Depression is one of the most widespread mental illnesses and a leading cause of disability both in the U.S. and globally. For decades, depression has been treated with a class of drugs called antidepressant medications.
These medications increase levels of serotonin and other neurotransmitters in the brain to help alleviate symptoms. However, they can take weeks or even months to produce the decided effects, and in some cases, they don’t work at all.
That’s why there’s been a lot of excitement around ketamine therapy as a potential treatment for mental illness. Ketamine therapy is a ground-breaking treatment that can offer rapid relief from severe depression and anxiety disorders.
Ketamine is very unique from traditional antidepressants and works in a completely different way. Rather than increasing levels of neurotransmitters, ketamine works by blocking the NMDA receptor.
This triggers a cascade of events that leads to the development of new neural connections in the brain, helping improve communication between nerve cells and alleviate symptoms of depression and anxiety.
What is Ketamine Infusion Therapy?
Ketamine for mood disorders is typically administered intravenously (IV) In low controlled doses in what has become known as ketamine infusion therapy. Ketamine infusions have a high bioavailability, meaning that they are rapidly absorbed into the bloodstream and have a rapid onset of action.
Thanks to the high efficacy of ketamine infusion therapy, it has become one of the most popular treatments for treatment-resistant mental illnesses.
What is Spravato?
Spravato (esketamine) is a ketamine-based nasal spray that the FDA approved in 2019 to treat severe depression.
Spravato is thought to work in a similar way to ketamine, by blocking the NMDA receptor and helping to create new neural connections in the brain.
Comparing Ketamine Infusions & Spravato
Spravato offers many of the same benefits as ketamine infusions, but there are some critical differences between the two treatments.
Mode of Administration
The main difference between ketamine infusions and Spravato is the way in which they are administered. Spravato is administered intranasally, while ketamine is administered intravenously. This means that Spravato is much less invasive than ketamine infusions which require the placement of an IV in the arm.
Bioavailability
Ketamine infusions are introduced directly into the bloodstream, which translates to a 100% bioavailability. Spravato, on the other hand, is only absorbed into the bloodstream partially when it’s introduced through the nose. This means that a higher dose of Spravato may be necessary to achieve the same therapeutic effect as ketamine.
Chemical Composition
Ketamine is a racemic mixture of two enantiomers: (R)-ketamine and (S)-ketamine. Spravato, on the other hand, is only (S)-ketamine. (S)-ketamine is thought to be up to three times more potent than (R)-ketamine. This means that Spravato may be more effective than ketamine, but this has not yet been proven in clinical trials.
Applications
Spravato is tailored for use in patients with severe depression who have not responded to other treatments. Ketamine, on the other hand, has shown great potential in treating a wide range of mental and physical health conditions, including depression, anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, chronic pain, suicidal ideations, and substance use disorders.
Insurance Coverage
Being an FDA-approved treatment, Spravato treatment is, in most cases, covered by insurance. Ketamine infusion therapy, on the other hand, is considered an off-label treatment not always covered by insurance. However, some insurance providers may offer reimbursement for ketamine infusion therapy after reviewing the individual case.
Dosage
During ketamine infusion, the dosage is titrated based on the patient’s weight and response to the medication, offering more flexibility. Spravato, on the other hand, is pre-packaged in specific dosages (56mg and 84mg), and patients and the provider will decide which dosage is best based on the patient’s response to treatment.
Bottom Line
Both ketamine infusions and Spravato offer rapid antidepressant effects in patients with severe depression who have not responded to other treatments. Ketamine infusion therapy is more flexible when it comes to dosage, while Spravato is less invasive thanks to its intranasal administration.
The decision of which treatment is best for each patient will be made on a case-by-case basis by the patient and their provider. If you or someone you love is struggling, don’t hesitate to reach out to a ketamine infusion center near you to see if this life-changing treatment could be right for you.
