What’s The Difference Between Ketamine & Esketamine?

As research continues to progress in the realm of mental health, innovative treatments such as ketamine and its enantiomer, esketamine, have made their mark. While these two compounds are closely related, they have specific differences and applications in psychiatric care.

Ketamine: What You Should Know

First developed as an anesthetic in the 1960s, ketamine has recently gained attention for its rapid antidepressant, anti-anxiety, and pain-relief effects. Its mode of action differs from most psychiatric medications, as it inhibits NMDA receptors in the brain. These receptors play a role in regulating mood, emotions, and pain.

Ketamine’s biggest advantage is its ability to provide fast relief—sometimes within hours or days—especially for individuals who have found little to no benefit from standard medications like antidepressants, anti-anxiety drugs, and opioids for chronic pain.

Typically, ketamine is administered intravenously in carefully controlled doses by medical professionals, though oral and nasal forms are also available. Ketamine infusion therapy, a common treatment method, has been shown to address various conditions such as depression, PTSD, anxiety disorders, bipolar disorder, OCD, substance use disorders, and chronic pain. However, it remains an experimental treatment and is not FDA-approved for these conditions.

What Is Esketamine?

Esketamine, marketed as Spravato, is a nasal spray developed by separating the ketamine molecule into two enantiomers: (R)-ketamine and (S)-ketamine. Esketamine, the (S)-form, is believed to be more potent, allowing for therapeutic effects at lower doses.

In contrast to ketamine, esketamine was approved by the FDA in 2019 for treating treatment-resistant depression in combination with an oral antidepressant. This provides a more standardized and regulated option for those battling depression.

Ketamine vs. Esketamine: Key Differences

Molecular Composition
While esketamine is derived from ketamine, they are not identical. Ketamine is a racemic mixture containing both “S” (esketamine) and “R” (arketamine) enantiomers, which, while chemically similar, can produce slightly different effects.

Administration
Ketamine is generally administered intravenously in a clinical setting under medical supervision. Esketamine, in contrast, comes as a nasal spray and can be more convenient, though it must still be administered under medical supervision to ensure safety.

FDA Approval
Esketamine is FDA-approved for treatment-resistant depression, while ketamine, though approved as an anesthetic, is used off-label for psychiatric conditions such as depression. As a result, esketamine is more likely to be covered by insurance, while ketamine treatments may not be.

Availability and Cost
Ketamine treatments can be costly and are frequently not covered by insurance due to their off-label status. Esketamine, on the other hand, is more accessible due to its FDA approval, making it more affordable for patients.

Range of Applications
Ketamine has demonstrated effectiveness in treating a variety of mental health conditions beyond depression, including anxiety, PTSD, bipolar disorder, OCD, substance use disorders, and chronic pain. Esketamine, however, is only FDA-approved for depression, making ketamine the more versatile option.

Final Thoughts

Both ketamine and esketamine represent significant advancements in treating treatment-resistant depression and other conditions. While they share a similar origin, they differ in their administration, accessibility, and applications.

At BlueGrass Health and Consulting Services, we specialize in administering ketamine infusion therapy in a controlled, safe environment. Our experienced professionals closely monitor and customize treatments to ensure the best outcomes for each patient.

If you or a loved one is struggling with treatment-resistant depression, chronic pain, or other conditions that haven’t responded to conventional treatments, ketamine infusion therapy might be a valuable option. We encourage you to contact us to explore whether ketamine therapy could be right for you.

If you’re interested in learning more, reach out to BlueGrass Health and Consulting Services and schedule your consultation today.