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FAQs

IV Ketamine vs. Oral Antidepressants

Oral antidepressants work through monoamine systems (serotonin, norepinephrine, dopamine). They require daily dosing, take weeks to work, and fail to help about one-third of patients. They often cause side effects like weight gain, sexual dysfunction, and emotional numbing.

IV ketamine targets glutamate, works within hours to days, and provides relief in many people who haven’t responded to multiple antidepressants. Infusions are intermittent rather than daily. Acute side effects occur only during and shortly after infusions.

Both routes deliver similar benefits. IV provides more precise control over dosing and blood levels. IM requires a simple injection rather than IV placement. The choice often comes down to patient preference and clinical factors.

Spravato is FDA-approved specifically for treatment-resistant depression, which may make insurance coverage easier. It’s self-administered as a nasal spray under supervision. Insurance typically covers Spravato but not IV ketamine.

IV ketamine uses the full ketamine molecule (both R and S enantiomers), while Spravato uses only the S enantiomer (esketamine). Some research suggests the R enantiomer contributes important antidepressant effects, potentially making IV ketamine more effective for some patients.

IV ketamine has a longer track record and more published research. Spravato’s approval is recent, though it underwent rigorous FDA trials.

Electroconvulsive therapy remains the gold standard for severe, treatment-resistant depression. It’s highly effective but requires anesthesia, causes temporary cognitive effects, and carries social stigma.

IV ketamine provides comparable efficacy for many patients without requiring anesthesia, causing seizures, or producing cognitive side effects. It’s less invasive and more acceptable to most patients.

Transcranial magnetic stimulation uses magnetic pulses to stimulate specific brain regions. It’s effective for treatment-resistant depression but requires daily sessions for weeks and works more slowly than ketamine.

Ketamine provides faster relief and may work for patients who haven’t responded to TMS. The treatments can potentially be combined.