Dr. Ben Yudkoff, Co-Founder and Chief Medical Officer at Lumin Health, hosted a Reddit AMA on the Spravato community on November 21, 2025. The below blog post is a recap of one of the questions presented on that AMA, syndicated to the Lumin Health blog in the event that it answers any questions about ketamine therapy, Spravato treatment, or general concerns you may have about treatment.
https://www.reddit.com/r/Spravato/comments/1p2ar6v/ama_im_dr_ben_yudkoff_psychiatrist_cofounder/
Don’t hesitate to get in touch with us if you’re interested in learning more about ketamine for depression at Lumin Health. Thank you once again to the moderators and community members for facilitating such an engaging discussion.
SnooMacarons3227 asks:
Hi Dr. I did ketamine IV for 2 years before the insurance cut everyone off. Im on spravato now w/1 paid out of pocket infusion a month ( w/2 spravato sessions a month) why do I feel SO much better after my IV sessions? I get zero dissociation with Spravato & I need that to deal with my plethora of issues. Why does Ketamine work SO much better??? Do u think insurance will EVER pay for real Ketamine IV again?
Answer:
Helloo Snoo. Quick answers, here: Spravato is dosed, on average, to be the equivalent of 0.2 mg/mg of ketamine delivered intravenously over 40 minutes. My guess is that the dose you are receiving of IV ketamine is much higher than that. Dosing is likely why you are feeling so differently. One quick foray into a long answer: ketamine is made up of two identical molecules, identical but for their orientation -- just like hands with a left sided hand and a right sided hand. The active orientation is the left sided orientation which is esketamine! The "ES" in esketamine stands for "sinnustrum" which is Latin for "left" (and from which we get the world "sinnister" as, in our own views, the devil sits on the left side). Spravato delivers 84 mg of esketamine, of which only 42-50 mg actually gets in. IV ketamine is an equal parts mixture of right sided ketamine (arketamine - which still has some activity, although markedly less than esketamine) and esketamine and you are probably just getting a higher dose.
Insurances in some states does pay for IV ketamine. Sometimes insurances will offer single-case agreements with ketamine providers for IV ketamine (importantly, not IM ketamine or troches). Some medical practices are built to have these agreements, others are not... I don't hear any signal of insurance companies generally paying for ketamine, thought. Because of it's mild psychedelic-effects, word on the street is that they prefer to cover the version that is FDA approved (Spravato).
