Nasal Esketamine vs. Intravenous (IV) Ketamine

Patients who are candidates for intra-nasal ketamine often do not know the difference between Nasal Esketamine vs. Intravenous (IV) Ketamine. Although both medications are effective for the treatment of resistant depression, they do have some important differences.

Earlier this year, the FDA approved a prescription-only Spravato/ Esketamine nasal spray for the treatment of resistant depression. This medication was well received in the psychiatric community because this drug works completely different than any other anti-depressants available in the market today. In the world of anti-depressants, an upgraded version of a drug is often marketed as a new drug. This is a problem because they essentially work the same way as their predecessor and are often referred to a “me-too drugs”. This can be a problem when a patient erroneously gets switched from one anti-depressant to a different antidepressant that’s a “me-too drug” and expects an improved response. In this case, the reason for treatment resistance is that the medications are mechanistically too similar to have a different response.

Spravato, on the other hand, is a new drug that goes through a completely different pathway in the body. It’s the first FDA approved antidepressant to do this. Although IV ketamine essentially works the same it is not FDA approved. But because so many patients have successfully treated their depression with Ketamine, IV ketamine is frequently used off label for depression.

However, these treatments are very costly and often do not have long-lasting effects. Prices can range between $600 – $800 per treatment and it is recommended to have 6 treatments over a 3 week period. This comes to a grand total of approximately $4200. With multiple treatments often required, most people can not afford to pay for such an expensive treatment. Also, because this is not an FDA approved drug, it is not a benefit covered by insurance companies.

How fast does Spravato (Esketamine) work?

Studies on Spravato (Esketamine) have found that it can reduce symptoms of depression in less than 24 hours. This is very beneficial for people in crisis situations who are at risk of suicide. Patients with treatment-resistant depression report notable improvements in symptoms within the first week of treatment. Most other antidepressants begin to take action over the span of 3- 6 weeks.

How does Spravato work?

Spravato (Esketamine) has unique origins (it is derived from the club drug ketamine) and it works differently from other antidepressants. Oral anti-depressants are thought to treat depression by balancing the neurotransmitters that affect mood. Spravato (Esketamine) targets the NMDA receptor and some evidence suggests that through modulation of the NMDA receptor, there can be actual changes in neuronal connections as well as improved growth and plasticity. Up to now, anti-depressants have only been able to control depressive symptoms rather than actually treating or “curing,” the root cause for the depressed

Who can administer Spravato?

Spravato must be administered by a health care provider at certified Sparvato treatment centers. The recommended schedule calls for two doses weekly for the first four weeks. The patient must be observed for two hours after the dose is administered.
A Time magazine article recording the experience of one patient taking Spravato highlighted both the benefits and downsides of the prescription. In it, a 37-year-old Spravato patient says: “It’s a pain to get done, but I went from being chronically unemployed to holding a job for over a year now. I’m a technical analyst for a human resources technology firm. If the treatment wasn’t working, I would have a harder time keeping the job.”