage and meet the criteria, Spravato may be the most affordable option on this page.
The setting, and the therapy around the medicine
Spravato and IV clinics are built around safe medication delivery. You’ll be monitored closely, and that’s a good thing. What happens in your mind during the session is usually treated as a side effect to wait out, and psychotherapy, if you have it, happens somewhere else.
KAP turns that around. The softened, dreamlike state is treated as part of the work. You prepare an intention beforehand, a ketamine-trained therapist or guide can sit with you during dosing, and integration sessions and groups help you make sense of what surfaced. Our ketamine-assisted psychotherapy page explains that model in depth.
Setting differs too. Spravato must be given in a certified clinic. IV requires a medical setting. At SomaVerse, everyone starts with troche sessions in office, at our Lawrence, Overland Park or Topeka office. Once you’ve completed at least our main program with us and are medically approved, you may be approved to continue troche sessions at home, with a sober support person present and a medical check-in after every dose. See supported at-home ketamine therapy for how we handle the safety side.
When Spravato or IV may be the better choice
We’d rather you get the right treatment than choose us by default. Spravato may be the better fit if you have treatment-resistant depression, insurance that covers it, and a preference for an FDA-approved medication with a standardized protocol. Several Lawrence and Kansas City practices are certified Spravato providers.
IV ketamine may make sense if you want the route with the most research behind it, need a carefully controlled dose, or haven’t responded to gentler approaches. It can also be a better match for people whose care team wants tight medical control throughout every session.
Troches with KAP tend to suit people who want therapy at the center, who prefer a gradual and gentler onset, who value a lower per-session cost, or who want options like group sessions and weekend retreats. None of these paths is right for everyone, and the is ketamine right for me page can help you sort through your situation.
Already receiving Spravato or IV? Integration is open to you
Many people in Lawrence, Topeka and Kansas City get excellent care at Spravato or infusion clinics and still leave sessions with experiences they don’t quite know what to do with. That’s exactly what integration is for.
SomaVerse works with clients receiving ketamine from other providers. Our ketamine integration therapy sessions and $20 integration groups are open to you whether your medicine comes from us or from a clinic across town. You don’t have to switch treatments to get support making meaning of them.
