Routes of administration
How ketamine is actually delivered
The route changes more than convenience. It changes absorption, dose predictability, what monitoring is
required, where it can legally be given, and the price.
Esketamine nasal spray (Spravato)
The only FDA-approved ketamine-derived treatment for treatment-resistant depression, restricted to certified centres under a REMS programme.
Intramuscular ketamine
A single injection rather than a titrated drip, which makes it cheaper and faster but removes the ability to adjust mid-session.
Intravenous ketamine infusion
The most studied route and the one the trial evidence rests on. Dose is precisely controlled and can be slowed or stopped mid-session.
Ketamine-assisted psychotherapy
Administration paired with a trained therapist present throughout the session and in structured integration work afterwards.
Sublingual and oral ketamine
Lower and more variable bioavailability than injected routes, usually used for maintenance between monitored sessions rather than as induction.
Side by side
The comparison clinic websites rarely put on one page.
| Route | Session length | Typical cost | Insurance | Clinics | |
|---|---|---|---|---|---|
| Esketamine nasal spray (Spravato) Intranasal |
120 min | $600–$900 | Often partially covered, subject to prior authorisation and documented failure of prior antidepressants. | — | Open |
| Intramuscular ketamine IM |
60 min | $300–$550 | Generally self-pay, as with intravenous administration. | — | Open |
| Intravenous ketamine infusion IV |
40 min | $400–$800 | Rarely covered by commercial insurance because administration for mood indications is off-label. | — | Open |
| Ketamine-assisted psychotherapy IM or sublingual with therapy |
150 min | $500–$1,200 | The therapy component is sometimes billable even where administration is not. | — | Open |
| Sublingual and oral ketamine Sublingual |
90 min | $100–$350 | Almost never covered. The FDA warned in 2023 about compounded products used at home without monitoring. | — | Open |