If you’re battling treatment-resistant depression, you know the frustration of trying antidepressant after antidepressant with no relief. Enter two promising options: SPRAVATO® (esketamine) and generic ketamine. Both have sparked hope for those who’ve felt stuck, but they differ in cost, administration, and effectiveness. So, which one should you choose? Let’s break it down.

Understanding SPRAVATO®

In 2019, the FDA approved SPRAVATO®, a nasal spray developed by Janssen Pharmaceuticals (a Johnson & Johnson subsidiary), for adults with treatment-resistant depression—those who’ve tried at least two antidepressants without success. It’s used alongside an oral antidepressant and works by targeting different brain pathways than traditional medications.

Here’s how it works in practice:

• Administration: You’ll visit a certified clinic where a provider supervises as you self-administer the nasal spray. Afterward, you’re monitored for at least two hours due to potential side effects like dissociation or sedation.
• Schedule: For the first four weeks, it’s twice weekly. Then, it drops to once a week for four weeks, followed by maintenance doses every week or every other week.
• Cost: Brace yourself—each dose can cost around $1,000 out-of-pocket, depending on insurance. Coverage varies widely, and many patients still face hefty bills

SPRAVATO® contains esketamine, a component of ketamine, but it’s been patented as a “new” drug. Research shows it reduces depression symptoms more than a placebo plus an oral antidepressant after four weeks. Sounds promising, right? But let’s look at its older cousin, ketamine.

The Case for Ketamine

Ketamine has been around for decades as an anesthetic, but it’s recently gained traction as an “off-label” treatment for depression, PTSD, anxiety, and chronic pain. “Off-label” means it’s not FDA-approved for these uses, but don’t let that scare you—up to a third of psychiatric meds in the U.S. are prescribed this way.

Here’s why ketamine stands out:

• History: It’s been studied extensively and used clinically far longer than SPRAVATO®.
• Administration: Typically delivered via an IV infusion in a clinic, it takes about 45 minutes per session.
• Dosing: Ketamine is tailored to your weight (e.g., 45mg for a 120-pound person, 90mg for a 240-pound person), ensuring a personalized experience.
• Cost: An equivalent dose is under $15, though clinic fees bump up the total. Many providers offer package deals, making it more affordable than SPRAVATO®.

So why isn’t ketamine getting the same hype? Its patent expired in 2002, leaving Big Pharma with little incentive to push it. Instead, Janssen isolated esketamine, patented SPRAVATO®, and brought it to market.

Comparing Efficacy

Does SPRAVATO®’s high price tag mean it’s more effective? Not necessarily. A recent meta-analysis (a study of studies) compared intranasal esketamine with IV ketamine. The findings? IV ketamine outperformed esketamine in reducing depression symptoms and had fewer dropouts due to side effects.

While we don’t have direct head-to-head trials yet, the data leans toward ketamine as the more potent option. Plus, its longer research history adds weight to its case.

Practical Considerations

Let’s get practical—how do these treatments fit into real life?

• Emergencies: SPRAVATO® might shine here. Its nasal spray form is ideal for quick use, like in a hospital for someone with suicidal thoughts.
• Time Commitment: SPRAVATO® requires 2+ hours per session (including monitoring), while ketamine infusions take about 90 minutes.
• Side Effects: Both can cause dissociation, dizziness, or nausea, but the meta-analysis suggests ketamine may be better tolerated.

Then there’s personalization:

• SPRAVATO®: Available in just two fixed doses (56mg or 84mg). A 120-pound college student and a 240-pound adult get the same amount—hardly tailored.
• Ketamine: Dosed by weight, so you’re more likely to get the “just right” amount.

Making the Choice

So, which is better for you? Here’s what to weigh:

• Cost: If insurance covers SPRAVATO® fully (rare!), it might be worth a shot. More likely, you’ll pay a chunk out-of-pocket. Ketamine, while not cheap, often costs less overall, especially with package deals.
• Effectiveness: Research favors IV ketamine.
• Personalization: Ketamine’s dosing flexibility wins here.
• Convenience: Ketamine sessions are shorter.

I’ve offered both treatments as a provider, and my take? Ketamine usually comes out on top. It’s more effective, customizable, and budget-friendly for most patients. That said, your situation—insurance, medical history, and preferences—matters most. Talk to your doctor to figure out what fits.

Conclusion

SPRAVATO® and ketamine both offer hope for treatment-resistant depression, but they’re not equal. SPRAVATO® has FDA approval and a shiny new patent, but ketamine brings a proven track record, better efficacy, and a lower price tag. Armed with the facts, you can make the choice that’s right for you.

Ready to Take the Next Step?

If you’re curious about SPRAVATO® or ketamine, don’t go it alone. Contact us at The Ketamine Clinic, brought to you by The Practice, (904) 977-0002 for a consultation—we’ll help you explore your options and find the path to feeling better.