Ketamine and esketamine are two advanced, interventional therapies that can provide relief when traditional depression treatments have not been fully effective. While they are closely related, there are important differences in how they’re used, administered, and covered by insurance.
At Palo Alto Mind Body, we offer both ketamine therapy and Spravato™ (the brand name for esketamine). Here’s what you should know about each option.
Ketamine was first developed as an anesthetic in the 1960s and gained FDA approval for this indication in 1970. Over time, researchers noticed its powerful impact on patients with severe depression, especially those who hadn’t responded to other treatments.
S-ketamine, phoneticized as esketamine, is a form of ketamine developed by Janssen Pharmaceutical Company. Marketed as Spravato™, it was FDA-approved in 2019 specifically for treatment-resistant depression (TRD) or suicidality.
Traditional antidepressants target serotonin, norepinephrine, or dopamine. Ketamine and esketamine are different. It is hypothesized that they treat depression by acting on the glutamate system, which is essential for functions such as brain communication, cognition, learning, and memory.
This unique action helps brain cells form new connections, which can quickly improve mood. Many patients feel better within hours or days, rather than the weeks it typically takes with standard antidepressants.
While it is thought that both ketamine and esketamine have a similar mechanism of action, they are technically different medications. Ketamine is made up of two mirror-image molecules called enantiomers, S-ketamine and R-ketamine. The commercially available form of the drug, known as racemic ketamine, is a 50/50 mixture of these two molecules. However, Spravato is just the S-enantiomer of racemic ketamine.
Ketamine is usually delivered through intravenous (IV) infusions in a clinical setting. You may also see it administered in intramuscular (IM), oral, or intranasal forms, but IV administration is considered the gold standard for ketamine. During treatment, our trained providers monitor you closely and guide you through the process.
Esketamine (Spravato™) is only available as a nasal spray. Because it’s a controlled medication that requires enrollment in a Risk Evaluation and Mitigation Strategy (REMS) program, it must be taken in a certified clinic under provider supervision. You can’t take it home, and you must be monitored for a minimum of two hours after the medication is administered.
Both options are administered with care and oversight to ensure your safety and comfort.
Coverage often plays a big role in deciding between these therapies:
Both ketamine and esketamine can provide meaningful relief from depression. The right choice often depends on your medical history, treatment goals, and preference for insurance coverage.
Our team at Palo Alto Mind Body will walk you through your options, help determine if you qualify for Spravato™, and design a treatment plan tailored to your needs.
If you’re considering ketamine or esketamine for depression, we’re here to help. Call the office or book online today to learn more about these treatments and explore whether they’re right for you.
