How does Esketamine nasal spray therapy differ from ketamine infusion therapy? Is Spravato a form of ketamine?
Esketamine vs ketamine: How are they similar? How are they different? Is Spravato ketamine?
Both ketamine treatment and Spravato treatment are used for treatment resistant depression. Treatment resistant depression means that depressive symptoms are not adequately relieved by any oral antidepressant that the patient has tried.
The Spravato nasal spray contains the drug esketamine. Esketamine is a form of ketamine. Both drugs work on the NMDA receptor in the brain. And, both are effective at treating mood disorders.
At a molecular level, esketamine is made up only of the left-hand version of the ketamine molecule. ketamine, on the other hand, is made up of right and left versions of the ketamine molecule, which we refer to as a racemic mix.
Putting aside the subtle differences between the drugs at the level of molecular chemistry, there are other differences that separate ketamine therapy from esketamine therapy. Some differences are in the way the drug is delivered, and others are administrative differences regarding FDA approval and insurance coverage.
Does intranasal esketamine work just as well for all the same conditions that ketamine infusion therapy works for?
This is an excellent question. We do not know definitely if esketamine sprayed into the nasal passages is equally effective to a series of IV infusions of ketamine for all the conditions that we use IV ketamine for.
The reason that we cannot be certain about this is that head-to-head studies that compare the efficacy of these two therapies have not been performed for every possible mental illness or pain syndrome. The cost and difficulty of performing these studies would be quiet high, and not practical.
When we look at why Spravato was released by the Janssen pharmaceutical company, we must consider the role of profit and politics. When a ketamine clinic provides IV infusion therapy for depression, anxiety, suicidal ideation, OCD, PTSD, migraines, bipolar, chronic pain, or any other condition, the treatment is off-label.
Off-label means that, while studies have been done to demonstrate ketamine’s efficacy, the FDA has not officially determined that ketamine infusion is indicated for the treatment of these conditions. Yet, doctors are allowed to use their discretion in administering the treatment, even without FDA approval.
Does the blessing of the FDA mean that one treatment is better than another? Not necessarily. Keep in mind that the drug ketamine is an FDA approved drug. It just has not been officially approved for use in treating a wide variety of health conditions.
The FDA approves many therapies. The first priority is safety.
But sometimes there does not seem to be much emphasis on efficacy by the FDA. For example, the FDA has approved cosmetic devices and other healthcare related technology that seem questionable when we look at the data. Just because the FDA signs off on a medical treatment, or does not sign off on it, does not tell us much.
Janssen developed the Spravato nasal spray device and utilized esketamine instead of the traditional racemic ketamine because they were able to patent and protect their work. It was essentially a workaround to ensure that they could bring ketamine to market, and also protect their profitability.
Additionally, Janssen has had to create the Spravato REMS program to ensure that the drug is safely distributed and administered. The company has put their reputation on the line to bring nasal esketamine to market to treat severe depression where antidepressant medication does not work.
An additional benefit that comes along with Janssen taking their product through official channels is that health insurance covers Spravato therapy in many cases. Most insurance companies will not cover off-label treatments, but they will cover FDA approved therapies, such as Spravato.
As you can see, there is a place in healthcare for both Spravato for depressive disorder, and ketamine assisted psychotherapy utilizing IV ketamine infusion. Both are an effective depression treatment, and ketamine infusion can be used for many other conditions.
A major benefit of Spravato is insurance coverage.
Spravato is covered by insurance and approved fully by the FDA for treating depression when traditional antidepressants do not work. For patients and doctors who feel most comfortable sticking to medical therapies that are approved and backed by a major pharmaceutical corporation, the Spravato esketamine nasal spray is an excellent way to gain access to the benefits of ketamine therapy for depression.
One example of how Jenssen’s product is used in major healthcare institutions is the esketamine clinics found in many public hospitals. A hospital that is owned and managed by a city, county, or state is under additional bureaucratic pressure, above and beyond that of a private hospital.
It is unlikely that such a hospital would ever dream of opening a ketamine clinic that offered off-label treatment with ketamine infusions. The public scrutiny would not allow it. On the other hand, esketamine nasal spray from Janssen follows all the rules required by such an institution.
Hence, Spravato clinics are being found in the psychiatric departments of many major hospitals, both public and private. Hospital administrators are overjoyed to have access to the ketamine revolution through Spravato.
In the world of private citizens who prioritize their physical and mental health, ketamine IV infusion therapy is the ultimate solution to a wide variety of mental health conditions. Ketamine doctors are able to treat many conditions, from depression and suicidal thoughts to OCD, anxiety, and PTSD, to migraines and chronic pain.
TMS is a therapy that works well with ketamine IV infusions, or with Spravato.
In addition to ketamine infusion, specialized clinics are also able to offer TMS therapy combined with ketamine. TMS, or transcranial magnetic stimulation is an FDA approved therapy that uses magnetic fields to generate precise currents in the brain to improve depressive symptoms.
Additionally, ketamine infusion doctors are not limited to specific treatment regimens. A ketamine expert can meet other experts at conferences, and implement new protocols in their clinic that are on the cutting edge of ketamine therapeutic models.
For example, Ketamine for reduction of Alcoholic Relapse, or KARE, is a protocol used for treating alcoholism. Relapses are reduced significantly with this form of ketamine assisted therapy.
Pharmaceutical companies, such as Janssen, would take years and millions of dollars of research money, to achieve FDA approval for treating alcohol use disorder. Yet, off-label ketamine infusion clinics are able to use the full ketamine molecule, delivered precisely through an IV, combined with psychotherapy as indicated by the KARE protocol.
For the full benefit of the complete ketamine molecular compound, IV infusion therapy is here today.
Why wait years for a watered down version of a treatment protocol that we already know has worked well for many recovering alcoholics, people with OCD (obsessive compulsive disorder), anxiety, chronic pain, depression, PTSD, and much more? Ketamine infusion clinics have the ability to treat patients today, when they need help the most.
For ketamine doctors who already know that they can help a wide variety of patients, it is a relief that the US healthcare system allows them to deliver this ground-breaking therapy with FDA approved IV ketamine, for such a wide spectrum of health conditions.
Spravato has its benefits, but the ultimate benefits of ketamine are realized with IV infusion of the complete molecule, the s-ketamine isomer and the r-ketamine isomer combined. Fortunately, patients have a choice, based on their own unique circumstances.
If you are interested in either Spravato or IV ketamine infusion therapy in the Washington Metropolitan Area, including Virgina and Maryland, please contact us for more information about our Annapolis ketamine clinic.