On March 5 of this year, the FDA approved a new therapy option for treatment resistant depression: esketamine (marketed as SPRAVATO™). Esketamine is similar to an existing drug—known as ketamine—which has a long history as a safe and effective fast-acting anesthetic and has also been increasingly used to treat depression and suicidal ideation. Because esketamine and ketamine are similar, exactly why they are similar, and more importantly, how they differ, can be tricky. Here are some key FAQs that can help you understand these two treatment options and help you decide if one might be the key in treating your depression.
Esketamine is derived from ketamine. Ketamine is composed of two mirror-image molecules that exist together but spin in difference directions. This is called a racemic mixture; ketamine is composed of two molecules known as R-ketamine and S-ketamine. When a racemic mixture is separated, each molecule on its own is called an enantiomer. Therefore, as the S-enantiomer of ketamine, esketamine is literally one-half of the molecular compound ketamine.
Although scientists are still studying exactly how and why these drugs stimulate relief from depressive symptoms so quickly and so effectively, most researchers currently believe that both drugs work by acting as N-methyl-D-aspartate (NMDA) receptors. Both medications restore the brain’s proper levels of a compound known as glutamate, which in turn re-establishes the correct balance of neurotransmitters required for a healthy, well-functioning brain.
Are ketamine and esketamine administered in the same way?
The route of administration is one of the biggest differences between ketamine and esketamine.
Ketamine Infusion Therapy delivers a precisely-controlled low dose of ketamine directly into the bloodstream through an IV. This delivery mechanism ensures that 100% of the drug enters the body; moreover, each treatment can be precisely controlled and quickly altered to meet the needs of each patient, each time.
Esketamine, as SPRAVATO™, is self-administered as a nasal spray. Delivered this way, the body absorbs less of the drug, and does so less evenly due to factors such as mucus, congestion, and the effectiveness of the delivery.
Both Spravato and Ketamine Infusion Therapy can only be administered in a clinic setting under close supervision (SPRAVATO™ is self-administered, but only while an approved clinician is monitoring). Patients are carefully monitored during and after treatment to watch for any possible side effects.
Because Spravato is so new, the studies specifically comparing the two are still limited, however, early evidence shows that while both treatment modalities offer fast-acting and highly effective relief from treatment resistant depression and other serious mood disorders, ketamine is more effective than Spravato. This is likely less to do with the chemical compound of the drug than with how it is administered. Ketamine infusion treatments enable the drug to be 100% bioavailable, while the nasal spray is likely to be less than 50% bioavailable; moreover, with IV infusion, the level of ketamine in the bloodstream can be more carefully and precisely controlled.
If you suffer from depression and are treatment resistant to medication or having unwanted side effects, call Ketamine Clinics of Los Angeles for a free phone consultation to see if Ketamine Infusion Therapy is a good treatment option for you 310-270-0625.
For more information about Ketamine Infusion Therapy treatments for depression, bipolar, anxiety, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), fibromyalgia, pain syndromes and other conditions contact us at Ketamine Clinics of Los Angeles in Southern California (Orange County) by clicking here or calling 310-270-0625.