For individuals struggling with treatment-resistant depression (TRD), both Spravato nasal spray and ketamine infusion therapy have emerged as groundbreaking treatments offering hope. While both are derived from ketamine and show remarkable effectiveness, they differ in their delivery method, composition, and administration process.
Understanding the distinctions between Spravato and ketamine infusions can help individuals make informed decisions about which treatment might best suit their needs. In this blog post, we’ll break down the key differences, from how they work to their safety, cost, and accessibility.
An Overview of Spravato Nasal Spray
Spravato is the brand name for esketamine, a derivative of ketamine. It was approved by the FDA in 2019 specifically for treatment-resistant depression when used alongside an oral antidepressant. Administered as a nasal spray, Spravato is designed to be more convenient and less invasive than traditional IV ketamine infusions.
Esketamine, the active ingredient in Spravato, is more potent than regular ketamine, which means smaller doses are required to achieve similar therapeutic effects.
Ketamine Infusion Therapy: A Brief Introduction
Ketamine infusion therapy involves administering racemic ketamine intravenously (IV). Racemic ketamine contains two mirror-image molecules: R-ketamine and S-ketamine. Both molecules work on the brain’s NMDA receptors, but the combined effect helps restore mood regulation pathways.
IV ketamine therapy has been used for decades as an off-label treatment for depression, anxiety, PTSD, and suicidal thoughts. It is not FDA-approved for mental health conditions, but numerous studies have demonstrated its rapid and effective results.
Key Differences Between Spravato and Ketamine Infusions
Composition
- Spravato (Esketamine): Contains only S-ketamine, the more potent half of racemic ketamine.
- Ketamine Infusion: Contains both R-ketamine and S-ketamine (racemic ketamine), which may offer broader effects for some patients.
Administration
- Spravato: Administered as a nasal spray in a clinical setting. Patients typically self-administer the spray under supervision.
- Ketamine Infusion: Delivered intravenously (IV) directly into the bloodstream over 40-60 minutes in a monitored medical setting.
FDA Approval
- Spravato: FDA-approved specifically for treatment-resistant depression in combination with oral antidepressants. This means it is widely recognized and covered by insurance plans.
- Ketamine Infusion: Used as an off-label treatment for depression, anxiety, PTSD, and suicidal ideation. FDA approval has not yet been given for these conditions.
Time to Effectiveness
- Spravato: Patients often require multiple sessions over several weeks before experiencing significant relief. Effects may not be as immediate as IV ketamine.
- Ketamine Infusion: Many patients report significant relief within hours or days of the first session, particularly for suicidal thoughts or severe depression.
Cost and Insurance Coverage
- Spravato: Since it’s FDA-approved, Spravato is more likely to be covered by insurance, though costs can vary. Out-of-pocket expenses are still significant without coverage.
- Ketamine Infusion: Generally not covered by insurance because it’s off-label. Each session can cost between $400 to $800 or more, depending on location and provider.
Duration and Treatment Schedule
- Spravato: Requires a specific treatment plan—initially twice per week for four weeks, then transitioning to weekly or bi-weekly maintenance. Each session involves monitoring for two hours.
- Ketamine Infusion: Typically involves an initial series of 6 sessions over 2-3 weeks, followed by maintenance infusions as needed. Sessions usually last about an hour with additional recovery time.
Which Treatment Is Right for You?
The choice between Spravato nasal spray and ketamine infusion depends on several factors, including:
- Severity of Symptoms: If you need rapid relief from suicidal thoughts or severe depression, IV ketamine may work faster.
- Insurance Coverage: Spravato’s FDA approval makes it a more cost-effective choice if insurance covers it.
- Preference for Administration: Some individuals prefer the non-invasive nasal spray (Spravato) over IV infusions.
- Treatment Goals: If broader effects are desired, the combination of R- and S-ketamine in IV therapy may be advantageous.
Consulting with a psychiatrist or mental health professional can help determine which treatment aligns with your needs.
Safety and Side Effects
Spravato
Common side effects include:
- Dizziness or lightheadedness
- Nausea or vomiting
- Dissociation (feeling “spaced out”)
- Elevated blood pressure
Ketamine Infusion
Side effects are similar to Spravato and include:
- Mild dissociation or hallucinations
- Nausea
- Elevated heart rate or blood pressure
Both treatments require monitoring in a clinical setting to ensure safety and minimize risks.
The Bottom Line
Both Spravato nasal spray and ketamine infusion therapy are revolutionary treatments for individuals suffering from treatment-resistant depression. While they share similarities, their key differences in composition, administration, FDA approval, and cost make them unique options.
Spravato offers a convenient, insurance-backed nasal spray treatment, while IV ketamine provides rapid relief with a broader spectrum of therapeutic effects. By understanding these differences, you can work with your healthcare provider to determine which option will best support your mental health journey.