By ketamine@dmin | April 30th, 2018 | Categories: Ketamine Infusion Therapy

Understanding the differences between IV ketamine vs. esketamine nasal spray can be helpful for those looking for an effective depression treatment. More than 16 million Americans are affected by major depression, and finding innovative treatments that provide better relief than conventional antidepressants is more essential than ever. Failure to treat depression increases the risk of drug and alcohol dependence, as well as the risk for suicide. 

Nasal ketamine, a.k.a. Spravato, was recently approved by the FDA as a treatment for hard-to-treat depression. But how is it different from intravenous ketamine treatment, and is it as effective? Here’s what you need to know.

IV Ketamine vs. Ketamine Nasal Spray: What’s the Difference?

Ketamine v Esketamine Infographic

There are two main routes of administration (ROAs) for ketamine to enter the body: IV ketamine infusions and esketamine nasal spray — also known by its brand name, Spravato. Both are considered safe and effective treatment options but esketamine has relatively little safety and efficacy data when compared to the 50+ years of data about IV ketamine and 20+ years of data about IV ketamine as an antidepressant. Both treatments offer hope to millions of patients suffering from treatment-resistant depression, but there are some important differences to be aware of.

First, note the chemical differences between the medications. Intravenous infusions use racemic ketamine, which is the full ketamine compound composed of both the S and R isomers of the molecule. Esketamine (S-ketamine) nasal spray is only one isomer of the ketamine compound. Both have been shown as effective treatments for severe depression, as well as other conditions such as suicidal thinking, anxiety, post-traumatic stress disorder (PTSD), and bipolar disorder, and some studies have shown the racemic mixture to be more effective than isolating just the S isomer. 

The most significant difference between IV ketamine and Spravato are not the molecules themselves, but the route of administration (ROA). Esketamine is only approved for nasal administration, while the racemic mixture is given intravenously. IV Ketamine infusions deliver ketamine directly into the bloodstream so the bioavailability (the amount of medicine that reaches the bloodstream and can be therapeutic) is 100%. With Esketamine nasal spray however, the bioavailability is typically 25-50%, since it must overcome certain hurdles before it can reach the bloodstream, such as a stuffy nose, variations in nasal cavities, allergies, administration technique, and other challenges of the sinuses, etc. For this and other reasons, the FDA approved Spravato with recommendations that the nasal spray be given in conjunction with a traditional antidepressant for best results.

Another thing to keep in mind is that the protocols surrounding Spravato treatment for depression require patients to stay in clinic for longer visits, many more frequent visits, and over a longer course of treatment than intravenous ketamine protocols. These factors can make esketamine nasal spray for depression cumbersome for some patients.  

Is Esketamine FDA Approved?

Yes. Esketamine, or Spravato, was approved by the FDA in March, 2019. Under the FDA mandate however, Spravato, like IV ketamine therapy, can only be administered by medical professionals in a clinical setting, and is not available for at-home use.

Does IV Ketamine or Nasal Ketamine Work Better?

It is possible to find effective relief through both methods, though there are some considerations to keep in mind.

More than 100 clinical trials conducted by leading medical institutions and universities have proven the efficacy of Intravenous Ketamine Infusion Therapy for the treatment of depression. There is much less research on ketamine administered via other ROAs, such as intranasally, and the research that is available has produced results that dont always hold up the same.

When ketamine is administered through a nasal spray, there are many uncontrollable variables, such as rate of absorption and continuity of care from one visit to the next, whereas intravenous infusions of ketamine are gradual and precise, allowing for maximumly predictable and controllable outcomes. Ketamine Infusion Therapy enables safe and slow exposure to the drug for reliably superior results in relieving symptoms of depression.

Ultimately, it comes down to accessibility. It’s easier for medical providers to offer ketamine nasally so there are likely more locations where patients can receive nasal ketamine than intravenous ketamine. In our experience, some patients experience positive outcomes with esketamine nasal spray, while most benefit from IV infusions. We recommend talking to a specialist with a detailed understanding of both treatment options to see what might be right for you.

How to Get Ketamine Infusion Therapy

World-renowned ketamine treatment experts at Ketamine Clinics Los Angeles provide concierge-level ketamine infusion treatments to patients in Brentwood, Santa Monica, Venice, Beverly Hills, Culver City, South Bay, Manhattan Beach, Redondo Beach, Newport Beach, Playa Vista, Playa del Rey, Marina del Rey, other neighborhoods in Los Angeles, communities in Orange County, and other Southern California areas. KCLA also treats out-of-state and international patients from around the world. 

If you’re searching for “ketamine treatment near me,” visit Ketamine Clinics of Los Angeles, the premier mental health treatment center specializing in ketamine therapy. Contact us to learn more and to schedule your free phone consultation. All inquiries are completely confidential.


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