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The Difference between Ketamine IV vs. SPRAVATO® Nasal Spray
2021-11-23T22:58:40Z
Medically reviewed on by
Regional Medical Director Greater St. Louis
For patients who require a fast-acting treatment for depression, ketamine-derived medications can provide immediate relief from symptoms. While Esketamine nasal spray was FDA-approved for the treatment of depression symptoms in 2019 under the name SPRAVATO®, patients have been receiving intravenous (IV) ketamine treatment for years. If you have treatment-resistant depression (TRD) or major depressive disorder (MDD), receiving ketamine treatment can have significant benefits. You may be wondering, what is the difference between SPRAVATO® nasal spray vs. ketamine IV for depression?
How do Ketamine and SPRAVATO® work?
First developed in the mid-20th century as an anesthetic and pain reliever, ketamine is widely used to provide rapid relief from symptoms of depression. There are two types of ketamine:
- Racemic: A mixture of both “R” and “S” mirror-image ketamine molecules, racemic ketamine is FDA approved as an anesthetic. A low dose is delivered via IV infusion as an off-label treatment for depression patients.
- Esketamine: This form of ketamine uses only the “S” molecule of ketamine and is delivered at certified treatment centers in the form of a nasal spray. SPRAVATO® esketamine spray is FDA approved to treat depression.
Ketamine IV treatment typically involves visiting a provider, getting an intravenous line (IV), and having a medical professional administer a dose of ketamine that is about one-tenth the strength of the dose used for anesthesia. The procedure takes about 40 minutes. Some patients may notice improvement right away, while others won’t notice an improvement in symptoms until they have received two additional infusions. Many recipients of ketamine IV treatment will need to return weekly, or up to three times a week, for continued results.
Esketamine nasal spray is a more potent form of ketamine that works much in the same way as IV ketamine for depression. Instead of receiving the medication from an IV line, however, you’ll spray it up your nose under the supervision of a healthcare provider. Esketamine nasal spray often begins working within hours.
If you have tried at least two antidepressants and have failed to find relief from your depression symptoms, one of these two different forms of ketamine may be right for you.
What is the Difference Between Ketamine IV and SPRAVATO® Nasal Spray?
One major difference between SPRAVATO® nasal spray vs. Ketamine IV is that while Ketamine IV treatments are used for depression, they are not FDA approved for treatment-resistant depression. Ketamine nasal spray, on the other hand, has FDA approval as a depression treatment.
Additionally, patients who are wary of needles may feel hesitant to receive a new intravenous line during each infusion. A nasal spray is a much less invasive method of receiving ketamine treatment.
Effects of Ketamine and SPRAVATO®
Traditional antidepressants are thought to work by boosting serotonin and other neurotransmitters. Those neurotransmitters then affect glutamate, which is also a key neurotransmitter. Ketamine is thought to skip ahead to directly affect the glutamate system. This leads to the activation of receptors that help build new pathways in the brain. Ketamine most likely affects the brain in additional, helpful ways. Researchers are actively studying its effect on treatment-resistant depression to better understand the role ketamine can play.
As with any medication, side effects are possible. The most common side effects of SPRAVATO® are sleepiness, dizziness, a feeling of dissociation, and anxiety. With IV ketamine for depression, side effects can include sleepiness, dissociation, dizziness, and nausea. Both medications should only be given in trusted medical clinics, where medical providers will observe patients for two hours after treatment to monitor for negative side effects.
Both treatments work quickly, but with IV ketamine for depression, it can take three infusions before a patient notices a change in mood. Esketamine nasal spray, on the other hand, often works within hours after treatment.
Another benefit of esketamine is that it may reverse stress-related changes in the brain. In addition, animal studies have indicated that esketamine is beneficial to the hippocampus, which is essential to learning and memory. In the long run, suffering from depression can shrink the hippocampus by up to 20%, making this a notable finding. It means that esketamine may aid in reducing the risk of depression-related dementia.
Which is More Effective?
Whether you choose SPRAVATO® nasal spray vs. ketamine IV treatment, both medications can be beneficial to you. However, because it is not FDA-approved, insurance does not cover IV ketamine for depression. Esketamine nasal spray, on the other hand, is likely to be a treatment covered by insurance. Therefore, the cost of this option will normally be much less. It should also be noted that ketamine or esketamine should be used in conjunction with antidepressants.
Typically, after a small number of infusions of ketamine IV treatment, patients may experience reduced acute thoughts of self-harm, decreased symptoms of depression, and decreased anxiety. The beneficial effects of each IV ketamine infusion can last for up to one week.
In the hours after esketamine nasal spray treatment, patients may experience reduced acute thoughts or actions of self-harm, decreased symptoms of depression, and decreased anxiety. The beneficial effects of esketamine nasal spray can last for up to two weeks.
Schedule Your No-Cost Consultation Today
SPRAVATO® can only be provided at certified clinics, such as Greenbrook Neurohealth Centers. If you believe you might benefit from esketamine nasal spray, schedule a no-cost consultation with the Care Team at Greenbrook Centers today and find out if SPRAVATO® could be right for you.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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