There are many factors to consider when choosing which antidepressant or anti-anxiety medication to take. There are several benefits and risks associated with many popular drugs. In this blog we’ll discuss the differences between ketamine and esketamine including what sets each apart and which might be the best to help improve your mental health.
Ketamine is one treatment for conditions such as depression, PTSD, and anxiety. Ketamine initially gained its reputation as a recreational drug which has the ability to alter sight, sound, and perception for those who take the drug. It can be dangerous to take this drug without medical supervision.
Ketamine functions by blocking the NMDA receptors thereby increasing neurotransmitter levels in the brain (particularly serotonin and other neurotransmitters) which help improve your mood. One benefit that sets ketamine apart from other medicines is that it is capable of increasing the production of new brain cells (also called neurogenesis).
ketamine and esketamine for depression is most often administered through intravenous infusions. The ketamine dose is often administered over a period of 40 minutes. A ketamine dose is also occasionally administered into the intramuscular space.
Frequency of Ketamine Doses
While the exact frequency and amount of doses may vary, patients typically receive doses spanned out across at least a few weeks to maximize the effectiveness of the medication.
No, as of 2023, Ketamine has not been approved by the FDA to treat depression. Despite ketamine not being approved by the FDA, it is still being analyzed for its efficacy to treat depression.
There is one medication that is approved to treat depression: esketamine. Treatment for depression can often involve a combination of psychiatric medication and CBT (cognitive behavioral)therapy.
Esketamine (esketamine brand name Spravato) is a fast-acting FDA-approved medication that acts by targeting the glutamate receptor system in the brain (as opposed to ketamine which acts on the NMDA receptors) to increase your mood. Esketamine is the first medication in over thirty years to be approved for the treatment of depression. Esketamine is a powerful drug which can help both men and women improve their mood and quality of life.
Unlike ketamine, Spravato can be administered through nasal spray which is much more convenient for patients. Due to its structural differences from traditional ketamine, esketamine does not produce the same dissociative and psychedelic effects as traditional ketamine.
There have been many studies that show that esketamine (Spravato) nasal spray is a safe and effective drug in the course of treatment of depression and TRD (Treatment-Resistant Depression).
There are several differences between ketamine vs esketamine which patients should be aware of before taking these medications.
| Category | Esketamine (Spravato) | Ketamine |
| Chemical Structure & Mechanism | S-enantiomer of ketamine; selectively targets NMDA receptors. Acts primarily via the glutamate system. | Racemic mixture (R- and S-ketamine); broader receptor activity including NMDA and others. |
| Safety & Efficacy | Fast-acting with documented trials for depression; side effects include dissociation and hypertension. | Also rapid-acting; long-term use less studied, with potential for broader side effects. |
| Regulation | FDA-approved and regulated under REMS program; Schedule III drug. | Schedule III drug; used off-label for psychiatric use without REMS oversight. |
| Insurance Coverage | Often covered due to FDA approval, though pre-authorization is usually required. | Coverage is limited since psychiatric use is off-label; often paid out-of-pocket. |
When comparing ketamine vs esketamine cost, it’s important to consider that esketamine nasal spray cost is generally higher due to its FDA approval and the specific administration requirements. While esketamine anxiety is not its primary FDA-approved use, it has shown some promise in treating anxiety disorders in off-label settings.
Esketamine insurance coverage varies depending on the insurer, but esketamine covered by insurance is more common in patients with treatment-resistant depression, though pre-authorization is typically required. Overall, the cost of esketamine can be a significant barrier for some patients, especially when insurance doesn't cover it fully.
When discussing ketamine vs esketamine potency, esketamine is considered more potent due to its S-enantiomer form, which more selectively targets NMDA receptors in the brain. This increased potency in ketamine vs esketamine potency allows for potentially lower doses of esketamine to achieve similar or greater effects, making it more efficient in treating conditions like depression.
Both ketamine and esketamine are effective in treating depression but Spravato (esketamine) is FDA-approved and does not include the dissociative side effects which may pose a risk to many patients
Note: It’s important to discuss your treatment and medication options with your psychiatrist before taking either of these (or any) psychiatric medication.
| Side Effect | Ketamine | Esketamine (Spravato) |
| Dissociation | Common, often more intense | Common, usually milder |
| Elevated Blood Pressure | Common | Common |
| Nausea/Vomiting | Occasionally reported | Occasionally reported |
| Sedation/Drowsiness | Common | Common |
| Headache | Less frequent | Common |
| Anxiety or Agitation | Possible during administration | Possible during administration |
| Addiction/Misuse Risk | Higher potential | Lower due to controlled delivery |
| Bladder Issues (long-term) | Possible with prolonged use | Less common but still a concern |
If you are currently dealing with symptoms of Treatment-Resistant Depression (TRD), Telapsychiatry can help you alleviate your symptoms and begin to enjoy your life again.
At Telapsychiatry, our deep insight into these forms of depression lets us customize our treatment to your specific requirements. We're here to support you through your journey toward improved mental well-being. Call us at 888-903-5505 or schedule an appointment online
FAQs
How does esketamine work?
Esketamine works by blocking NMDA receptors in the brain, which influences glutamate signaling, a key neurotransmitter involved in mood regulation. This leads to rapid antidepressant effects, often within hours.
Is esketamine addictive?
Esketamine carries a lower risk of addiction compared to ketamine, mainly due to its controlled administration. However, there is still some potential for misuse, especially if used outside of a clinical setting.
How is esketamine administered?
Esketamine is administered as a nasal spray under strict supervision in a medical setting. This method ensures safe use, as it requires monitoring for side effects like blood pressure changes or dissociation.
What is the difference between esketamine and ketamine?
Esketamine is the S-enantiomer of ketamine and has a more targeted effect on NMDA receptors. While both work through similar mechanisms, esketamine is generally more potent and specifically approved for depression.
Are ketamine and esketamine the same thing?
No, ketamine is a racemic mixture, containing both R- and S-ketamine, while esketamine is just the S-enantiomer. Esketamine tends to have a more potent effect on the brain's glutamate system.
How long does esketamine take to work?
Esketamine typically takes effect within hours, offering rapid relief from symptoms of depression. The fast-acting nature is one of the reasons it’s considered an innovative treatment for resistant depression.
How are ketamine and esketamine different?
Ketamine is a racemic mixture of two molecules (R- and S-ketamine), whereas esketamine is the S-form, which is more potent in targeting NMDA receptors. Esketamine is FDA-approved for depression treatment, while ketamine is used off-label for similar conditions.
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