Many patients are finding relief from treatment-resistant depression, PTSD, and other chronic illnesses by utilizing ketamine to improve their symptoms. Now, with the FDA-approved form of ketamine (Spravato, also known as esketamine) hitting the market, many consumers are curious about the difference between the two.
Let's dive into everything you need to know about the difference between ketamine and Spravato.
What is Ketamine?
Ketamine has been used for decades as an anesthetic, but in recent years, it has gained recognition for its powerful antidepressant effects. It is a racemic mixture, meaning it contains two mirror-image molecules: R-ketamine and S-ketamine. By modulating the brain’s glutamate system, ketamine encourages synaptic growth, leading to rapid and often profound relief from depressive symptoms.Ketamine is typically administered intravenously (IV) in a controlled medical setting. This method allows for precise dosing and immediate bioavailability, meaning 100% of the medication reaches the bloodstream.
Ketamine For Treatment-Resistant Depression
Ketamine has begun to solidify its place in the treatment of Major Depressive Disorder (MDD) across the globe.
Studied for its ability to loosen repressed emotional trauma and improve the effects of psychotherapy (MDMA, LSD, Psilocybin) since the early 70’s, ketamine has evolved into one of the most novel treatments for MDD in this century.
Since 2006 ketamine has been studied more in-depth for the treatment of “Treatment-Resistant Depression (TRD)” with a success rate that has climbed as high as 80% or better for many patients who suffer with this debilitating disease.
Thousands of people are placed on antidepressants such as SSRIs, SNRI, and other widely prescribed medications that are ineffective in reducing depressive symptoms. Many of these medications take weeks to months for effects to be realized and often end up starting all over, creating a vicious cycle of one failed treatment after another.
People who are currently struggling with major depressive disorder (MDD) may have TRD if they have not responded adequately to at least two different antidepressants of adequate dose and duration in the current depressive episode.
What Is Spravato (Esketamine)?
With the success of ketamine therapy used intravenously seen across the nation, the creation of an FDA approved treatment was inevitable. In 2019 a nasal spray, esketamine, also known as Spravato, was approved for the treatment of Treatment-Resistant Depression.
Unlike ketamine, Spravato contains only the S-ketamine molecule, which has a higher affinity for NMDA receptors in the brain.
Spravato is self-administered in a healthcare setting under medical supervision. This ensures proper dosage and allows monitoring for any potential side effects, such as dissociation or increased blood pressure. While nasal administration is convenient, it has a lower bioavailability—approximately 50% compared to IV ketamine. Factors like nasal congestion can also impact its absorption.
With the addition of this new medication, patients across the nation now have the option to utilize ketamine or esketamine treatments for their depression.
The science behind ketamine and esketamine
Ketamine is a racemic mixture of two enantiomers that are mirror images of each other, S-ketamine (esketamine) and R-ketamine. Esketamine is the S (+) enantiomer of ketamine.
One of the enantiomers, S-ketamine (esketamine), binds more potently to the N-methyl-D-aspartate receptor than the other enantiomer, R-ketamine. Both enantiomers of ketamine have been researched but so far there is no conclusive evidence about which enantiomer is better for the treatment of mood disorders.
Spravato was created by taking the (S)-enantiomer of ketamine.
Both ketamine and Spravato target the NMDA receptors in the brain, which play a crucial role in regulating mood and emotions. By increasing glutamate levels, these therapies stimulate the growth of new synapses, helping to rewire neural pathways affected by depression and other mood disorders.
Both medications are given under the direct supervision of trained healthcare providers.
Ketamine vs Esketamine (Spravato)
Ketamine and esketamine are very similar in terms of their molecular structure, yet they do differ.
Let's dive into the details of both ketamine and esketamine, in terms of administration, dosage, bioavailability, administration time-frame, medication conjunction, treatment timeframe, and insurance coverage.
Administration |
Ketamine is administered through an IV over a predetermined amount of time to slowly allow for the comfort and ease of transition into a relaxed state to enhance the cognitive effects of the treatment. |
Spravato is self-administered over five to ten minutes in two to three successive intranasal sprays administered in five-minute increments. |
Dosage |
The dose is determined by weight and titrated to effectiveness and comfort of the patient. |
Spravato comes in two doses 56mg and 84mg. Your healthcare provider will select the appropriate dose based on your response to the treatment. |
Bioavailability |
The bioavailability of IV ketamine is 100%. Meaning the dose that is given is the amount that will reach the brain. |
Esketamine has a bioavailability of approximately 50%. Things such as clogged nasal passages and swallowing part of the medication can affect the amount of medication that reaches the brain. |
Administration
|
Ketamine is administered in six Maintenance booster infusions are often needed, and the frequency is individualized based on the response of the client. These boosters may be given once a month to two to three times a year. |
Weeks 1 to 4: Spravato is administered twice a week for eight doses. Weeks 5 to 8: Once weekly Week 9 and after: Every 2 weeks or once weekly* *Dosing frequency will be individualized to the least frequent dosing to maintain remission/response. |
Medication
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Ketamine can be administered in conjunction or as a single treatment for clients with MDD. |
Spravato must be given in conjunction with an oral antidepressant. |
Treatment
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IV ketamine treatment is approximately 1 hour and 15 mins to 1 and a half hours. |
Spravato is a minimum of 2 hours after the initial dose is administered. |
Insurance
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Currently insurance does not pay for the cost of ketamine treatment. Your insurance provider may however reimburse you once treatment is received. |
Your insurance may cover the cost of Spravato. Your responsibility could be as little as $10 for each dose. |
Which treatment is best for you?
Choosing between ketamine and Spravato depends on several factors, including your diagnosis, treatment goals, and personal preferences.
If you’re looking for a rapid and highly customizable treatment, IV ketamine may be the better option. It delivers 100% bioavailability, offers the flexibility of personalized dosing, and has shown broader efficacy due to the presence of both R- and S-enantiomers.
Spravato, on the other hand, is an FDA-approved option with the benefit of insurance coverage, making it more accessible for many patients. Its ease of use as a nasal spray and structured treatment protocol may appeal to those seeking a more standardized approach. Ultimately, the "better" choice comes down to your specific needs, how your body responds to the medication, and your healthcare provider's recommendations.
Spravato Savings Program
Janssen CarePath is now offering a new savings program for eligible commercially insured patients! Eligible patients can pay $10 per treatment for Spravato™ medication costs.
NeuroMend: Leading Provider in Ketamine Therapy
Ketamine therapy is redefining the landscape of mental health treatment, especially for individuals with treatment-resistant depression. Despite the lingering stigma, ketamine’s therapeutic potential continues to gain recognition in the medical community. At Neuromend, we specialize in safe and supportive ketamine IV therapy, providing a tailored approach that prioritizes your comfort and mental health.
Reach out to us today for a free consult and discover how Neuromend’s ketamine therapy can make a difference in your journey to improved mental health.
*Disclaimer: As of September 29, 2023, NeuroMend no longer offers Spravato treatments. We apologize for any inconvenience and encourage you to consult with our team or your healthcare provider for alternative options.
ABOUT NEUROMEND INFUSION CENTER
We are an Evidence-Based Center of Excellence and the leading provider of Ketamine Infusions, IV Infusions and Ketamine Consulting Services for Ketamine Clinics and IV Therapy Clinics.
We Provide Effective Treatment For The Following Conditions: Major Depressive Disorders, Post-traumatic Stress Disorder (PTSD), Bipolar Depression, Obsessive Compulsive Disorder (OCD), Chronic Migraines, Severe Anxiety, Fibromyalgia.
