IV Ketamine v. Esketamine (Spravato)
The discovery of ketamine as a highly effective, treatment for a wide range of mood disorders and neuropathic pain has been hailed as arguably the most significant development in psychiatry during the past few decades. It has been designated as a “breakthrough therapy” by the FDA for its exceptional benefits and fast acting results. Ketamine is an effective alternative for treating symptoms of anxiety, depression, PTSD, and more.
1. How does ketamine therapy work?
Ketamine is an NMDA receptor antagonist that works by stimulating brain derived neurotrophic factor (BDNF), activating the limbic system, and strengthening the interaction between the conscious and subconscious levels of the mind. In patients treated with ketamine therapy, researchers have observed increased neuronal growth and connectivity in as little as one hour after treatment that improves mood, cognition and the ability to disengage from routine thought patterns, heal unhealthy neural pathways and achieve clarity.
2. What are the benefits of ketamine therapy compared to conventional treatments?
Ketamine’s response rate is more than double that of traditional antidepressants, especially in patients with treatment-refractory mood and chronic pain, even if their symptoms have persisted for decades without relief. Additionally, ketamine has the ability to go to work rapidly, unlike most antidepressants which can take weeks to exert their full effects.
Ketamine patients identify more strongly with positive self-images and values and often report a newfound sense of meaning or purpose. Ketamine has also been found to increase people’s compassion and sensitivity to others, as well as reduce the fear of death and increase joy in living.
3. What is the difference between IV ketamine and nasal esketamine?
Two of the most researched and evidence-based types of ketamine therapy include:
Intravenous (IV) Ketamine
Intravenous (IV) ketamine has been safely used as an FDA-approved anesthetic since the 1960s, and substantial research supports its off-label use for mood, anxiety, and chronic pain disorders. Ketamine, sometimes referred to as racemic ketamine, is a mixture of two mirror-image molecules “R” and “S” ketamine. IV ketamine have been shown to help relieve symptoms of disorders including:
- Chronic Pain
- Bipolar Disorder
- Phantom Limb Pain
Esketamine, also known as its brand name Spravato, is a different type of ketamine that only uses the “S” molecule. In 2019, Spravato became the first FDA- approved nasal spray to treat:
- Adults with treatment-resistant depression
- Depressive symptoms in adults with suicidal thoughts or actions
4. How are IV ketamine and Spravato administered?
IV ketamine is given as an infusion into the bloodstream. During the infusion, patients experience deep relaxation and typically wear an eye mask in a dimly lit room with aromatherapy. IV ketamine is delivered at a slow and controlled dose and a registered nurse is present for the duration of the infusion. Blood pressure, heart rate and oxygen saturation are monitored.
Spravato is self-administered intranasally with a nasal spray. During the treatment, patients administer the Spravato nasal-spray themselves under the supervision of a healthcare provider. After patients administer Spravato, there is an observation period during which patients can rest comfortably while blood pressure is monitored.
5. Are IV ketamine and esketamine inpatient or outpatient treatments?
Both IV ketamine and Spravato are outpatient procedures that do not require a hospital stay. They are, however, administered under supervision of a healthcare provider. Following both types of ketamine treatment, patients should have someone available to accompany them home safely.
6. How long is an IV ketamine treatment session? What about Spravato?
Each IV ketamine infusion lasts about 40 minutes compared to Spravato treatments which typically last about 2 hours.
7. Will just one treatment session be enough?
While most patients experience positive results after their first ketamine session, one ketamine treatment is typically not sufficient to achieve remission. Subsequent treatment sessions help prolong the positive effects.
For IV ketamine, patients typically receive a course of 6-12 ketamine infusions over 2-4 weeks. The frequency and number of sessions are individualized.
Spravato patients typically self-administer nasal treatment twice weekly for weeks 1-4 followed by once weekly for weeks 5-8. Week 9 or thereafter, Spravato may be administered once every other week for maintenance. The frequency and number of Spravato sessions are also individualized.
8. Are either ketamine or Spravato covered by insurance?
IV ketamine infusions for mood and chronic pain disorders are currently cash pay procedures. For Spravato, patients may receive insurance coverage for the medication cost. Additionally, there is a cash fee for the two-hour Spravato observation.
Our care team can assist patients in determining their specific insurance coverage as well as any out-of-pocket costs. To learn more about ketamine therapy, or to schedule a consultation, contact us with our online form or give us a call at (877) 847-3984.