SPRAVATO® vs. IV Ketamine Therapy: What’s the Difference?
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If you’ve been searching for treatment options for depression that hasn’t improved with traditional medications, you may have come across SPRAVATO® (esketamine) and IV ketamine therapy.
Both treatments are related to ketamine and have been studied for their rapid effects on depression symptoms. But despite their similarities, SPRAVATO® and IV ketamine are not the same treatment.
So, what’s the difference between SPRAVATO® and IV ketamine? How are they administered? Who may benefit from each? And how do you know which option might be right for you? Let’s break it down.
What Is SPRAVATO®?
SPRAVATO® is the brand name for esketamine, a medication derived from ketamine. Unlike traditional ketamine, SPRAVATO® is administered as a nasal spray.
SPRAVATO® is FDA-approved for adults with treatment-resistant depression and can be used either on its own or alongside an oral antidepressant medication. It is also FDA-approved, in combination with an oral antidepressant, for depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior.
Treatment-resistant depression generally refers to depression that has not improved adequately after trying multiple antidepressant treatments.
Because SPRAVATO® may cause side effects such as sedation, dissociation, and increases in blood pressure, it cannot simply be picked up at a pharmacy and taken at home. It must be administered under the supervision of a healthcare provider with patients monitored for at least two hours after treatment.
What Is IV Ketamine?
IV ketamine therapy uses ketamine administered directly into the bloodstream through an intravenous infusion.
Ketamine has been used as an anesthetic for decades, but researchers have also studied its effects on depression and other psychiatric conditions. Unlike SPRAVATO®, IV ketamine is not FDA-approved specifically as a treatment for depression. Its use for psychiatric conditions is considered off-label.
That doesn't mean there isn't evidence supporting its use. Research has found that low-dose IV ketamine can have rapid antidepressant effects, particularly for people with treatment-resistant depression. Clinical guidelines and reviews recognize ketamine and esketamine as potential options when other depression treatments have not provided adequate relief.
At Professional Psychiatric Services, IV ketamine is offered as an alternative treatment option for individuals struggling with treatment-resistant depression and other mental health conditions. PPS's current treatment program typically begins with a series of six infusions over approximately two to three weeks, with each infusion lasting about 40 minutes.
SPRAVATO® vs. IV Ketamine: The Key Differences
While the two treatments are related, there are several important differences to understand.
1. Medication
SPRAVATO®: Contains esketamine, one of the two molecules that make up ketamine.
IV ketamine: Uses ketamine itself, which contains both the R- and S-ketamine molecules.
Both interact with the brain's glutamate system and NMDA receptors, which is different from how many traditional antidepressants work.
2. How It's Administered
SPRAVATO®: Administered as a nasal spray under medical supervision.
IV ketamine: Delivered through an intravenous (IV) infusion, allowing the medication to enter the bloodstream directly.
The route of administration can affect how quickly and predictably the medication enters the body, which is one reason clinicians may consider the two treatments differently.
3. FDA Approval
This is one of the biggest distinctions.
SPRAVATO® is FDA-approved for treatment-resistant depression in adults.
IV ketamine is not FDA-approved specifically for depression or another psychiatric disorder. The FDA-approved ketamine products are indicated as anesthetics, although clinicians may prescribe ketamine off-label for psychiatric conditions.
FDA approval does not automatically mean one treatment is more effective for every person. It means that the medication has gone through a specific FDA approval process for a particular use.
4. Treatment Setting and Monitoring
Both treatments require appropriate medical supervision.
SPRAVATO® has specific requirements through the SPRAVATO® REMS program because of potential risks including sedation, dissociation, respiratory depression, and misuse. Patients must remain under observation for at least two hours following administration.
IV ketamine treatment also involves monitoring throughout the infusion and recovery period. Because ketamine can temporarily affect blood pressure, perception, coordination, and awareness, treatment should be provided by qualified medical professionals in an appropriate clinical setting.
5. Dosing and Treatment Schedule
SPRAVATO® follows an FDA-approved dosing schedule that begins with twice-weekly treatment during the first four weeks. Depending on response and tolerability, treatment may then become less frequent during the maintenance phase.
IV ketamine treatment schedules can vary based on the individual, the condition being treated, and the clinician's treatment plan. At PPS, new patients typically begin with a series of six infusions over two to three weeks.
The goal isn't necessarily to continue treatment indefinitely. Your provider will evaluate your response and determine what makes sense for your individual needs.
What Do SPRAVATO® and IV Ketamine Have in Common?
Despite their differences, there are some important similarities.
Both can work differently from traditional antidepressants
SPRAVATO® and ketamine affect the brain's glutamate system, rather than primarily targeting serotonin or norepinephrine like many traditional antidepressants.
Both may provide relatively rapid effects
One reason ketamine-based treatments have received so much attention is their potential for relatively rapid improvement in depression symptoms compared with traditional antidepressants, which can take several weeks to work.
However, response varies from person to person, and neither treatment should be viewed as a guaranteed or immediate cure for depression.
Both require professional evaluation
Neither treatment is appropriate for everyone. A psychiatric evaluation can help determine whether ketamine-based treatment is appropriate based on your symptoms, medical history, current medications, treatment history, and overall goals.
Both can have temporary side effects
Some people experience effects such as dizziness, nausea, increased blood pressure, sedation, or dissociation during or after treatment. These effects are one reason appropriate medical monitoring is important.
So, Which Is Better: SPRAVATO® or IV Ketamine?
There isn't a universal answer. The best treatment option depends on the individual.
Factors your provider may consider include:
Your diagnosis and symptoms
Whether you've been diagnosed with treatment-resistant depression
Previous antidepressant treatments and how you responded to them
Other medications you're currently taking
Your medical history
Your treatment goals
How you feel about different treatment methods
Your insurance coverage and other practical considerations
It's also important to remember that newer or faster-acting treatments don't necessarily replace traditional mental health care. Medication management, psychotherapy, lifestyle changes, and other treatments may still play an important role in your overall care plan.
Is Ketamine Treatment Right for You?
If you've tried multiple treatments for depression without getting the relief you need, you don't necessarily have to keep doing the same thing and hoping for a different result.
Ketamine-based treatments may offer another option to discuss with a qualified mental health professional.
At Professional Psychiatric Services, treatment is not one-size-fits-all. Our interdisciplinary team offers a range of mental health services and can help you understand your options and develop a treatment plan based on your individual needs. PPS currently offers IV ketamine therapy and SPRAVATO® for treatment-resistant depression, alongside services including medication management, psychotherapy, and Deep TMS therapy.
If you're wondering whether ketamine therapies could be right for you, reach out to PPS to schedule an evaluation and talk through your options with our team.
This article is intended for educational purposes only and does not replace individualized medical advice. Treatment decisions should be made with a qualified healthcare professional who can evaluate your specific needs.
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