Ketamine vs. Esketamine for Depression
New hope for treatment-resistant depression.
Posted Apr 07, 2019
Ketamine has a long and varied past as a pharmaceutical.
It was developed in 1962, tested on subjects in 1964 and approved as an anesthetic in 1970 in the United States. Ketamine was used in the Vietnam War as the field anesthetic of choice for soldiers, particularly those with PTSD. And ketamine became a staple in the field of veterinary medicine.
In the late 1960s and early 1970s, ketamine grabbed the interest of psychedelic researchers like Humphry Osmond, John C. Lilly, Marcia Moore, and Stanislav Grof due to its calming, dissociative and trancelike effects. Loosening repressed traumas and gaining higher consciousness were the goals of using ketamine with psychotherapy.
In the 1980s, Ketamine’s popularity shifted to the club culture. It was widely known by its street name "Special K." The fast-acting, floaty, dreamy and sensation deepening effects made it a popular drug at raves, night clubs, and parties.
Ketamine evolved again over the decades. Most notably in 2006, when researchers began studying its use as an application for Treatment-Resistant Depression (TRD). Studies found Ketamine was better at getting across the blood-brain barrier, unlike SSRIs, SSNIs and other widely available antidepressants—and highly successful at reducing symptoms of depression.
With such positive outcomes, Ketamine clinics began opening around the globe around 2012. Adults with unbearable depressive symptoms were able to receive ketamine treatment via intravenous, nasal, sublingual, orally or intramuscularly infusions.
Data collected over the next few years showed relief of treatment-resistant depressive symptoms in about 80% of people who were prescribed Ketamine. The depression treatment benefits discovered placed Ketamine in the World Health Organization's List of Essential Medicines, which encourages its use far and wide.
6 Things to Do
On March 16th, 2019, the FDA approved the first Esketamine nasal spray for Treatment-Resistant Depression, called Spravato. Esketamine is different than Ketamine, and the confusion begins there for many. Here are some things to know.
1. Molecular differences: Understand that Ketamine and Esketamine are similar but they’re not the same. Simply stated, they have the same molecular makeup but Esketamine is more potent than Ketamine. Both can be used to treat resistant depression. For a scientific understanding read more here.
2. Who is the right candidate for Ketamine or Esketamine treatment? Studies suggest these medications should be limited to adults with treatment-resistant depression, without a history of substance or alcohol abuse disorders and without significant other medical conditions.
3. Ketamine and Esketamine are not first-line treatments for depression. It's vital to know these medications are pharmacological treatments for difficult depression cases. Treatment-Resistant Depression occurs when an individual has not clinically responded to two or more rounds of antidepressant medications. Read more about Treatment-Resistant Depression
4. This is a treatment, not a recreational drug. Another fact to keep in mind is that dosages of Ketamine and Esketamine are significantly lower than any dose that's used as an anesthetic or a club drug. These medications have been carefully synthesized and studies to address symptoms of depression.
5. Educate yourself. Read as much as you can about Ketamine and Esketamine. There will be more mental health professionals familiar with Ketamine than Esketamine—at least right now. Ask to visit Ketamine Clinics or arrange for a consult with a specialist. The more you learn, the better informed you'll be about which medication (Ketamine or Esketamine) and which modality (IV, Sublingual, Nasal Spray, etc) is best suited to your needs.
6. Get a genetic test. I always recommend patients get a psychiatric panel genetic test to aid in their depression treatment. It can speed up recovery from depression when target-specific medications are identified. Furthermore, if you're a non-responder to SSRIs, SSNIs, MAOs or other medications—or you carry genetic alleles for treatment-resistant depression—it may help get your insurance to cover other kinds of depression treatments.
7. Insurance may or may not cover your treatment. If you're interested in exploring Ketamine or Esketamine to reduce your Treatment Resistant Depression, call your insurer to find out about your coverage. Many Ketamine clinics and prescribing doctors, NPs and PAs will also help you navigate the financial path to this promising treatment.