Ketamine Vs Spravato
Today we're tackling a topic that's often misunderstood but holds immense promise for those struggling with severe depression: the differences between IV ketamine and intranasal esketamine, more commonly known as Spravato.
As many of you know, The Anderson Clinic was proud to be the first ketamine clinic in Ohio, pioneering intravenous ketamine therapy for treatment-resistant depression nearly a decade ago. We’ve witnessed firsthand the profound, life-changing impact this treatment has had for hundreds of our patients. And today, I’m excited to announce that after careful consideration and extensive training, The Anderson Clinic is now offering Spravato, expanding our comprehensive approach to mental wellness.
But what are the differences? And which might be right for you or someone you care about? Let's break it down."
They do have some Shared Common Ground:
Both IV ketamine and intranasal esketamine (Spravato) are revolutionary precisely because they work differently than traditional antidepressants. They target the NMDA receptor system which currently as of this podcast no other oral antidepressant does, and rapidly promote neuroplasticity, helping to repair damaged neural connections in the brain that are often implicated in severe depression. And they can increase the dentritic spines along neurons such that they can communicate better with their neighbors. This is why they can achieve rapid relief, often within hours or days, unlike typical antidepressants which can take weeks to months.
Both are used for treatment-resistant depression (TRD).
Spravato has an indication for Major Depressive Disorder (MDD) with acute suicidal ideation or behavior.
While neither of these two options are 'magic bullets,' they are powerful tools used in a structured, medical environment, as part of a comprehensive treatment plan that often includes traditional therapy and other psychiatric oral or injectable medications.
IV Ketamine - The Gold Standard We've Mastered
For nine years, IV ketamine has been our cornerstone. It's the original, and in many cases, it remains the gold standard for rapid, robust, and often profound antidepressant effects. Why? Because of its direct, precise delivery. It can also be used for a variety of conditions: depression, anxiety, PTSD…not just for TRD.
What are the “Pro’s” to intravenous ketamine?
There is controlled, precise dosing. And because IV ketamine is 100% bioavailable, your brain sees 100% of the dose we deliver to you intravenously, which is calculated based on your body weight.
Intravenous ketamine is what’s known as a racemic mixture: 50% R- and 50% S-enantiomers. Think of it as mirror images of the whole molecule. The IV delivers the entire dose directly to the bloodstream, bypassing first-pass metabolism in the gut. When delivered by other means, the dosage has to be increased since so much of the liver chews it up
The setting is similar: both IV ketamine and Spravato are administered in a medical clinic, requiring continuous monitoring by medical professionals.
The time course is a little different:
For IV ketamine, you receive 3 infusions a week over the course of two weeks. For Spravato you have 2 visits a week for a month, one visit a week for a month then a visit every couple of weeks until you start seeing symptomatic improvements.
Patient Experience for both: Often involves a dissociative experience, which can be part of the therapeutic process for some, but is closely monitored. Some experience a state of extreme relaxation or euphoria, some people just experience an odd sense of dislocation, like you’re the third person observer in a dream that you’re in.
For IV ketamine, you may potentially have a faster, stronger initial response for some; often very customizable dosing within certain limits.
The Cons for IV ketamine: It is NOT FDA-approved for depression (off-label use, but well-supported by research); and for what it’s worth, about 70% of the medications psychiatrists prescribe are considered “off-label” based on the drug’s neurochemistry and how it acts on the brain. Take topiramate, for example: Initially marketed as an antiseizure medication, it turns out it's also great for migraine headache prophylaxis! People started taking it to avoid migraines, and they started realizing they weren’t finishing all the food on their plates, they were going down a pant size or two, and had lost their taste for sweets. IT is now used for binge eating disorder. So, in other words, don’t let the “off-label” label scare you.
Cost of coverage:
With IV ketamine, there is typically higher out-of-pocket costs because insurance doesn’t cover it. With Spravato, most insurances can cover part of the cost IF you carry a diagnosis of treatment-resistant depression AND have tried and failed at least 3 oral antidepressant agents.
Intranasal Esketamine (Spravato) - The FDA-Approved Evolution
Obviously the Delivery Method is a little different: Self-administered nasal spray in a supervised clinic setting.
The Pharmacokinetics are a bit different as well: It's esketamine only, the S-enantiomer or “left-handed” version of ketamine. It's one half of the racemic ketamine mixture. The absorption through the nasal passages is different from IV, and it undergoes some metabolism through the liver, so the dosage is a bit different accordingly.
Setting: Administered in a certified Spravato treatment center (like The Anderson Clinic!), requiring a two-hour observation period due to potential side effects like dissociation, sedation, blood pressure changes. Of note, both require transportation to AND from the clinic, as you will be in no fit state to drive.
Spravato has FDA Approval for TRD: Crucial point for insurance coverage. This is a major advantage for many patients, who wouldn’t be able to afford it otherwise.
Another Pro: intranasal is obviously less invasive than IV for all my needle phobics out there!
Cons of Spravato: it requires a lot more visits and clinic time, which means a little more time off work than if you were receiving IV ketamine.
So both are great options for different reasons, but how do we decide which is right for you?
There is no 'one size fits all.' Deciding between IV ketamine and Spravato is a nuanced clinical decision, not a coin flip. If you think you can simply pick based on convenience, you're missing the point. While The Anderson Clinic offers both and the decision is made through a comprehensive consultation, considering:
Severity of depression, including suicidality
Previous treatment history
Tolerance for dissociation
Insurance coverage (where Spravato has a significant advantage due to its FDA approval)
Logistical considerations (time commitment, travel, availability of a driver and how frequent)
Individual response.
Both are part of a holistic treatment strategy, often alongside psychotherapy and other psychiatric care.
We’ve been offering ketamine for the past nine years and were the first in the state of Ohio. We don't just offer treatments; we offer unparalleled expertise in administering and managing these complex therapies.
Your next step isn't to self-diagnose or self-prescribe. It's time to schedule a consultation with our team at The Anderson Clinic. We will conduct a thorough evaluation to determine if either IV ketamine or intranasal Spravato is appropriate for your unique situation, and if so, which pathway offers you the greatest chance of reclaiming your life from depression.
You don't have to suffer in silence, and you don't have to navigate these complex treatment options alone. Visit www.andersonclinic.net, check us out on social media @AndersonClinicCincy with a Y or call us at (513) 321-1753 to learn more and schedule your consultation. Start feeling better faster!