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Understanding the Difference Between Spravato (Esketamine) and IV Ketamine: A Comprehensive Guide
- January 3, 2025
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NeuroMod Health
In recent years, ketamine-based treatments have gained significant attention for their potential to treat mental health conditions like depression, particularly for individuals who have not found relief from traditional medications. Among these treatments, Spravato (esketamine) and IV ketamine stand out as two key options, both offering new hope to patients struggling with conditions like treatment-resistant depression (TRD).
While these treatments both involve ketamine, they differ in how they are administered, their chemical makeup, and their FDA-approved uses. In this blog, we’ll explore the differences between Spravato and IV ketamine in detail, breaking it down in a way that’s easy to understand, even if you don’t have a medical background.
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What is Ketamine?
Ketamine was first created in the 1960s as an anesthetic. It is commonly used in surgery due to its ability to induce a trance-like state while providing pain relief, sedation, and memory loss. Over time, researchers discovered that ketamine also has powerful effects on mood and can rapidly alleviate symptoms of depression and anxiety. This discovery has opened the door to using ketamine for mental health treatment, particularly in people who don’t respond to other therapies.
However, not all ketamine treatments are the same. Spravato and IV ketamine are two different forms of this drug, each with its own method of administration and use.
What is Spravato (Esketamine)?
Spravato, also known by its generic name esketamine, is a type of ketamine that is administered as a nasal spray. It was developed by Johnson & Johnson and approved by the U.S. Food and Drug Administration (FDA) in 2019 specifically for treatment-resistant depression (TRD) and depression with suicidal ideation.
How is Spravato Different from Ketamine?
Esketamine, the key component in Spravato, is the S-enantiomer of ketamine. Without diving too deep into chemistry, this simply means that esketamine is one specific half (or isomer) of the ketamine molecule. This S-enantiomer is considered more potent in affecting the brain’s glutamate system, which is involved in mood regulation.
How is Spravato Administered?
Spravato is administered via nasal spray in a clinical setting under medical supervision. It’s not something that can be taken at home. Patients typically go to a doctor’s office or clinic twice a week for the first month, and after that, the frequency decreases based on how well the treatment is working. Because the drug can cause dissociative effects (making you feel disconnected from reality) and increase blood pressure, patients are required to stay under observation for about two hours after each treatment.
FDA Approval and Use
Spravato is FDA-approved specifically for:
- Treatment-resistant depression (TRD): Depression that hasn’t responded to at least two other antidepressant treatments.
- Depression with suicidal ideation: Depression that includes thoughts of suicide.
This makes it one of the few treatments on the market specifically aimed at people who have not had success with standard antidepressants like SSRIs or SNRIs.
What is IV Ketamine?
IV ketamine refers to the use of ketamine that is delivered through an intravenous (IV) infusion. Unlike Spravato, this is the racemic mixture of ketamine, meaning it contains both the S- and R-enantiomers of the drug (as opposed to just the S-enantiomer found in Spravato).
How is IV Ketamine Administered?
IV ketamine is given through an infusion into the bloodstream. This usually takes place in a medical setting like a clinic or hospital. The process involves being hooked up to an IV for a short period of time (typically around 40 minutes). Like Spravato, IV ketamine can cause dissociative effects, so patients are closely monitored during the infusion and for a brief time afterward.
FDA Status and Off-label Use
IV ketamine was originally approved by the FDA as an anesthetic, not as a treatment for depression. However, doctors have been using it off-label for mental health conditions, meaning they prescribe it for uses that aren’t specifically approved by the FDA. This is common in medical practice and legal, especially when emerging evidence suggests that a drug can be effective for conditions beyond its original purpose.
Doctors often use IV ketamine to treat:
- Depression (including TRD)
- Anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Chronic pain
Although IV ketamine is widely used in mental health care, its off-label status means that it might not be covered by insurance, and its long-term effects are still being studied.
Key Differences Between Spravato and IV Ketamine
| Feature | Spravato (Esketamine) | IV Ketamine |
|---|---|---|
| Chemical Composition | Esketamine (S-enantiomer of ketamine) | Racemic mixture (both S- and R-enantiomers) |
| Delivery Method | Nasal spray | Intravenous infusion |
| FDA Approval | Approved for TRD and depression with suicidal ideation | FDA-approved for anesthesia; off-label for depression |
| Administration Setting | Administered in a clinic under supervision | Administered in a clinic or hospital setting |
| Monitoring | Two hours post-administration | Monitored during and after infusion |
| Cost and Insurance | Higher cost but often covered for approved uses | May be less expensive but insurance coverage is limited |
| Frequency of Treatment | Twice weekly for first month, then tapered | Initial series of infusions, followed by maintenance |
Which Treatment is Right for You?
- FDA Approval: If you have treatment-resistant depression or depression with suicidal ideation, Spravato may be your best option, as it is FDA-approved for these conditions and more likely to be covered by insurance.
- Broader Use: If you are dealing with other conditions like anxiety, PTSD, or chronic pain, your doctor may recommend IV ketamine, which is used off-label for these purposes.
- Administration Preference: If the idea of an IV is uncomfortable for you, Spravato’s nasal spray might seem more appealing. However, if you prefer an option that involves a one-time infusion rather than repeated nasal doses, IV ketamine might be preferable.
- Cost and Coverage: Spravato tends to be more expensive upfront but is often covered by insurance for the conditions it is approved to treat. IV ketamine, because it’s off-label, may not be covered by insurance, and you might have to pay out-of-pocket.
Both Spravato (esketamine) and IV ketamine are exciting, fast-acting treatments that offer hope to people with depression and other mental health conditions that haven’t responded to traditional therapies. While they share similarities, they also have important differences in how they work, how they’re administered, and what they’re approved to treat.
If you or a loved one is considering one of these treatments, it’s important to consult with a healthcare provider to determine which option is best suited to your specific needs. With the right guidance, either treatment could potentially offer the relief you’ve been seeking.
