Esketmine vs Ketamine: Which is Better? (Nasal Spray or IV)

Intravenous (IV) ketamine and intranasal esketamine have both been used as powerful antidepressants and antianxiety treatments, but recent research suggests that IV ketamine may be superior in several ways. Dr. Kaveh explains the differences between IV ketamine and intranasal esketamine and why IV ketamine may be a better option for patients seeking treatment for depression and anxiety.

Summary of Advantages of IV Ketamine compared to Intranasal Esketamine:

Here's a summary of the main advantages to intravenous (IV) ketamine:

• Better ability to treat depression compared to intranasal sprays
• IV provides faster time to depression relief
• Infusions allow more precise and personalized dosing
• Side effects can be treated faster because of direct medical supervision

Effectiveness of IV Ketamine for Treating Depression

One of the main advantages of IV ketamine is its efficacy as an antidepressant and antianxiety treatment. IV ketamine can produce rapid and substantial improvements in symptoms of depression and anxiety, with some patients experiencing relief within hours of treatment. In contrast, intranasal esketamine has been found to be less effective in treating depression and anxiety, with a slower onset of symptom improvement. The number-needed-to-treat for IV ketamine is as low as 2 compared to 6 for intranasal ketamine (a lower number needed to treat is better means the treatment is more effective).

IV Ketamine Works Faster than Intranasal Sprays

Another advantage of IV ketamine is the speed at which it can produce symptom improvement. IV ketamine can rapidly produce significant improvements in symptoms of depression and anxiety within 24 hours of treatment of a single treatment, while intranasal esketamine can take several weeks to produce similar results. This is because IV ketamine is able to cross the blood-brain barrier more quickly and directly than intranasal esketamine, allowing it to produce faster and more robust effects.

Oral Ketamine is Even Less Efficient Than IV Ketamine

When ketamine is taken orally only 10-30% of the ketamine actually reaches your body. That's because over 50% is metabolism by the liver.

Medical Monitoring During IV Ketamine Infusions for Safety

Safety is another important consideration when choosing between IV ketamine and intranasal esketamine. IV ketamine is administered under the direct supervision of a doctor, which allows for more accurate and titratable dosing. This means that the physician can adjust the dosage as needed to achieve the desired therapeutic effect, while minimizing the risk of adverse effects. In contrast, intranasal esketamine is self-administered with only two dosage options (56mg and 84mg).

In the following patient populations, close medical monitoring is even more important to ensure the safety and effectiveness of ketamine therapy:

• Older adults
• Patients with heart disease
• Individuals with kidney problems

Guidance Can Make IV Ketamine Even More Effective

Guidance and compassion are key to the healing potential of ketamine therapy. A recent study showed that even computer programs to reinforce positive self references can make a single IV ketamine infusions even more effective over 4 weeks.

IV Ketamine is Comparable to Electroconvulsive Therapy

Furthermore, IV ketamine has been found to be comparable to electroconvulsive therapy (ECT) in treating depression. While ECT can produce slightly greater symptom improvement, it is associated with a number of adverse effects, such as memory loss and cognitive impairment. IV ketamine, on the other hand, has been found to produce comparable improvements in symptoms of depression and anxiety with fewer adverse effects.