Ketamine vs Esketamine: Understanding the Similarities and Differences

Depression plays a role in many people’s abilities to function, attend school, complete work activities, and be present. In 2021, it was reported that 46.1% of adults in California have symptoms of anxiety or depression. For most people, conventional treatment options work, but 30% of them might have what is known as treatment-resistant depression.

BNI Clinics wants them to know that other options are available. These include ketamine and esketamine therapies. Today, we are going to discuss how these treatment options are similar and different to each other when it comes to recovering from their depression symptoms.

Understanding the Basics: Ketamine vs. Esketamine

If you’re researching alternative treatment options on Google and your insurance company’s website, terms like “ketamine” and “esketamine” will pop up. Both reduce depression symptoms and appear to be associated with each other. But what are they?

Ketamine is an anesthetic developed in the 1960s and used for pain relief. It has also been known to reduce persistent symptoms of depression and suicidal ideation rapidly. Typically, it is administered intravenously. Ketamine is not considered a U.S. Food and Drug Administration (FDA) approved medication when it comes to treating mental health conditions.

Esketamine is derived from ketamine to treat depression. It is an FDA-approved medication sometimes referred to by its brand name, Spravato, a nasal spray. It is recommended that it is used in conjunction with oral antidepressants to treat resistant depression symptoms.

The Similarities Between Ketamine and Esketamine

Ketamine and esketamine are both proven treatment options for individuals who have been unable to recover from depression successfully. For those who undergo either therapy option, they are often able to find a relief that they might not have felt in a long time. According to clinical trials, people who have had slight improvement after 2 to 4 antidepressants have up to a 50% chance of rapid depression reduction when it comes to either ketamine or esketamine.

Additionally, both treatment options work differently than traditional antidepressants because they work with multiple receptors, such as the NMDA receptor, in the central nervous system. As a result, both substances have a greater potency and last longer than the effects of antidepressants, allowing for a higher chance of therapy being effective in creating new neural pathways.

Ketamine and Esketamine can only be administered by specially trained professionals in certified clinics. These are typically outpatient procedures requiring a few hours of observation before the client can go home.

How Are Ketamine and Esketamine Different?

They also have many differences that should be considered. One of the most significant differences is that ketamine is not currently FDA-approved, while esketamine is. This means that many insurance companies are reluctant to cover ketamine therapy, but they might cover esketamine. If an insurance company covers either treatment option, it varies from plan to plan.

These two substances are also administered differently. Both are administered by trained professionals in a clinical setting and require supervision afterward. However, ketamine is administered intravenously, while esketamine is a nasal spray.

Esketamine is derived from ketamine, but that doesn’t mean it shares the same common side effects. Ketamine results in side effects like double vision, feeling strange or loopy, loss of appetite, nausea, and slight pain at the injection site. Esketamine might result in feelings of sleepiness, increased blood pressure, dissociation, nausea, and a bad taste in the mouth.

Ketamine vs Esketamine for Treatment-Resistant Depression

The biggest question that people have when it comes to these two treatment options is whether they are safe and effective.

A 2024 study comparing the two substances found that the majority of participants had side effects (88.89% for ketamine and 81.68% for esketamine). However, on average, people experienced less than 3 side effects for each, and all were described as mild and subsiding within 20 minutes of their treatment. This suggests that side effects are common but don’t have lasting consequences.

A small study that examined both ketamine and esketamine found that when ketamine was used as the primary tool for reducing suicidal thoughts, 5 of the 9 participants found relief within 72 hours. The same study found that when ketamine was used as a secondary tool, 7 of the 13 participants saw a reduction in their suicidal ideation. While this study also examined esketamine, the researchers found no significant response compared to the control group.

This isn’t to say that esketamine is inadequate in the long term. The above study had only focused more on the short-term effectiveness of these substances on a small sample size. In another study from 2022, the researchers focused more on the long-term efficacy of esketamine. There, they found that esketamine was able to sustain reduction through the 3-month follow-up, with 64.2% maintaining a reduction in their depression symptoms. Researchers noted that many of the people who were finding relief at the 3-month mark did not have the same experience at the 1-month mark, which suggests that continuing esketamine treatment beyond the initial period provides a more successful response.

Ketamine Treatment Is Available in Los Angeles

Understanding the difference between ketamine and esketamine is an essential part of determining which treatment provides you with the best chance of recovering from treatment-resistant depression. Our ketamine clinic is here to answer any questions you might have, as well as provide expert guidance on what treatment options will safely support your healing journey.

BNI Clinics is dedicated to providing safe and effective ketamine treatment to people in the Los Angeles area. Our psychiatric evaluations offer a direction to heal from conditions that have left many people unable to see a way to keep going. To get started today, call us at 310-691-5005.

BNI Clinics: Science-based, evidence-backed, compassion-led