Ketamine or Spravato: What is the Difference?
Learn about the difference between Ketamine and Esketamine, known as Spravato, and how these treatments are administered and might be able to help you.
Ketamine and Esketamine, known as Spravato, are gaining recognition in the mental health field as treatment options for patients diagnosed with treatment-resistant depression, major depressive disorder (MDD), and suicidal ideation. Ketamine is off-label to treat anxiety, PTSD, pain management, and fibromyalgia. If you are considering your treatment options and have not found relief with other medications–ketamine or Spravato might be a treatment option for you.
A study by The Lancet quantified the presence of major depressive disorder and anxiety worldwide as one of the top causes of the global health burden. It has increased sharply since 2020 as a result of COVID-19. Globally, there is a renewed focus on mental health and the need for treatment options and access to mental health services. Spravato is approved by the FDA to treat treatment-resistant depression and is covered by some insurance companies, making it more accessible to those who qualify.
Although Ketamine and Spravato share some similarities, they differ in many ways. At Mindwell, we can help you decide which option is best for you based on your medical history.
What is Ketamine?
Ketamine is traditionally known as a dissociative anesthetic and has been used during surgery for nearly six decades. The FDA approved ketamine in 1970 for procedural sedation. It is a common emergency room anesthetic because of its ability to maintain breathing and heart function during surgery while keeping the mind sedated and pain levels low. Ketamine’s interaction with the NMDA receptor is believed to be the reason it causes amnesiac, anesthetic, and dissociative effects.
In the mental health field, ketamine has been studied for over 20 years as an alternative to major antidepressant drugs and treatments. Ketamine given intravenously, in the form of an IV, remains an off-label use for anxiety, PTSD, and pain management.
How is Ketamine Administered?
Ketamine can be administered intravenously or by a sublingual tablet placed under the tongue or between the gums and cheek. At Mindwell, we offer intravenous ketamine treatments. Intravenous administration allows the most control over the dose and how quickly the ketamine is administered. Although uncommon, if a patient becomes nauseous or needs to slow down the treatment, the IV allows the health professional to stop the treatment and meet the patient’s needs. When the patient feels better, the treatment can start again. The treatment generally takes an hour from start to finish. After the treatment is complete, the patient can not drive for 24 hours, transportation should be arranged.
What are the Benefits of Ketamine?
Ketamine is not FDA-approved for the treatment of depression, but it has a long history of being an “off-label” treatment option for patients with a wider variety of symptoms. Ketamine treatments can be used with antidepressants, but they are not required. Many people report feeling changes immediately after their first treatment. Ketamine continues to work even after it has been metabolized in the body. The time frame directly following treatment is crucial for making progress. Preliminary studies show that when ketamine treatments are combined with talk therapy like Cognitive Behavioral Therapy, the antidepressant effects are sustained for a longer period.
What is Spravato?
In 2019, Janssen Pharmaceuticals applied for and received FDA approval for its intranasal drug called Spravato. Spravato, the brand name for esketamine and was created by taking the (S)-enantiomer of ketamine. Spravato is approved to treat treatment-resistant depression or major depressive disorder (MDD) with suicidal thoughts or actions. Treatment-resistant depression is defined as having tried two or more antidepressants at the appropriate dose and duration, without finding relief. Spravato is not approved as a treatment for preventing or relieving pain.
Traditional antidepressants target serotonin, norepinephrine, dopamine, and glutamate. The goal is to increase communication between neurotransmitters to elevate a person’s mood, but this can take weeks or months to see an improvement–if any at all.
On the other hand, Spravato skips those neurotransmitters and goes to work immediately on glutamate production, which is the most abundant chemical messenger in the brain. This boost in glutamate production excites brain cells and boosts brain function, memory, and helps with depressive symptoms. Spravato is fast-acting, and patients can feel a sense of relief within 24 hours of treatment.
How is Spravato Administered?
The treatment plan for Spravato is different from an IV infusion. Spravato is taken intranasally through a spray inserted into the nostril and inhaled through the nose. The esketamine is absorbed by the nasal passage lining and enters the bloodstream.
At Mindwell, the course of treatment for Spravato is twice a week for the first month. During the second month, they take it once a week. After that, they'll take it once a week or once every two weeks. Spravato will be self-administered in the office under the supervision of a healthcare provider. Once the nasal spray is administered, the patient will relax for two hours under physician observation. After the treatment is complete, the patient can not drive for 24 hours, transportation should be arranged.
What are the Benefits of Spravato Treatment?
Spravato is made from esketamine, it is believed to be the more potent molecule of ketamine. The potency means that lower doses can be administered, and some people report that the side effects are less with Spravato than with IV Ketamine treatments.
During the main clinical trial for Spravato, those who took Spravato along with their oral antidepressant experienced a greater reduction of depression symptoms at four weeks compared to those who received a placebo plus an oral antidepressant. Spravato is approved to be used in conjunction with an oral anti-depressant to treat treatment-resistant depression. It can take some patients between one and three sessions to feel the benefits of Spravato.
Will Insurance Cover Treatment?
Spravato is FDA-approved, and many insurance companies cover treatment. Mindwell is in the process of getting “in-network” with many insurance providers in the Greenville area. You can contact us at our office to find out if your insurance will cover or reimburse your treatment with Spravato. Ketamine is still considered off-label and is not covered by insurance.
Explore Your Treatment Options With Mindwell
Have you tried SSRIs without success? Most people who suffer from pain, treatment-resistant depression, PTSD, and anxiety finally find relief with ketamine therapy. We understand that the process of trying treatment after treatment can be overwhelming, confusing, and costly–but it doesn’t have to be! At Mindwell, we offer ketamine treatments that show positive results for people who haven’t found relief with other therapies.
Mindwell serves the greater Greenville, South Carolina area and beyond, our experienced and trustworthy medical staff can help guide you during this process. Contact us today and set up a consultation to see if ketamine treatments are right for you. There is no charge for this informational call. Contact us by phone, email, or the contact button to get started.
Disclaimer: This material is intended for general information purposes only and does not constitute medical advice. Responses to inquiries, whether by email, telephone, or other means, do not constitute medical advice.
