The Difference between Ketamine IV vs. SPRAVATO® Nasal Spray

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.