Ketamine vs Spravato: Hope for Treatment-Resistant Depression

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Feb 18

Written By KetaRevive

Feeling lost in a maze with no exit, even after trying conventional antidepressants? This is a reality for many battling treatment-resistant depression. The emerging discussion around ketamine vs Spravato is bringing new hope to those with treatment-resistant depression, major depressive disorder, and even suicidal thoughts.

Ketamine and Spravato (esketamine) are gaining attention as potential mental health breakthroughs, but they operate differently. They're transforming lives when traditional oral antidepressants fall short. Exploring options like ketamine treatments could offer a new path.

Understanding Ketamine and Spravato

Ketamine, historically used as an anesthetic, is now recognized for its potential in treating depression and certain pain conditions. In the 1990s, Yale researchers discovered that low doses of IV ketamine could provide rapid relief, particularly for treatment-resistant cases. This has led to its increasing use as an alternative depression treatment option.

Spravato, containing the active ingredient esketamine, is an FDA-approved nasal spray. Spravato is specifically for treatment-resistant depression (TRD) and major depressive disorder with suicidal ideation (MDSI). Spravato nasal spray is designed to complement an oral antidepressant, adding an extra layer of support.

How Do They Work?

Both ketamine and Spravato influence the brain's NMDA receptors, crucial for synaptic plasticity. By interacting with these receptors, they aim to boost glutamate levels. Glutamate is a key neurotransmitter.

This process helps improve communication between brain cells. Enhanced connections are vital for mood regulation. It also helps cognitive functions like memory.

Long-term depression can shrink the hippocampus by up to 20%. Spravato promotes neuroplasticity. This could help regenerate crucial brain connections diminished by depression.

Administration and Access

Ketamine is typically administered intravenously. Nasal Esketamine vs. Intravenous (IV) Ketamine clarifies the differences in treatment administration methods. The intravenous ketamine delivery method ensures rapid and controlled dosage.

Spravato, a nasal spray, offers self-administration under medical supervision. This method provides a less invasive treatment option. Patients receive the nasal spray spravato at a certified treatment center.

Spravato, classified as a controlled substance (DEA Schedule III), carries a risk of misuse. The FDA hasn't issued specific guidelines for ketamine use. Both substances have addictive potential.

Effectiveness of Ketamine vs Spravato

How do their effectiveness compare? A Cambridge study in *The Journal of Clinical Psychiatry* indicated similar efficacy between ketamine and Spravato for TRD.

Yale University research also found no major difference in patient response between intravenous and intranasal forms. However, a 2022 *BMC Psychiatry* study reported a higher response rate for IV ketamine (70.6%) compared to intranasal esketamine (52.9%). Intravenous ketamine appears to be a highly effective depression treatment option for some.

Ketamine boasts a 70% success rate with TRD, with nearly 90% experiencing symptom relief in clinical trials. Research indicates that 35% of IV ketamine users achieve complete remission. These ketamine treatments offer hope where other treatment options have failed.

Breaking Down the Specifics: Ketamine vs. Spravato

Several key differences warrant consideration. The differences are important when deciding between treatment options. Here is what people should know.

Chemical Composition

Generic ketamine is racemic ketamine, comprising equal parts esketamine and arketamine. This combination might influence the body's response to treatment. This generic drug form has been used for decades, though not always for mental health disorders.

Spravato exclusively uses esketamine. Preclinical studies suggest esketamine's 2- to 3-fold higher affinity for NMDA receptors. This means it is potentially effective at lower doses than racemic ketamine.

Cost and Insurance

Cost is often a major factor. Generic ketamine isn't typically covered by insurance for depression as it's used off-label, usually leading to out-of-pocket expenses.

Spravato, including Medicare, often receives insurance coverage. However, total Spravato treatment costs can be six times higher than ketamine treatment, despite similar outcomes. Many insurance companies require prior authorization for Spravato.

For Spravato, programs like "Spravato with Me" can potentially reduce costs to as low as $10 per visit.

Side Effects

Research indicates that ketamine and Spravato have similar side effects. These can include nausea, dizziness, or even panic attacks. Common side effects may also include elevated blood pressure.

These side effects are usually transient, resolving within a few hours. Monitoring by a healthcare provider during and after esketamine administration is mandatory.

Although intravenous delivery might seem daunting for those with needle phobias, it's common to need an IV at some point. Intravenous ketamine is a controlled and effective method.

Long-Term Usage

Treatment frequency can vary.

Spravato typically involves twice-weekly sessions for the initial month, followed by a maintenance phase of less frequent treatments. Eventually tapering to discontinuation.

Since ketamine isn't FDA-approved for depression, there's no standard guideline. It's making each ketamine therapy approach individual. This often involves an initial series of IV infusions followed by maintenance treatments as needed.

Ketamine and Pain Management

Ketamine isn't solely for depression. A 2019 review highlighted its short-term pain relief benefits. A 2014 study showed low-dose ketamine providing substantial relief for neuropathic pain, with effects potentially lasting up to three months.

A Quick Glance at Benefits

Treatment: IV Ketamine

Success Rate/Improvement: 70% success for TRD; 90% saw reduction in symptoms

Noteworthy Details: 35% experience complete remission after full treatment; effective in reducing suicidal thoughts and provides relief from Post Traumatic Stress Disorder.

Treatment: Spravato (Esketamine)

Success Rate/Improvement: Up to 46.1% remission rate; 62% better social functioning

Noteworthy Details: Improvements seen in work ability, quality of life, and overall health; FDA-approved and generally covered by insurance coverage, even with some health disorders.

Weighing Ketamine vs Spravato: The Options for Depression

The best path for major depressive disorder depends on individual factors. Balancing cost against convenience is essential. Spravato may be more convenient due to its nasal spray delivery method.

Ketamine appears superior based on research for efficacy. If previous depression treatments have proven ineffective, finding a suitable medical approach is urgent. Choosing the method that works for the individual may provide clarity.

Frequently Asked Questions (FAQs)

What is the main difference between ketamine and Spravato?

Ketamine is a racemic mixture administered typically via IV infusion, while Spravato is an FDA-approved esketamine nasal spray. Ketamine works a little differently than Spravato and the method works through different routes as well.

Is Ketamine or Spravato better for treatment-resistant depression?

Both show similar effectiveness. Although some studies suggest IV ketamine may have a slightly higher response rate. If other treatments haven't worked then a medical professional can provide an approved treatment.

Are there any off-label uses for ketamine?

Yes, ketamine is used off-label for conditions like neuropathic pain and Post Traumatic Stress Disorder. It shows promising results. Always discuss with your healthcare provider.

Which treatment is more affordable?

IV ketamine is often more affordable upfront. While it's not usually covered by insurance, Spravato's total treatment cost can be higher, even with insurance coverage. There are still financial programs to help people with Spravato costs.

How do I know which treatment is right for me?

Consult with your healthcare provider. You should discuss your medical history, and treatment goals. Your doctor should be able to assess what is the proper and effective treatment for your depression symptoms.

Conclusion

For those battling treatment-resistant depression, exploring ketamine vs Spravato is crucial. Discuss your history, health, and goals with your healthcare provider. It could lead to better effective mental health.

Both IV ketamine and Spravato can be transformative for individuals with severe depression. Considering all factors ensures an informed decision. There are options for you if conventional antidepressants do not work.

Always prioritize finding a treatment that aligns with your needs.

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