Common Questions About Ketamine and Esketamine (Spravato)
Ketamine and esketamine (Spravato) are becoming a popular topic of discussion among mental health providers and patients suffering from depression, anxiety, and PTSD. If you are new to the conversation, you likely have many questions including:
- What are ketamine and esketamine?
- How are ketamine and esketamine administered?
- What are the benefits of ketamine and esketamine treatment?
- What are the downsides to consider?
- Where can I get ketamine and esketamine treatments?
What are ketamine and esketamine?
Ketamine is an anesthetic agent discovered 50 years ago and FDA approved in 1970 for procedural sedation after 105 studies involving over 10,000 patients.
Esketamine (Spravato) is an active ingredient that was isolated from ketamine in 1997 and FDA approved for the use of depression in 2019, then again for the treatment of suicidal thoughts in 2020.
These treatments are ideal for patients who struggle with suicidal thoughts, have tried multiple antidepressant medications with no relief, or who don’t tolerate antidepressants due to side effects.
Studies over the last 20 years have shown that low doses of ketamine can quickly improve symptoms of depression, anxiety, PTSD, and resolve suicidal thoughts. Initial studies revealed a response rate in over 30% of patients to a single infusion, while subsequent studies have shown that up to 90% of people responded to multiple infusions, with up to two-thirds of those having no subsequent symptoms of depression for a time. (Response is defined as a 50% reduction in depressive symptoms.)
How do ketamine and esketamine work?
Ketamine and esketamine are not traditional psychiatric medications and work differently than anything else a psychiatrist may prescribe. Both medications increase neuronal growth factors for three days after administration, resulting in rapid neuronal growth.
This rapid neuronal maturation enhances the brain’s response to neurotransmitters, such as serotonin, dopamine and norepinephrine. In this regard, ketamine improves the brain’s response to psychiatric medications, and many people who respond to ketamine subsequently reduce other medications.
As anesthetic agents, these medications may induce a dissociative state where people might feel dizzy or light-headed that can be dose-dependent. Some patients may even experience a side effect of euphoria, though this may not be necessary for the medication to have a beneficial effect.
How are ketamine and esketamine administered?
The FDA has outlined a risk evaluation and mitigation strategy protocol (REMS) in utilizing esketamine (Spravato) for the treatment of depression, anxiety, PTSD, and suicidal thoughts and behaviors. We follow a similar protocol for the administration of ketamine due the fact that ketamine contains esketamine.
Esketamine is only administered through nasal inhalation, while ketamine may be administered intranasally (IN), sublingually, intravenously (IV) or intramuscularly (IM) through an injection. Both are administered under medical supervision by a trained mental health professional.
Depending on a patient’s response, a few treatments may be all that is needed, or maintenance treatments may be recommended at set intervals determined by your healthcare team.
What are the benefits of ketamine and esketamine treatments?
- They work faster. Ketamine and esketamine work differently than oral antidepressants, allowing them to act rapidly to reduce suicidal thoughts and symptoms of depression, anxiety, and PTSD sometimes within hours.
- They provide new hope for chronic depression. Because they work differently, ketamine and esketamine can provide new hope to patients who have not improved with other antidepressant medications without side effects.
- They can provide lasting results. While it will likely take multiple treatments, they do not need to be taken daily, as is the case for most antidepressants. Most patients will need six initial treatments over 2-3 weeks followed by occasional maintenance treatment.
- FDA approval. Esketamine was approved by the FDA in 2019 to treat depression and in 2020 to treat suicidal thoughts. Although ketamine is essentially a generic equivalent of esketamine, the treatment of depression with ketamine is an off-label use, though it has a well-established safety profile and has been used for over 50 years in procedures throughout the world, including use by emergency medical personnel and combat technicians on the battlefield.
- The services are typically covered by insurance. Most insurance providers cover esketamine and ketamine treatments for patients who have tried other antidepressants without success. At Advanced Brain + Body Clinic, we work with insurance providers to make ketamine treatments affordable and available for those who need it most. Many other clinics charge patients directly for this service, so working with your insurer sets us apart.
What are the downsides to consider?
It may come with mild side effects. Ketamine side effects may include nausea, dizziness, blurred vision, or a feeling of being dissociated from one’s body. Heart rate and blood pressure can also increase by approximately 20 points for the duration of treatment. These side effects typically diminish quickly but can take a good night’s rest to completely clear. Although these symptoms are mild, you will need someone to drive you to and from your appointment. Frequent, long-term use at doses much higher than what we administer has been associated with bladder irritation.
Where can I get ketamine and esketamine treatments?
At Advanced Brain + Body Clinic, we offer ketamine and esketamine treatments prescribed by mental health professionals, a holistic approach to health and wellness, plus psychiatric medication management. We work with patients and insurers to find the best treatment options, taking into consideration an extensive mental health and medical history.
If you or someone you know is suffering from major depression, panic attacks, or has symptoms of PTSD from a traumatic event, ketamine or Spravato may provide relief. Ask your healthcare provider or schedule an appointment with Advanced Brain + Body Clinic to see if ketamine or esketamine are right for you.
Call 612-682-4912 to schedule your appointment!
Dr. Brian Johns is a Minneapolis psychiatrist and a mental health leader who helped shape ketamine treatment for depression in Minnesota and the nation. He co-authored a Minnesota VA Hospital medical trial to open the door for ketamine treatment to change–from a revolving-door hospital intervention, to an ongoing regimen at an outpatient clinic–while setting the benchmark for ketamine infusions nationwide. He then developed the region’s first ketamine infusion clinic. Over the past several years, he has administered or overseen thousands of ketamine treatments.