Treatment Comparison · Baltimore, MD

Ketamine vs. SPRAVATO®
in Baltimore

An honest, physician-reviewed comparison — how they work, FDA approval, cost, insurance, and which conditions each treats

The short answer: SPRAVATO® (esketamine) is an FDA-approved nasal spray for treatment-resistant depression and MDD with suicidal ideation. IV ketamine infusion therapy uses racemic ketamine, is given intravenously, and is used off-label for a broader range of conditions — depression, PTSD, anxiety, OCD, bipolar depression, and chronic pain. Both act on NMDA receptors, but they differ in form, FDA status, cost, insurance coverage, and which conditions they treat. At Vita Nova in Canton, Baltimore, our focus is physician-led IV ketamine infusion therapy.

Physician-Led IV Ketamine Johns Hopkins Faculty MD Ketamine from $375 (Members) LegitScript Certified Free Insurance Verification

Private physician-supervised IV ketamine treatment suite at Vita Nova Ketamine and Wellness Clinic, 513 Bayview Blvd, Canton, Baltimore MD 21224

Private IV ketamine treatment suite — Vita Nova · 513 Bayview Blvd, Canton, Baltimore MD 21224

Medically Reviewed By

Dr. Brijen L. Joshi, MD

Last reviewed July 2026

Founder & Medical Director, Vita Nova · Johns Hopkins Faculty Physician · Assistant Professor, Anesthesiology & Critical Care Medicine · Chief, Thoracic Anesthesia, Johns Hopkins Hospital · Board-Certified Anesthesiologist

🛡️ LegitScript Certified 💉 Board-Certified Anesthesiologist 🏥 Johns Hopkins

Not Sure Which Is Right?

Start with a free insurance verification — we check your benefits before your first visit, then your provider walks you through whether IV ketamine is right for you.

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BusinessRate Best Mental Health Clinic Baltimore 2026 — Vita Nova Ketamine & Wellness Clinic

🏥 Johns Hopkins Faculty MD

💳 HSA / FSA Cards Accepted

🅿️ Free Parking · Canton Baltimore

Mon–Fri: 1PM–8PM · Sat: 10AM–2PM
513 Bayview Blvd, Canton Baltimore MD 21224
(443) 563-1059

Key Differences at a Glance

FDA approval: SPRAVATO® is FDA-approved for TRD and MDD with suicidal ideation. IV ketamine is off-label for both mental health and pain.

Conditions: IV ketamine is used for a broader range — PTSD, anxiety, OCD, bipolar, postpartum, and chronic pain — beyond SPRAVATO®'s two approved uses.

Form: IV ketamine is an intravenous infusion given by clinical staff. SPRAVATO® is a nasal spray taken in a certified healthcare setting.

Cost: IV ketamine at Vita Nova is from $375/session (member) or $499.99 (non-member). SPRAVATO® is often copay-only with PPO at certified centers.

Insurance: IV ketamine is usually self-pay with a superbill for out-of-network claims. SPRAVATO® is often covered after prior authorization.

At Vita Nova: our focus is physician-led IV ketamine infusion therapy, supervised by a Johns Hopkins faculty anesthesiologist.

Side-by-Side Comparison

Ketamine vs. SPRAVATO® — Full Comparison

The two share a related mechanism — both act on NMDA receptors — but differ meaningfully in FDA approval, insurance, administration, and eligible conditions. Here is everything in one view.

IV ketamine infusion therapy vs. SPRAVATO® (esketamine) — clinical and cost comparison. Vita Nova provides physician-led IV ketamine in Baltimore, MD.
Feature	IV Ketamine Infusion	SPRAVATO® (Esketamine)
Active compound	Racemic ketamine (R- and S-enantiomers combined)	Esketamine (S-enantiomer only)
FDA approval	Off-label for mental health and pain	FDA-approved for TRD and MDD with suicidal ideation
Form & administration	Intravenous infusion given by clinical staff	Nasal spray self-administered in a certified healthcare setting
Session length	40–60 min (mental health) · 2–4 hrs (chronic pain)	~2 hrs including post-dose monitoring (FDA REMS requirement)
Conditions used for	TRD · PTSD · anxiety · OCD · bipolar · postpartum · chronic pain · fibromyalgia · neuropathy · migraine · and more	TRD · MDD with acute suicidal ideation or behavior
Insurance	Usually off-label and self-pay; some PPO plans reimburse out-of-network with a superbill	Often covered by PPO with a copay after prior authorization, at certified centers
Cost at Vita Nova	$499.99/session mental health ($375 member) · $1,499.99 chronic pain ($1,125 member)	Not offered at Vita Nova at this time — see note below
After your session	A driver is required; no driving the rest of the day	A driver is required; monitoring period before discharge

About availability: Vita Nova's current focus is physician-led IV ketamine infusion therapy. SPRAVATO® is described here for educational comparison and is offered at certified centers. If your diagnosis and coverage point toward SPRAVATO®, your provider will tell you clearly during your consultation.

How They Work

Shared Mechanism, Different Compounds

Both ketamine and SPRAVATO® target NMDA receptors in the brain — blocking them to increase glutamate signaling and promote synaptogenesis, the formation of new synaptic connections. This underlies the rapid onset that distinguishes both from traditional antidepressants, which act on serotonin and norepinephrine and take weeks to work.

The difference is the compound. Ketamine is a racemic mixture of two mirror-image molecules — the R-enantiomer (arketamine) and the S-enantiomer (esketamine). SPRAVATO® contains only esketamine, which binds the NMDA receptor roughly 3 to 4 times more strongly than arketamine, according to the FDA clinical pharmacology review.¹ Because esketamine was studied and approved as a distinct drug, it carries FDA approval for specific depression indications.

Route matters too. IV ketamine delivers approximately 100% bioavailability directly into the bloodstream, while intranasal esketamine reaches roughly 30–50%.² The R-enantiomer present in IV ketamine but absent from SPRAVATO® has its own activity, which is one reason the two have somewhat different clinical profiles despite the shared mechanism — they are related, but not interchangeable.

Clinical note: because the compounds are related but not identical, some patients who do not respond to one may respond to the other. If you have tried SPRAVATO® without adequate response, IV ketamine may still be evaluated. Your provider discusses this during your evaluation at Vita Nova.

FDA Approval & Uses

What Each Treatment Is Used For

FDA approval status shapes insurance coverage and the clinical conversation about which option fits your situation.

FDA approval status and eligible uses — IV ketamine vs. SPRAVATO®.
Condition	IV Ketamine	SPRAVATO®
Treatment-resistant depression	Off-label · evaluated clinically	FDA-approved · primary indication
MDD with suicidal ideation	Off-label	FDA-approved
PTSD	Off-label · evaluated	Not FDA-approved for this use
Anxiety disorders	Off-label · evaluated	Not FDA-approved for this use
Bipolar depression	Off-label · evaluated	Not FDA-approved for this use
OCD	Off-label · evaluated	Not FDA-approved for this use
Chronic pain (fibromyalgia, neuropathy, migraine…)	Off-label · evaluated	Not FDA-approved for this use

Off-label prescribing is a standard, legal medical practice when a licensed physician determines it is clinically appropriate. All treatment decisions at Vita Nova require a comprehensive clinical evaluation, and not every patient who completes one will be offered a care pathway.

Cost & Insurance

Cost & Insurance — Which Is More Affordable?

The answer depends almost entirely on your diagnosis and insurance. See the full pricing guide for a complete breakdown.

Cost comparison — IV ketamine at Vita Nova vs. SPRAVATO® at certified centers.
Cost factor	IV Ketamine (at Vita Nova)	SPRAVATO® (certified centers)
Per session — non-member	$499.99 (mental health) · $1,499.99 (chronic pain)	Often copay-only with qualifying PPO after prior authorization
Per session — Vitality Circle member	$375 (mental health) · $1,125 (chronic pain)	PPO coverage applies regardless of membership
Insurance	Off-label — usually self-pay; superbill provided for out-of-network claims	FDA-approved — often PPO-covered with prior authorization
HSA / FSA	Accepted	Accepted

First step: verify your insurance before assuming either option is out of reach. Some PPO plans reimburse more of an out-of-network ketamine infusion than patients expect. Start your free insurance check →

Choosing Between Them

Which Is Right for You?

There is no universal answer — it depends on your diagnosis, coverage, and clinical history. Here is a framework to think it through before your consultation, where your provider makes the final recommendation.

IV Ketamine May Be Right If…

Your condition falls outside SPRAVATO®'s approved uses — PTSD, anxiety, OCD, bipolar, postpartum depression, or chronic pain
You don't have PPO coverage for SPRAVATO®, or your plan won't cover it for your diagnosis
You didn't respond adequately to SPRAVATO® and your provider wants to evaluate the full racemic compound
Member session pricing makes infusions financially workable for you

SPRAVATO® May Be Right If…

You have a qualifying diagnosis of treatment-resistant depression or MDD with suicidal ideation
You have PPO insurance and want to maximize coverage — it's often copay-only after prior authorization
You've documented two or more adequate antidepressant trials without adequate response
You prefer intranasal administration in a certified setting

Our Approach

Physician-Led IV Ketamine in Baltimore

At Vita Nova, IV ketamine infusion therapy is developed and supervised by Dr. Brijen L. Joshi, MD — a Johns Hopkins faculty anesthesiologist — with continuous cardiac and blood-pressure monitoring on every infusion. It's the same protocol foundation used in hospital settings, delivered in a private room at 513 Bayview Blvd, Canton, Baltimore MD.

Our current focus is IV ketamine. If your evaluation points toward SPRAVATO® instead, we'll tell you honestly and help you understand your options — no pressure, no upsell. Vita Nova is LegitScript certified, an independent verification of licensing, sourcing, and advertising standards.

Frequently Asked Questions

Ketamine vs. SPRAVATO® — Questions Answered

The questions patients ask most when comparing the two. Medically reviewed by Dr. Brijen L. Joshi, MD.

Ketamine infusions use racemic ketamine — a combination of two mirror-image molecules — delivered intravenously over 40 to 60 minutes, and are used off-label for mental health and pain. SPRAVATO® (esketamine) contains only the S-enantiomer of ketamine, is given as a nasal spray in a certified healthcare setting, and is FDA-approved specifically for treatment-resistant depression and major depressive disorder with suicidal ideation. Both act on NMDA receptors, but they differ in form, FDA status, insurance coverage, and the conditions they treat. Vita Nova provides physician-led IV ketamine infusion therapy at 513 Bayview Blvd, Canton, Baltimore MD 21224.

Neither is universally better — the right choice depends on your diagnosis, insurance, and clinical history. SPRAVATO® is FDA-approved specifically for treatment-resistant depression and is often PPO-covered, which can make it the more affordable starting point for qualifying patients. IV ketamine is off-label but is also evaluated for treatment-resistant depression and offers flexibility across a wider range of conditions where SPRAVATO® has no FDA approval. At Vita Nova, your provider reviews your history and coverage and recommends the most clinically appropriate pathway — including IV ketamine — during your evaluation.

Yes — because SPRAVATO® (esketamine) is FDA-approved for treatment-resistant depression and MDD with suicidal ideation, it's eligible for PPO insurance coverage. Many patients pay only their specialist copay after prior authorization is approved, sometimes as low as $0 once their deductible is met. Coverage depends on your specific PPO plan, your diagnosis, and prior-authorization approval, and SPRAVATO® is administered at certified centers. Vita Nova's focus is IV ketamine; if SPRAVATO® looks like the better fit for your coverage, your provider will point you in the right direction during your consultation.

Usually not in full — IV ketamine is off-label for mental health and pain, so most standard plans don't cover it, though some PPO plans offer partial out-of-network reimbursement. Vita Nova verifies your specific benefits at no cost before your first visit and provides a superbill with itemized billing codes to support any out-of-network reimbursement claim to your carrier. HSA and FSA funds are accepted, and Community Heroes discounts apply for veterans, first responders, nurses, teachers, and seniors 65+. Verification takes 1–2 business days with no commitment.

IV ketamine for mental health at Vita Nova is $499.99 per session for non-members and $375 for Vitality Circle members; chronic-pain infusions are $1,499.99 ($1,125 member). The Complete Series of six infusions is $2,849.94 ($2,250 member) and includes 3 complimentary hydration IVs. SPRAVATO® is FDA-approved and often PPO-covered at certified centers — many patients pay only a copay, sometimes as low as $0 after their deductible. For patients without PPO coverage for SPRAVATO®, IV ketamine at member pricing may be the more affordable out-of-pocket option depending on the number of sessions. See the full pricing guide.

IV ketamine infusions for mental health last 40 to 60 minutes plus recovery time; chronic-pain protocols run 2 to 4 hours. SPRAVATO® sessions take about 2 hours total — the nasal spray is self-administered, followed by a post-dose monitoring period required under the FDA REMS program. Both treatments require a driver afterward — you may not drive, operate machinery, or travel home unaccompanied. For IV ketamine at Vita Nova, you're monitored continuously by clinical staff throughout the infusion.

SPRAVATO® (esketamine) holds FDA approval only for treatment-resistant depression and major depressive disorder with acute suicidal ideation. IV ketamine is evaluated off-label for a significantly broader range — PTSD, anxiety disorders, OCD, bipolar depression, postpartum depression, and chronic pain conditions such as fibromyalgia, neuropathy, chronic back pain, migraine, arthritis, and sciatica. For patients whose primary concern falls outside SPRAVATO®'s approved scope, IV ketamine is often the more appropriate pathway. Your provider at Vita Nova reviews all relevant indications during your evaluation.

No — they're related but pharmacologically distinct. SPRAVATO® is esketamine, the S-enantiomer of ketamine. IV ketamine is racemic, containing both the S-enantiomer and the R-enantiomer (arketamine). Per the FDA clinical pharmacology review, esketamine binds the NMDA receptor roughly 3 to 4 times more strongly than arketamine — but arketamine, present only in IV ketamine, has its own activity and a different profile. Route matters too: IV delivers about 100% bioavailability, while intranasal esketamine reaches roughly 30–50%. These differences shape their session structures and clinical applications — they are not interchangeable formulations.

In some cases, yes — patients move between treatments based on clinical response, insurance changes, or an evolving diagnosis. A patient with a qualifying treatment-resistant depression diagnosis and PPO coverage may pursue SPRAVATO® for its insurance benefit, while a patient who didn't respond adequately to SPRAVATO® may be evaluated for IV ketamine, which delivers the full racemic compound. Vita Nova provides IV ketamine and can advise you on whether SPRAVATO® at a certified center makes sense for your situation. Any change is guided by your provider based on your clinical history.

Both share core side effects because both block NMDA receptors at subanesthetic doses: transient dissociation (a sense of detachment or altered perception), dizziness, nausea, a temporary rise in blood pressure during the session, and headache. With IV ketamine, effects tend to be more intense but shorter, largely resolving within 1–2 hours of the infusion ending. With SPRAVATO®, onset is more gradual and effects resolve during the post-dose monitoring period. At Vita Nova, blood pressure and vital signs are monitored continuously throughout every IV ketamine infusion, and a driver is required afterward. Full details are reviewed during your evaluation and on our Side Effects & Risk Disclosures page.

References:

FDA, Esketamine (SPRAVATO®) Clinical Pharmacology Review, NDA 211243 — NMDA affinity ~3–4× greater for esketamine than arketamine. accessdata.fda.gov
Bahji A, et al. Comparative efficacy of racemic ketamine and esketamine for depression. PMC9635017 — bioavailability ~100% IV vs ~30–50% intranasal.
FDA, SPRAVATO® Prescribing Information — approved for TRD (2019) and MDD with suicidal ideation (2020).

Physician-Led IV Ketamine · Free Verification

Not Sure Which Path
Fits You?

Start with a free insurance verification — we check your benefits before your first visit. Your provider then reviews your history and tells you honestly whether IV ketamine is right for you, or whether another option fits better.

📍 513 Bayview Blvd · Canton Baltimore MD 21224 · 🅿️ Free Parking
Mon–Fri: 1PM–8PM · Sat: 10AM–2PM · (443) 563-1059

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Ketamine vs. SPRAVATO®in Baltimore