The five forms at a glance
| Form | FDA status | Typical cost per session | Insurance |
|---|---|---|---|
| Spravato® (esketamine) nasal spray | FDA-approved for treatment-resistant depression, including, since 2025, as a standalone (monotherapy) treatment | Drug + clinic fees; list price is high; most insured patients don't pay it | Often covered with prior authorization; depends on your plan's criteria |
| IV infusion | Off-label | ~$300–$800 (HealingMaps median $450) | Rarely covered; visits sometimes billable |
| IM injection | Off-label | ~$200–$500 (HealingMaps median $350) | Rarely covered |
| Oral lozenges / troches (compounded) | Off-label, compounded; subject of a specific FDA compounding risk alert for at-home use | ~$200–$450/month | Not covered |
| Ketamine-assisted psychotherapy (KAP) | Off-label (drug) + psychotherapy | ~$400–$1,200 per session (HealingMaps median $650) | Therapy portion sometimes billable |
Cash prices are estimates from HealingMaps, a commercial ketamine clinic directory. By its own disclaimer, HealingMaps may be paid for reviews, endorsements, advertising, and affiliate links. No government agency publishes U.S. ketamine clinic prices. One peer-reviewed study of Maryland clinic websites found advertised prices from $360 to $2,500 per infusion. With that much spread, confirm every price directly.
Spravato® (esketamine) nasal spray
Esketamine is a form of the ketamine molecule that Janssen developed and took through FDA trials. It is approved for treatment-resistant depression in adults. Together with an oral antidepressant, it is also approved for depressive symptoms in adults with major depression with acute suicidal thoughts or actions. Since January 2025 it can be used on its own for treatment-resistant depression. The suicidal-thoughts indication still requires an oral antidepressant. Its label says Spravato® has not been shown to prevent suicide or reduce suicidal thoughts or behavior, and it does not replace hospital care when that is needed. More of what the label says about suicidal thinking is on our conditions page.
Spravato® has the largest regulatory trial program, the most structured oversight, and the best insurance coverage. The tradeoff is that structure itself. Spravato® can only be given at certified treatment centers under a federal safety program (REMS). Each dose is followed by at least two hours of monitored observation and a check that you're clinically stable before you leave. You can't take it home.
FDA approval and tighter oversight do not make Spravato® the more effective form. Whether it or IV ketamine works better is still an open question. The studies that compared them are covered in Ketamine vs. Spravato, along with cost, coverage, and how you receive each.
IV ketamine infusions
The most-studied off-label form, and the workhorse of most ketamine clinics. Dosing is precise and can be adjusted mid-session. The research showing rapid antidepressant effects was largely done with IV ketamine at 0.5 mg/kg over 40 minutes. Those effects often appeared within 24 hours.
Because it's off-label, no federal program dictates screening or monitoring standards. Quality is set entirely by the clinic. That's why how you choose one matters so much.
IM injections
Intramuscular ketamine delivers a similar experience with simpler logistics, since there's no IV line. It gives less mid-session control over dosing. Some clinics offer it as a lower-cost alternative. The evidence base is thinner than IV but the pharmacology is closely related.
IV vs. IM ketamine, side by side
| IV infusion | IM injection | |
|---|---|---|
| How it is given | Through an IV line | A shot into a muscle, with no IV line |
| Session length | Typically about 40 minutes for depression | Varies; ask the clinic |
| Dose control | Precise, and can be adjusted mid-session | Less mid-session control over dosing |
| Evidence | The most-studied off-label form | Thinner than IV; the pharmacology is closely related |
| FDA status | Off-label | Off-label |
| Typical cost per session | ~$300–$800 (HealingMaps median $450) | ~$200–$500 (HealingMaps median $350) |
| Insurance | Rarely covered; visits sometimes billable | Rarely covered |
Oral lozenges and at-home programs
Compounded sublingual ketamine is often prescribed via telehealth and shipped to your home. It's the cheapest form, and the one the FDA has specifically warned about: no safe or effective psychiatric dose has been established, and at home no clinician is present if breathing slows or blood pressure spikes. Our article on at-home ketamine therapy explains the FDA alert in full, how these programs work, and what to ask one.
That doesn't mean every at-home program is reckless. Some involve meaningful screening and virtual monitoring. Still, this form puts you furthest from the evidence base and from medical supervision. Read Safety & Side Effects before considering it.
Ketamine-assisted psychotherapy (KAP)
KAP pairs a dosing session with structured psychotherapy. That means preparation beforehand, a therapist present during the experience, and integration sessions after. The theory: ketamine opens a window of psychological flexibility that therapy can use. Evidence is promising but younger than for ketamine alone. Quality depends heavily on the therapist. Expect significantly higher per-session costs driven by clinician time.
KAP vs. an infusion alone
| What a session includes | How the ketamine is given | Evidence | Typical cost per session | Insurance | |
|---|---|---|---|---|---|
| KAP | Preparation beforehand, a therapist present during the dosing session, and integration sessions after | Varies; ask the clinic | Promising, but younger than for ketamine alone | ~$400–$1,200 (HealingMaps median $650) | Therapy portion sometimes billable |
| IV infusion | An infusion of about 40 minutes, with blood pressure, breathing, and oxygen monitored, then rest until the clinic clears you to leave | Through an IV line | The most-studied off-label form | ~$300–$800 (HealingMaps median $450) | Rarely covered; visits sometimes billable |
At a glance
- Spravato® is the only form FDA-approved to treat depression, and the most likely to be covered by insurance. Generic ketamine is FDA-approved only as an anesthetic.
- IV infusion has the deepest research base among off-label forms and the most precise dosing.
- Compounded at-home ketamine is the cheapest and least supervised form. It also carries a specific FDA compounding risk alert.
- KAP adds structured therapy to dosing; promising, costlier, therapist-dependent.
- The delivery form decides who oversees your care, how closely you are monitored, and whether insurance pays.
Sources
- Spravato® (esketamine) Full Prescribing Information — indications, including monotherapy for TRD (Jan 2025) (PDF)
- Johnson & Johnson — Spravato® approved in the U.S. as monotherapy for treatment-resistant depression (Jan 2025)
- U.S. FDA — Compounding Risk Alerts, including the October 2023 warning on compounded ketamine products for psychiatric use
- McIntyre et al., "Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation," American Journal of Psychiatry (2021) — PubMed
- HealingMaps (commercial ketamine clinic directory) — Ketamine Infusion Therapy Cost; estimates from its own clinic and inquiry data, updated May 2026, methodology not published — cash-pay price estimates
- Crane et al., "False or Misleading Claims in Online Direct-to-Consumer Ketamine Advertising in Maryland," JAMA Network Open (2023) — advertised infusion prices in Maryland, 2023 — PubMed