Some of you may be deciding between Intravenous (IV) Ketamine for treatment of your mood disorder, or Johnson & Johnson’s (J&J’s) new “ketamine-lite” nasal spray, s-ketamine (Spravato). For the treatment of major depressive disorder, PTSD, anxiety and other mood disorders, IV Ketamine remains the Gold Standard and, as such, we do not offer Spravato at our center. Let me explain why.
The first reason stems from Spravato’s chemical nature. The ketamine administered by centers providing IV Ketamine, and the ketamine used in hospitals for over five decades as a safe and effective anesthetic, is called “racemic.” In other words, the ketamine composition used in IV applications consists of two mirror image forms or isomers: r-Ketamine and s-Ketamine. For a while, it had been unclear which form was more biologically active and effective, but we now know that both isomers are important and work in different ways to achieve ketamine’s desired overall effect. Research studies have shown that IV racemic ketamine is more effective than Spravato, since Spravato contains only the s-isomer.
The second reason has to do with the route of delivery. With IV Ketamine, we know precisely how much ketamine you are receiving and over what time period. Because these measurements are precise and we control the application, we can make small adjustments from treatment to treatment to achieve your desired level of efficacy. Spravato is a nasal spray whose absorption rate varies with each individual and even between applications for the same individual. Some of the medication will run down the back of your throat, some will spray into the air or onto the floor…only an unmeasured amount actually gets absorbed. Dosing and speed of absorption are difficult to predict, as is efficacy. If you do not respond, it is impossible to determine if the lack of response is due to the failure of absorption or to the Spravato itself.
Patients following the Spravato protocol are also required to simultaneously take an SSRI. Many of you have taken SSRIs in the past and found them to be ineffective, replete with unwanted side effects, or both. With IV Ketamine treatments, there is no requirement that patients be prescribed any other psychotropic medications.
Finally, Spravato can also be significantly more expensive. The racemic ketamine that our practice and other IV centers use is generic and relatively inexpensive. On the other hand, J&J spent hundreds of millions of dollars to get Spravato approved by the FDA. To recoup that cost and to make a profit, Spravato carries a very big price tag. Some insurance companies will pay for it, others will not. If not, the cost of Spravato treatment is often far more expensive than the alternative.
In keeping with our conviction to provide patients with the safest, most effective and most cost-efficient treatment, we believe that racemic IV Ketamine is the best choice to treat mood disorders and depression.