Ketamine infusion therapy and Spravato (esketamine) are both innovative treatments for depression and
particularly effective for individuals with treatment-resistant cases. However, they have distinct differences in their formulation, administration, and clinical applications.
Ketamine infusion therapy involves administering ketamine (which consists of ~50% esketamine) intravenously, in a controlled clinical environment. When given intravenously, 100% of the ketamine is absorbed into the body. This method allows for precise dosing and the ability to monitor patients closely for immediate side effects and to adjust the administration of the medication if needed. It also allows prompt and efficient medical intervention if an adverse event occurs because the patient already has IV access and can quickly be given any additional medications as needed.
Infusions usually last between 40 minutes to an hour, and many patients report rapid improvements in depressive symptoms within hours or days after treatment. The 100% bioavailability and flexibility in dosage which is tailored to each patient's specific needs, makes it a highly personalized approach.
On the other hand, Spravato is a nasal spray formulation of esketamine, which is a stereoisomer of ketamine. When given intranasally only about 30% of ketamine is absorbed by the body. Approved by the FDA for treatment-resistant depression, Spravato is also administered in a doctors office under medical supervision. Spravato doses cannot be customized for patients the way it can be in an infusion and Spravato has a maximum dose that cannot be exceeded. In a ketamine infusion, the dose can continue to be increased as long as the patient is responding positively.
Both treatments share a similar mechanism of action, primarily involving the modulation of glutamate levels in the brain, which is crucial for synaptic plasticity and mood regulation. Research indicates that both modalities can lead to significant reductions in depressive symptoms, with some studies suggesting that ketamine infusion may provide more immediate and more pronounced effects compared to Spravato. This may be attributed to ability to precisely customize the medication in an infusion. The side effect profiles are similar, with ketamine infusions and Spravato causing dissociative experiences during the treatment, sedation, nausea and blood pressure changes - all of which can be managed with addition
Ultimately, the choice between ketamine infusion therapy and Spravato may depend on which is available in your area or personal preference as to the route of administration. If you would like to learn more please visit our resources page to find a collection of scientific research on the topic.
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