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.
Depression is a mental health disorder that affects millions of people worldwide. While traditional oral antidepressants are effective for many people, there are still many individuals who do not respond to these medications. This is where Spravato comes in. Spravato is a medication that has been approved by the FDA for the treatment of depression, and it works in a different way than traditional oral antidepressants.
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 which 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 can also have transformative effects on an individual’s worldview. Following treatment, many people who have experienced ketamine report beneficial shifts in their awareness or perspective.
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:
- Anxiety
- Depression
- Chronic Pain
- PTSD
- Bipolar Disorder
- Fibromyalgia
- Phantom Limb Pain
- Neuralgia
Esketamine (Spravato)
Spravato, also known as esketamine, is a type of medication that is administered as a nasal spray. It is a derivative of ketamine, which is an anesthetic drug that has been used for decades. Spravato works by blocking a receptor in the brain called N-methyl-D-aspartate (NMDA). By blocking this receptor, Spravato increases the production of a neurotransmitter called glutamate. Glutamate is essential for the growth and development of neurons in the brain, and it is believed to be involved in the formation of new neural connections. By increasing the production of glutamate, Spravato is believed to help improve the symptoms of depression.
Spravato is effective for individuals who have not fully responded to traditional oral antidepressants. There are many people who have tried several different antidepressant medications and have not found complete relief from their symptoms. In these cases, Spravato may be a viable option.
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 the 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. Thereafter, Spravato may be administered once every other week for maintenance. The frequency and number of Spravato sessions are also individualized.
Additional Facts About Spravato
- Administration: Spravato is administered via nasal spray under the supervision of a healthcare provider, while oral antidepressants are taken in pill form at home.
- Chemical structure: Spravato contains esketamine, which is chemically different from traditional oral antidepressants such as SSRIs and SNRIs.
- Speed of action: Spravato has been shown to have a faster onset of action, with some patients experiencing relief from depression symptoms within hours or days of treatment. Many people who have taken oral antidepressants report that it can take several weeks or even months for the medication to take effect.
- Dosage: The dosage of Spravato is administered in a specific way, with the initial doses given more frequently than maintenance doses. In contrast, oral antidepressants are typically taken at a consistent daily dose.
- Frequency of administration: Spravato is typically administered twice weekly for the first month, and then weekly or bi-weekly thereafter, while oral antidepressants are taken daily.
- Side effects: Both Spravato and oral antidepressants can cause side effects, but the types and severity of side effects differ. Common side effects of Spravato include dissociation, nausea, and dizziness. These side effects can occur during an active treatment session but typically subside the same day. Conversely, common side effects of oral antidepressants include weight gain, sexual dysfunction, gastrointestinal issues, and other systemic side effects.
- Efficacy: Clinical trials have shown that Spravato can be effective in treating treatment-resistant depression, while oral antidepressants have been shown to be effective for a range of depressive disorders.
- Cost: Both Spravato and oral antidepressants can be covered by some insurance. At Neuro Wellness Spa, we are proud to accept nearly every insurance provider. Plus, our team handles all the paperwork, so you can focus on what’s important.
- Accessibility: As Spravato must be administered in a REMS-certified healthcare setting, it may not be as accessible for patients who live in remote or rural areas, compared to oral antidepressants which can be obtained through a pharmacy.
- Potential for abuse: Spravato is not physically addicting but it could be psychologically addicting if used recreationally at higher doses or greater frequencies than healthcare professionals use clinically.
Spravato is a promising medication that offers a different approach to treating depression than traditional oral antidepressants. There are many people who have tried several different antidepressant medications and have not found little relief from their symptoms. In these cases, Spravato may be a viable option.
If you would like to learn more about ketamine-based medications, or you need a referral to a trusted provider, schedule an appointment today. Neuro Wellness Spa also offers a range of effective mental health treatments, including talk therapy, psychiatric medication management, and TMS therapy known to treat depression successfully. Schedule a consultation today.