IV Ketamine vs. Intranasal Esketamine
At PAX Institute, we are committed to offering innovative, evidence-based treatments to help our patients navigate mental health challenges, including depression, anxiety, PTSD, and chronic pain. Among the most effective treatments in our practice are ketamine-based therapies, which have shown promise for individuals who have not responded to traditional medications and depression treatment.
There are different types of ketamine therapy. Two of the most common methods are IV ketamine and intranasal esketamine. While both are highly effective, they have key differences in administration, effectiveness, and patient experience. In this blog post, we will explore these differences in detail, highlight their respective benefits, and explain how PAX Institute uses both treatments to provide the most personalized and effective care.
What is IV Ketamine?
IV ketamine is administered intravenously, directly into the bloodstream. This method has been widely used for decades in both anesthesia and pain management, but its use in mental health treatment is more recent. For conditions such as depression, anxiety, and PTSD, IV ketamine is typically delivered in a series of infusions over the course of several weeks or months, with the specific frequency and duration determined by the patient’s needs.
What is Intranasal Esketamine?
Esketamine is a derivative of ketamine, specifically the S-enantiomer of ketamine, which is thought to be more potent in its antidepressant effects. Intranasal esketamine was approved by the FDA in 2019 for the treatment of treatment-resistant depression (TRD). It is administered as a nasal spray in a clinical setting under the supervision of healthcare professionals. Esketamine works through mechanisms similar to ketamine, primarily by influencing NMDA receptors in the brain, but it offers a different method of delivery.
Key Differences Between IV Ketamine and Intranasal Esketamine
While both IV ketamine and intranasal esketamine are effective treatments for mental health disorders, there are several important differences to consider:
1. Administration Method
IV Ketamine: As the name suggests, IV ketamine is administered via a needle directly into the bloodstream. The treatment takes place in a clinical setting, with the patient typically sitting comfortably in a reclining chair during the infusion. The process generally takes about 40 minutes to 1 hour, depending on the prescribed dosage and individual factors.
Intranasal Esketamine: Esketamine is administered as a nasal spray, which the patient inhales during their appointment. It potentially takes a little longer, with sessions lasting approximately 2 hours to include monitoring time and observation of side effects. This makes it a more convenient option for patients who prefer a needleless administration.
2. Mechanism of Action
IV Ketamine: Ketamine acts on the NMDA receptors in the brain and has rapid antidepressant effects, often bringing relief from symptoms of depression in as little as 24-48 hours. This fast-acting nature makes it particularly beneficial for patients with treatment-resistant depression or those in need of more immediate relief.
Intranasal Esketamine: Esketamine also works on NMDA receptors, but because it is the S-enantiomer of ketamine, it is theorized to have a more focused impact on mood regulation. Its nasal administration leads to faster absorption compared to oral medications.
3. Onset and Duration of Effects
IV Ketamine: The effects of IV ketamine are rapid—patients often begin to feel the therapeutic effects within 30 minutes of the infusion, with the full effect usually experienced within 1 to 2 hours. Many patients report feeling a significant mood improvement after a single session. However, the effects of IV ketamine may wear off over time so maintenance infusions may be necessary.
Intranasal Esketamine: Esketamine’s effects are typically felt within 30 minutes to 1 hour of administration, with some patients experiencing an immediate sense of relief from symptoms. However, because esketamine is approved as a maintenance therapy for treatment-resistant depression, it may require ongoing sessions to maintain the benefits.
4. Treatment Protocol
IV Ketamine: A typical IV ketamine treatment plan involves an initial series of six infusions over the course of 2-3 weeks. After this initial phase, patients often enter a maintenance phase, where they receive infusions periodically.
Intranasal Esketamine: For esketamine therapy, the FDA-approved protocol involves two sessions per week for the first four weeks, followed by once-weekly or once-monthly sessions for ongoing maintenance. Esketamine is designed as a long-term treatment to help manage symptoms of depression over time.
5. Side Effects
IV Ketamine: Most side effects of IV ketamine are mild and temporary. Patients may experience dissociation, nausea, or headaches during or after the infusion, but these side effects typically subside shortly after the treatment. Blood pressure and heart rate may temporarily increase during the infusion, so patients are closely monitored.
Intranasal Esketamine: Common side effects of esketamine include dissociation, dizziness, nausea, headache, and a feeling of being detached from reality. As with IV ketamine, these side effects generally wear off after the session. Since esketamine is administered nasally, patients may also experience nasal irritation or a slight burning sensation in the nose.
6. Insurance Coverage and Accessibility
IV Ketamine: Insurance coverage for IV ketamine can vary, and some insurance plans may not cover the treatment. However, at PAX Institute, we work closely with patients to provide support and answer any questions related to the financial aspects of treatment.
Intranasal Esketamine: Esketamine is FDA-approved and may be covered by insurance for those who meet the criteria for treatment-resistant depression. Coverage may still vary, and PAX Institute can assist in navigating insurance options.
Which Treatment is Right for You?
At PAX Institute, we recognize that every patient’s mental health needs are unique. Both IV ketamine and intranasal esketamine are effective and evidence-backed treatments for depression and other mood disorders. The right treatment for you depends on various factors, including your medical history, the severity of your symptoms, and your treatment goals.
Our team will work closely with you to determine the most appropriate course of action, whether that involves IV ketamine, intranasal esketamine, or a combination of both. We take a patient-centered approach, offering individualized treatment plans to ensure the best possible outcomes for your mental health.
Conclusion
Both IV ketamine and intranasal esketamine have shown significant promise in the treatment of treatment-resistant depression and other mental health conditions. The primary differences between them lie in the method of administration, onset of effects, and treatment protocols. At PAX Institute, we are proud to offer both of these effective options and will work with you to determine the best fit for your needs.
If you're ready to explore ketamine therapy for mental health or have any questions about how these treatments could benefit you, contact PAX Institute today to schedule a consultation in Sioux Falls, South Dakota. We’re here to help you take the next step in your mental health journey.
References:
Daly, E. J., et al. (2019). Efficacy and safety of esketamine nasal spray plus an oral antidepressant in treatment-resistant depression: A randomized clinical trial. JAMA Psychiatry, 76(3), 289–298.
Zarate, C. A., et al. (2012). A randomized trial of intravenous ketamine in treatment-resistant depression. Archives of General Psychiatry, 69(6), 563-570.
Gulotta, A. (2021). Ketamine infusion therapy for treatment-resistant depression: An overview. Journal of Clinical Psychopharmacology, 41(6), 723-731.
