There is no argument that certain drugs have significant therapeutic promise, but they also come with serious risks. No doubt most have read about the tragic death of Matthew Perry in 2023 with ketamine playing a contributing role. Using substances under clinical supervision and using them recreationally are two different and important factors to consider. Let’s find out more about these two drugs which can help with depression and other conditions. What is the difference between Esketamine (Spravato) and Ketamine?
Are Spravato and Ketamine FDA-Approved?
In 2019 Esketamine or Spravato was FDA approved for treatment-resistant depression (TRD) in adults, including those with acute suicidal ideation.
However, Ketamine infusion therapy is not approved as yet.
What Is Ketamine?
Ketamine had traditionally been used as an anesthetic for minor surgical procedures since the 1960s. During the 1990s psychiatric researchers became interested in its ability to reduce depression when administered in very low doses. Many people with depression have a decrease in the number of connections between brain cells. Ketamine seems to help these connections to regenerate.
Since 2000 many patients with depression have found that standard treatments and other therapies plus psychotherapy do not suffice or are ineffective. Ketamine has been able to improve symptoms of depression where other therapies have failed. This includes OCD, PTSD, anxiety disorders, and suicidal thoughts.
What developed was an intravenous administration of ketamine providing rapid antidepressant effects within hours after treatment and allowing lost nerve connections in the brain to regenerate.
Although available in many clinics across the country, this intravenous delivery of ketamine remains off-label and not approved by the FDA for the treatment of depression.
Contact Psychiatry Unplugged if you have questions about its safety.
What Is Esketamine?
Also known as Spravato, Esketamine was FDA-approved in 2019 and is a derivative of Ketamine. It is able to be absorbed by certain areas of skin, so it is administered as an intranasal inhalation or a nasal spray. It is approved for depression and especially treatment-resistant depression, or TRD.
This is relatively new and already patented. It must be administered under clinical care and is taken with an oral antidepressant. The course includes two times a week for four weeks, then more doses once a week for every other week as maintenance.
Precautions and Side Effects for Both Drugs
After receiving the drugs, patients must remain at the psychiatry clinic for one to two hours for observation. Any side effects typically occur within that time frame.
Side effects for both can include vomiting, nausea, panic attacks, and headaches. Additional side effects are sleepiness, increased blood pressure, disassociation, double vision, loss of appetite, and difficulty speaking.
Patients cannot drive home. They must have a friend or relative take them home. Uber or other services cannot be used.
A study done in 2023 found that ketamine and Esketamine are equally effective in improving TRD, but IV infusion treatment is more cost-effective for patients and medical professionals.
Since Spravato/Esketamine is FDA-approved, it is covered by some insurance companies. However, patients must prove they have tried at least two other treatments to improve their depression.
Some Final Thoughts About Risks
It is becoming clear that Ketamine is being used as a recreational drug as well as used for depression. Some clinics dispensing Ketamine are allowing patients to take the drug home.
Patients need to be educated about the dangers of ingesting Ketamine without medical supervision. There are reports that many patients are using more than they are supposed to. It would be helpful to collect data on Ketamine use since Ketamine poisoning increased by 81% between 2019 and 2021. Contact Psychiatry Unplugged if you have tried several types of depression treatments without success. Call (844) 616-1616 to schedule a consultation, or request an appointment through our secure online form. We have psychiatry clinics in Los Angeles, Burbank, and Las Vegas.
