Esketamine nasal spray for Depression or Ketamine infusions?
Advantage of esketamine nasal spray for depression
What is the advantage of esketamine nasal spray by Spravato® for depression compared to IV ketamine infusion?
Esketamine nasal spray by Spravato® has been approved in the US for some time now and is now also approved by the EU Commission for the treatment of moderate to severe episodes of major depressive disorder (MDD), to support a therapy with oral antidepressants.
However, for ketamine to have an antidepressant effect, a certain serum concentration of ketamine must be present for a certain time.
Because ketamine is broken down very quickly in the body, esketamine nasal spray must be administered at a very high dose to achieve this high serum concentration of ketamine. The high dose of esketamine means that side effects are more frequent and patients need longer follow-ups. In addition, the risk of developing addiction is higher with fast-approaching serum concentrations.
With intravenous administration of Ketamine, this concentration is guaranteed from the beginning and the risk of side effects and addiction are minimised.
One might think that one advantage of esketamine nasal spray compared to intravenous ketamine infusions when reading mayor depression is that one can self-administer the spray at home if needed. However, this is not the case: esketamine nasal spray may only be administered by medical personnel. Patients must remain under medical observation for at least two hours after the administration.
Moreover, esketamine nasal spray has a less effective antidepressant result than the ketamine racemate used for IV infusions. This is supported by the study by Bahji, Vazqeez, Zarate (2021), which concluded that intravenously administered ketamine appears to be more effective than intranasally administered esketamine in treating depression.
Why is esketamine nasal spray recommended for depression?
This is for a simple reason: esketamine was patentable to the manufacturer, Jansson, making it appear to be a reputable and trustworthy medicine. Racemic ketamine, which is used in ketamine infusions in our clinic on Mallorca and our practices in Germany (Munich and Berlin), has been on the market since 1970 and is therefore no longer patentable.
The cost per application for racemic ketamine is less than esketamine.
So the only advantage of esketamine nasal spray is that no vein needs to be punctured. Using Esketamine, side effects are more frequent and patients must be observed for at least as long as after an infusion. The antidepressant effect is less strong and less sustained than with intravenous ketamine.
We always administer ketamine intravenously and also combine ketamine infusions with other therapeutic modalities such as magnetic stimulation (rTMS), neurofeedback, hypnosis and psychotherapy in the treatment of major depression and treatment-resistant depression. The Instituto Dr. Scheib in Mallorca and the private practices of Dr. Scheib in Berlin and Munich are one of the few providers of this combined ketamine therapy, which promises an even faster and more stable improvement than ketamine infusions alone.
Ketamine infusions are also suitable for other clinical pictures: in patients with obsessive-compulsive disorders, chronic pain, as well as addictive disorders, this therapy is successful. Postpartum depression can also be treated with ketamine infusions, as the substance breaks down in the body within a few hours.
Due to the Corona pandemic, we have decided to create treatment options with ketamine therapy in Germany for patients with depression at short notice.
We offer intensive outpatient therapies at our new locations in Munich and Berlin.
For a non-binding preliminary telephone consultation, or an appointment for a psychotherapeutic evaluation consultation for indication and therapy planning (subject to a fee, also possible online or by telephone) in Germany or on Mallorca, contact us now:
You can also contact us by phone for appointments at +49 700 99100000, or directly at the secretary’s office in our clinic in Spain at +34 687 708 507. You can reach the practice in Berlin at 0049 30 63428891.
You are also welcome to visit our Website for Germany:
Video: Ketamine treatment and hypnosis for severe depression
Video: Patient with severe depression 3 Months after treatment