Spravato vs Ketamine

Spravato vs. Ketamine: Understanding the Differences 

Spravato and ketamine are both innovative mental health treatments, offering hope to those who haven’t responded to standard therapies. While Spravato is derived from ketamine, the two have distinct features that set them apart. In this article, we’ll examine Spravato and ketamine side by side, highlighting what makes each unique to help you make an informed decision about which option is best for you. 

What is Ketamine? 

Ketamine is a dissociative anesthetic that has been used in medical settings since the 1960s. Originally developed as an anesthetic for surgeries, ketamine has more recently gained attention as a transformative psychiatric medicine. Unlike standard antidepressants, which may take weeks to produce noticeable improvements, ketamine can alleviate symptoms of depression and anxiety within hours. 

Ketamine is commonly administered via intravenous (IV) infusion but can also be given intramuscularly (IM), orally, or intranasally. Ketamine treatments are primarily administered in clinics under the supervision of medical professionals. However, some telehealth clinics provide ketamine through the most, mainly in oral form. 

What is Spravato? 

Spravato is the brand name for esketamine, which is one of the two mirror-image forms (enantiomers) of ketamine. An enantiomer refers to one of two molecules that are mirror images of each other, and ketamine consists of two: R-ketamine and S-ketamine (esketamine). 

Spravato was developed specifically for treatment-resistant depression (TRD) by the pharmaceutical company Janssen and Janssen. Unlike ketamine, which is used off-label for mental health treatment, Spravato received FDA approval for TRD in 2019, providing a regulated and insurance-covered treatment option for eligible patients. The FDA approved Spravato for major depression with suicidal ideation (MDSI) one year later. 

Ketamine vs. Spravato: Mechanism of Action How does ketamine work? 

Ketamine functions by blocking NMDA receptors in the brain, which are proteins involved in learning and memory. This leads to increased several therapeutic effects including:

● Boosts the production of brain-derived neurotrophic factor (BDNF), which supports nerve cell growth and survival. This may help repair neurological dysfunction linked to mental health disorders. 

● Enhances glutamate activity, a neurotransmitter responsible for excitatory signalling between nerve cells. This helps activate nerve circuits which are underactive in mental health disorders. 

● Improves synaptic plasticity, strengthening connections between nerve cells and increasing the brain’s ability to adapt. 

● Enhances functional connectivity, improving communication between brain regions and helping individuals move past rigid negative thought patterns. 

How does esketamine work? 

Esketamine shares a similar mechanism of action, interacting with NMDA receptors. However, esketamine has a stronger affinity for these receptors compared to generic ketamine, and is estimated to be four times more potent. 

Ketamine vs. Spravato: Administration and Dosing How is ketamine administered? 

Ketamine is typically given intravenously (IV), with the drug being injected directly into the veins. A standard dose for depression treatment is 0.5 mg/kg and treatment often begins with an initial phase of six infusions over two to three weeks, followed by maintenance sessions as needed. The doses and treatment schedule can vary significantly, depending on a person’s unique condition and treatment response. 

How is esketamine administered? 

Esketamine is administered as a nasal spray in a clinical setting under strict supervision. Spravato must be administered in line with the Risk Evaluation and Mitigation Strategy (REMS), a set of clinician and patient requirements, to ensure safety. Patients self-administer the spray under the guidance of healthcare professionals and are monitored for at least two hours post-administration. Treatment typically involves two sessions per week for the first month, followed by weekly or biweekly maintenance doses based on the patient’s response. Doses begin with 84 mg, but may be reduced to 56 mg. Unlike ketamine, the dosing and treatment regime is much more fixed. 

Is Ketamine or Spravato More Effective?

In an observational study from Cambridge University, the outcomes of patients with TRD receiving either intravenous ketamine or intranasal esketamine were compared. The study found that both treatments led to improvements in depressive symptoms, with no significant difference in effectiveness between the two. However, patients receiving IV ketamine had slightly better symptom improvements and higher remission rates.

Another observational study from the Mayo Clinic found no significant differences in treatment response or remission scores between adults who had IV ketamine or Spravato. 

Is Spravato Safer than Ketamine? 

Both Spravato and ketamine have similar side effects, including dissociation, dizziness, nausea, and increased blood pressure. However, one study found that IV ketamine was associated with significantly higher treatment-emergent adverse events compared to Spravato. The study reported that dissociation, hypertension, dizziness, and sedation occurred in 50% of IV ketamine patients versus 27% of Spravato patients. However, discontinuation rates due to adverse events were similar between the groups. 

Spravato vs. Ketamine: Cost 

One major factor in choosing between Spravato and ketamine is cost. Ketamine infusions typically cost between $400 and $800 per session and are rarely covered by insurance. In contrast, Spravato is FDA-approved and covered by most insurance plans, significantly reducing out-of-pocket costs for many patients. However, Spravato is exclusively available for patients with TRD and MDSI, and patients must meet the eligibility criteria in order to receive the medication. 

Ketamine vs. Spravato: Which is Right for Me?

When choosing between ketamine and Spravato, consider the following factors: 

● Spravato is only available for specific types of depression whereas ketamine can be used “off-label” for several mental health disorders. 

● Administration Method: Ketamine is typically given intravenously, while Spravato is a nasal spray. The IV route of administration can be more uncomfortable for patients. ● Insurance Coverage: Spravato is often covered by insurance, whereas ketamine infusions may not be. 

● Effectiveness: Both treatments tend to show equal effectiveness in relieving depression. 

● Safety Profile: Both have similar side effects, but Spravato’s monitored administration may offer enhanced safety. 

● Cost: Ketamine infusions can be expensive without insurance coverage, whereas Spravato is typically covered. 

Spravato Treatment at Aurora Wellness

At Aurora Wellness, we’re a REMS-certified provider of Spravato. Our team of dedicated psychiatrists ensures that treatments are administered safely and effectively, providing comprehensive support throughout your mental health journey.