Ketamine is a well-established medical treatment with decades of use in anesthesia, emergency medicine, and pain management. In recent years, it has also emerged as an evidence-based option in mental health care, delivered in carefully supervised settings for conditions such as depression, PTSD, and other psychiatric disorders.
As ketamine treatment has expanded, so have the models of delivery.
Today, patients researching ketamine therapy typically encounter four primary options:
- Ketamine-Assisted Psychotherapy (KAP)
- At-home ketamine programs
- IV ketamine infusions
- Spravato (esketamine nasal spray)
Although these treatments all involve ketamine or a ketamine-derived compound, they differ significantly in structure, supervision, cost, insurance coverage, and therapeutic philosophy.
Understanding these differences is essential before deciding which approach may be appropriate.
Comparing the Philosophies Behind Each Model
While the medications overlap, the underlying treatment philosophy differs.
Medical Models
- At-home ketamine
- IV ketamine
- Spravato®
These approaches primarily aim to reduce symptoms by acting on neurobiological pathways — including glutamate modulation and downstream neuroplastic effects.
Medical + Integrated Psychotherapy Model
- Ketamine-Assisted Psychotherapy (KAP)
KAP builds on the idea that altered states may create a window of increased emotional flexibility and cognitive openness — but that therapeutic guidance determines whether those experiences translate into lasting change.
In other words:
- Medication-only models ask: Can we reduce symptoms?
- KAP asks: How do we use this state to facilitate psychological growth?
At a glance - how do the treatment models compare?
Ketamine-Assisted Psychotherapy (KAP)
Core Orientation: Integrated Biological and Psychological Care
Ketamine-Assisted Psychotherapy (KAP) combines medically supervised ketamine with structured psychotherapy. Rather than treating ketamine purely as a medication, KAP views it as a catalyst within a therapeutic process.
Treatment typically includes both psychiatry and psychotherapy:
- Medical clearance by a medical doctor
- Preparation sessions to clarify goals and build psychological safety
- Dosing sessions supported by clinical oversight
- Integration sessions to process insights and translate them into behavioral change
- Ongoing monitoring by a medical doctor
This structure recognizes that while ketamine can temporarily increase neuroplasticity and emotional openness, lasting change often depends on how the experience is processed and integrated.
In practice, KAP may support:
- Reprocessing of trauma
- Shifting rigid cognitive patterns
- Increased emotional access
- Interrupting depressive rumination
- Behavioral change aligned with new insight
Unlike medication-only models, psychotherapy is not optional or secondary — it is central to the treatment design.
Insurance & Cost Considerations
Medical consultations and psychotherapy sessions are often covered, making KAP significantly more financially accessible than IV infusion models in many cases.
At-Home Ketamine Treatment
Core Orientation: Convenience and Symptom Relief
At-home ketamine programs have grown rapidly due to telehealth expansion. These programs typically involve:
- Medical screening via telehealth
- Prescription of oral ketamine (often lozenges or troches)
- Self-administration at home
- Remote follow-up monitoring
The primary emphasis is symptom reduction rather than structured psychotherapy.
Some programs may recommend therapy separately, but psychotherapy is not typically built into the dosing model itself. The experience occurs in a home setting without in-person therapeutic containment.
For some individuals, the convenience and lower upfront cost are appealing. However, the absence of structured therapeutic integration may limit the potential for deeper psychological restructuring.
At-home ketamine is generally:
- Not covered by insurance
- Focused on biochemical mood improvement
- Designed for accessibility and flexibility
A newer category of at-home ketamine programs prescribes very low daily doses of oral ketamine (microdosing programs), typically without structured psychotherapy or integration support. Their core orientation is symptom management through frequent low-dose administration. These programs have grown in popularity due to their low upfront cost and accessibility. However, the clinical evidence supporting daily low-dose ketamine for mental health is limited, context-specific and not definitive compared to the evidence based for intermittent and supervised protocols.
IV Ketamine Infusions
Core Orientation: Rapid Neurobiological Intervention
IV ketamine infusions are delivered in specialized medical clinics. Ketamine is administered intravenously under direct supervision, allowing for precise dosing and monitoring.
This model is often selected for:
- Rapid symptom reduction
- Treatment-resistant depression
- Acute symptom severity
Because IV delivery produces predictable plasma levels, it is considered a highly controlled medical approach. However, psychotherapy is typically not integrated into infusion sessions.
Patients often receive:
- A series of infusions over several weeks
- Maintenance treatments over time
While many patients report rapid symptom relief, IV ketamine primarily targets neurobiology rather than psychological restructuring.
Cost Considerations
Infusion series are often more expensive than other models and are rarely covered by insurance.
Spravato®
Spravato is an FDA-approved intranasal esketamine treatment for treatment-resistant depression.
It differs from IV ketamine in that:
- It is FDA-approved for specific indications
- It must be administered in a certified clinic
- It operates under a Risk Evaluation and Mitigation Strategy (REMS) program
Spravato® sessions involve:
- In-clinic administration
- Monitoring for side effects
- Ongoing antidepressant use
While it is medication-based and regulated, psychotherapy is not structurally embedded into the dosing model.
Insurance coverage is more common with Spravato® compared to IV ketamine, although prior authorization is often required.
Practical considerations
There is no universally “best” ketamine treatment. The appropriate model depends on:
- Symptom severity
- Treatment history
- Access to licensed psychotherapy
- Insurance coverage
- Desire for deep therapeutic work versus rapid symptom reduction
Some individuals prioritize rapid relief. Others prioritize integration and meaning-making.
Understanding these trade-offs helps patients make informed decisions with their treatment team.
Why Journey Clinical Emphasizes Psychotherapy with Preparation & Integration
Journey Clinical’s collaborative care model centers on Ketamine-Assisted Psychotherapy delivered by licensed therapists in collaboration with medical providers.
The emphasis is on:
- Structured preparation
- Intentional integration
- Ongoing therapeutic support
- Responsible medical oversight
Rather than separating medication from therapy, this approach integrates them into one coordinated treatment process. For individuals seeking not only symptom reduction but sustained psychological change, that distinction may matter. Read the full guide on preparation and integration for KAP if you are interested to learn more.
Outcomes: 87% of Journey Clinical patients experience improvement in their anxiety and depression clinical scales after completing a full course of KAP.
Insurance and Cost Considerations: Journey Clinical is in network with many major insurance plans including Aetna, Anthem, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and others. Medical consultations and psychotherapy sessions are often covered, making KAP significantly more financially accessible.
Final Takeaway
Ketamine treatments share a common compound but differ in design.
The key distinction is not only how ketamine is administered — but whether psychotherapy is integrated into the experience.
For patients exploring their options, understanding that difference is essential.
If you are ready to explore whether KAP is right for you, Journey Clinical's care team is here to help. Create your patient portal to get started.
https://my.journeyclinical.com/get-started
Frequently Asked Questions
What is the difference between KAP and IV ketamine?
IV ketamine focuses on biological symptom reduction. KAP integrates psychotherapy into the treatment process to support emotional processing and behavioral change.
Is at-home ketamine as effective as clinic-based treatment?
Effectiveness varies by individual. At-home programs focus primarily on symptom relief, while clinic-based or psychotherapy-integrated models provide additional structure and monitoring.
Is Spravato® the same as ketamine?
Spravato® contains esketamine, a derivative of ketamine, and is FDA-approved for treatment-resistant depression.
Is ketamine-assisted psychotherapy (KAP) right for me if I have never tried therapy before?
KAP can be a powerful entry point into therapeutic work. Our therapist matching team will help you find a provider who meets you where you are, regardless of your prior experience with therapy.
Related Articles
- Ketamine and the Brain
- Ketamine-Assisted Psychotherapy (KAP): How It Works and What to Expect at Journey Clinical
- Ketamine-Assisted Psychotherapy: Why Psychotherapy Matters
- Ketamine & KAP research: curated library of 30+ clinical studies
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