As non-traditional treatments for depression have grown in both popularity and medical acceptance, ketamine has increased in use as a method for treating depression. If you have considered alternative methods for treating your treatment-resistant depression, you have likely heard of using Spravato or ketamine to help your symptoms.
Many people hear “Spravato” and “ketamine” used interchangeably, but is Spravato the same as ketamine? Spravato is actually derived from ketamine, but they are not the same thing. While they have similarities, both in chemical structure and in use, there are important differences between Spravato and ketamine that you should know before deciding what treatment method is right for you.
Ketamine was originally developed as an anesthetic in the 1960s. Ketamine binds to NMDA receptors in the brain, increasing the amount of the neurotransmitter glutamate and leading to new neural pathways. It’s been shown to reduce symptoms of depression, and most significantly, suicidality.
While ketamine is often associated with recreational use, it is regularly used in clinical settings now to treat treatment-resistant depression and other mental health issues. In a clinical setting, ketamine is administered intravenously, after which the patient is kept for observation.
Ketamine therapy is legal in a clinical setting, but it’s labeled a Schedule III controlled substance and is illegal for recreational use. Ketamine is not FDA-approved and is not covered by insurance.
Spravato is an FDA-approved nasal spray – the brand name for esketamine – approved in 2019. It is a derivative of ketamine, not the same molecule, and it is the only form of ketamine that is FDA-approved.
Spravato is administered nasally in a clinic with supervision. It’s used primarily for treatment-resistant depression and Major Depressive Disorder (MDD) with suicidal ideation. After taking Spravato, 50-70% of patients with treatment-resistant depression experienced significant relief.
There are several significant differences between ketamine and its derivative esketamine (Spravato), including:
Setting. Ketamine is usually administered in specific ketamine clinics, while Spravato is used in certified psychiatric healthcare settings.
There are many similarities between ketamine and Spravato. Both act on NMDA receptors, changing neural pathways in similar ways and creating similar effects on patients’ moods. And while they’re administered in different ways, this doesn’t seem to make much of a difference on their effectiveness; one Yale study found no difference between nasal esketamine and IV ketamine administration in their effectiveness.
Both treatments are also fast-acting compared to traditional antidepressants. Patients often notice reductions in their depressive symptoms immediately following or even during a session, as opposed to needing to wait weeks to see if antidepressants work.
Both treatments are used for treatment-resistant depression. They’re particularly effective at reducing depressive symptoms that don’t respond well to antidepressants. Because they target glutamates, they work well for those who don’t respond well to serotonin-based antidepressants.
And of course, both treatments require clinical supervision. Both treatments can have acute psychiatric effects – primarily disassociation – while patients undergo treatment, making it essential that they are both administered in a controlled clinical setting.
Spravato and Ketamine are not for everyone. While ketamine has a reputation for recreational use, it is not compatible with every potential patient and should only be administered to those who have undergone proper vetting.
Spravato is potentially suitable for patients who have tried at least two antidepressants without success. In some cases, it may be acceptable for patients with MDD who have suicidal ideation, given its extremely powerful effects at reducing suicidality. In other cases, it may be difficult to get a psychiatrist to agree to administer Spravato or for insurance to cover it.
Ketamine infusions are often sought by patients not covered for Spravato, or those who prefer IV delivery. Because it’s administered in ketamine clinics and is seldom covered by insurance, the parameters to qualify for ketamine therapy are not quite as strong as those for Spravato, but the basic principles still apply. It’s best for patients with treatment-resistant depression and suicidal ideation, but it’s also used for those with PTSD or chronic pain.
Whether or not you end up qualifying for Spravato or ketamine therapy, it’s very important that you consult a psychiatrist or mental health provider before attempting to take either medication. Recreational ketamine can be extremely dangerous – both for your mental and physical health — so avoid bypassing official channels when attempting to use it.
If you’re unsure about using more medications to treat your depression, you can also consider trying Transcranial Magnetic Stimulation (TMS). TMS is a non-drug, FDA-cleared option to treat treatment-resistant depression using magnetic stimulation of neural pathways.
Critically, TMS has no known systemic side effects, and it’s covered by most insurance plans. Those in the Clearwater/Tampa Bay area can check out Advantage TMS to learn more about TMS intervention for depression and get started with their treatment.
Fortunately, there are many options available now to alternatively treat treatment-resistant depression. Spravato and ketamine are related, but they’re not identical. Still, both show promise for alleviating treatment-resistant depression and suicidality.
At Advantage TMS, we can discuss your treatment-resistant depression options like whether Spravato or TMS might help your symptoms and answer any additional questions you may have about your treatment plan. Give us a call today!
Li L, Vlisides PE. “Ketamine: 50 Years of Modulating the Mind.” Frontiers in Human Neuroscience. 2016;10:612. https://doi.org/10.3389/fnhum.2016.00612
Nikayin S, Murphy E, Krystal JH, Wilkinson ST. “Comparative effectiveness of intravenous ketamine and intranasal esketamine in clinical practice among patients with treatment-refractory depression: an observational study.” Journal of Clinical Psychiatry. 2023;84(2). https://pubmed.ncbi.nlm.nih.gov/36724113/
U.S. Department of Justice, National Drug Intelligence Center. “Ketamine Fast Facts.” Product No. 2003-L0559-011. June 2003. https://www.justice.gov/archive/ndic/pubs4/4769/index.htm
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