Ketamine vs. SSRIs: A Comparison of Depression Treatment Options

Depression is a complex mental health condition, and the path to finding the right treatment can vary significantly between individuals. Traditional treatments for depression, such as Selective Serotonin Reuptake Inhibitors (SSRIs), are often the first approach for many patients. However, for some individuals, SSRIs may not provide adequate relief, or they may experience persistent side effects. In such cases, alternative treatments like ketamine and its derivative, esketamine (Spravato), are emerging as viable options. This article will directly compare and contrast the use of SSRIs with ketamine, focusing on their mechanisms of action, effectiveness, safety profiles, and costs. 

Understanding SSRIs 

Selective Serotonin Reuptake Inhibitors (SSRIs) are a first-line treatment for depression. Examples include Prozac (fluoxetine), Zoloft (sertraline), and Lexapro (escitalopram). 

These medications boost the availability of serotonin, a neurotransmitter that helps regulate mood and emotional responses. Additionally, SSRIs have been shown to increase levels of brain-derived neurotrophic factor (BDNF), a protein vital for the growth and survival of nerve cells. BDNF may aid in repairing damage caused by depression and strengthen nerve circuits that are crucial for emotional regulation and resilience. 

At Aurora Wellness Clinic, we provide medication management. We’ll work closely with you to ensure your antidepressant prescriptions and dosages are right for you to maximize benefits and minimize side effects. If SSRIs aren’t right for you, we can help you explore alternative options. 

What is Ketamine? 

Ketamine was initially developed as an anesthetic but has gained significant attention as an alternative treatment for depression and other mental health disorders. Unlike antidepressants, ketamine works through a different mechanism in the brain, blocking proteins called NMDA receptors. This mechanism modulates the signaling of the neurotransmitter glutamate, leading to several downstream effects, including: 

● Increased neural activity in the prefrontal cortex (PFC) - a region that is often underactive in depression 

● Increased synaptic plasticity - the ability for nerve cells to strengthen and to form new connections, helping modulate nerve circuits associated with emotional regulation 

● Increased production of BDNF 

● Changes in functional connectivity (how different brain regions interact) - potentially helping patients “break free” from firing patterns associated with negative thinking

Ketamine is administered through various methods, including intravenous (IV) and intramuscular (IM) injections, nasal sprays, and oral tablets. 

What is Spravato? 

Spravato is the brand name for esketamine, a more targeted version of ketamine that has been approved specifically for treatment-resistant depression (TRD) and major depressive disorder with suicidality (MDSI). Esketamine works similarly to ketamine but has a more potent interaction with NMDA receptors compared to ketamine. 

Unlike ketamine, which is used “off-label,” Spravato is approved by the U.S. Food & Drug Administration (FDA). Licensed providers, such as our Aurora Wellness clinic, follow a strict protocol for administering the medication under medical supervision. 

Effectiveness: Ketamine vs. SSRIs 

SSRIs are effective for 60-70% of individuals with depression, especially when combined with psychotherapy. However, the response time is slower, with noticeable improvement often taking 2 to 6 weeks. For patients with TRD, SSRIs may not provide sufficient relief, leaving them searching for alternative options. 

Ketamine has shown impressive results in treating depression, especially for those who have failed to respond to antidepressants. Studies show that around 50% of patients with TRD respond to ketamine, and 30% achieve full remission. Ketamine also has more rapid action than SSRIs, showing benefits within hours or days after treatment, so it may be the best option for those in need of urgent relief. Studies show that Spravato has a similar effectiveness and rate of onset to ketamine. 

Safety: Ketamine vs. SSRIs 

Both ketamine and SSRIs are generally considered safe when used as prescribed, but they do come with distinct side effects and safety profiles. 

● SSRIs: Common side effects of SSRIs include nausea, weight gain, sexual dysfunction, insomnia, and gastrointestinal disturbances. In some cases, individuals may experience heightened anxiety during the first few weeks of treatment. Long-term use of SSRIs can lead to concerns like dependence, metabolic changes, and cardiovascular issues. 

● Ketamine: Ketamine and Spravato share similar side effects, which are typically mild and resolve after treatment. These may include temporary dissociation, dizziness, nausea, and increased blood pressure. The risk of psychological dependence is relatively low when these medications are administered in a controlled clinical setting. However, ketamine has an abuse potential, and if misused outside a clinical environment, it can have severe health consequences.

Cost Comparison: Ketamine, Esketamine (Spravato), and SSRIs 

Cost is an essential consideration for many patients when selecting a treatment for depression. 

● SSRIs: SSRIs are generally covered by insurance, and their out-of-pocket costs are relatively low, especially compared to more advanced treatments. However, some individuals may still face financial strain depending on their insurance coverage or if long-term treatment is required. 

● Ketamine: Ketamine therapy is typically not covered by insurance and can be a significant upfront investment, particularly if administered via intravenous (IV) infusion. 

● Spravato: Because Spravato is FDA-approved, it is often covered by insurance for patients who meet specific criteria. As a result, it is typically more affordable than IV ketamine therapy. Depending on their insurance plan, Spravato may still have some out-of-pocket costs for some patients, but it is a more cost-effective option for individuals with TRD and MDSI. 

At Aurora Wellness, we work with insurance providers to maximize coverage for our Spravato services. Our medication management services can also help patients navigate the costs of different medications and available insurance options. 

Are SSRIs or Ketamine Right For Me? 

If you're struggling with depression and unsure whether SSRIs or alternatives like ketamine or Spravato are right for you, our team at Aurora is here to help. We'll guide you in choosing the treatment that best fits your needs, considering your medical history, cost, and how quickly you need symptom relief.