Should I Choose a Spravato Nasal Spray Treatment or a Ketamine IV Infusion?
People suffering from mental disorders like depression, anxiety, PTSD and are having lackluster results from their current medication might be delighted to hear that Ketamine can be an amazing solution. But do you choose Spravato® (esketamine) nasal spray or ketamine infusions? Here we show things to consider Spravato® nasal spray vs ketamine infusions:
| Ketamine IV | esKetamine Nasal | |
|---|---|---|
| Number of initial treatments | 6 | 11 |
| Sequence of treatments | Weeks 1-2-3: one infusion minimum of 48 hours apart, for 6 infusions | Weeks 1-4: 2 treatments per week Weeks 5-7: 1 treatment per week Weeks 8+: 1 treatment every other week as needed |
| Maintenance treatments | Tailored to the individual. Soonest would be 1-2 weeks after loading period. | Per Spravato® protocol, may start 2 weeks after last nasal treatment, continue every other week as needed. |
| Driver Required | Yes | Yes |
| Discharge Criteria | Accompanied by responsible individual. See additional tabs for discharge requirements | Accompanied by responsible individual. See additional tabs for discharge requirements |
| Costs per treatment | $500 (patient-out-of-pocket) | Total costs: $890 – $1185 per visit (pending insurance coverage) $300 E&M charge (minus insurance coverage). $295 Medication per capsule (min 2, max 3) total charge of $590 – $885 (minus insurance coverage). |
| Verifying Benefits | Patient may elect to contact primary insurance to coordinate E&M reimbursement | Benefits Investigation via CarePath Program. Jansen Pharmaceuticals Pharmacy Benefit. J&J Financial Assistance Program |
| Insurance Coverage | Superbill submitted by patient for reimbursement of E&M. No insurance verification by KWC | CarePath performs benefits investigation. Coverage is plan/carrier specific and coverage may include; E&M, medication costs or none/all of the above. |
| Operating Expenses | ||
| Appointment Length | 45-60 minutes | 120 minutes |
| (Monitoring sequence) | 1. Pre-infusion hemodynamics 2. BP/HR/SPO2 monitored every 5 mins during infusion (20 mins) 3. Post-infusion monitoring (20 mins) | 1. Pre-treatment BP 2. BP taken 40 mins after dosing. 3. Maintain patient monitoring for additional 80 minutes |
Quick Summary Of Spravato® vs IV Ketamine
If you want the quick summary, here it is. IV Ketamine can offer consistent and highly effective results at a fraction of the price (currently when writing this), in a shorter period of time with less frequent visits. Spravato® ketamine treatment is an alternative for those who would prefer a non-IV treatment and who would like insurance coverage. Learn more about ketamine treatment for depression.
About Spravato® Treatment
What is Spravato® ketamine treatment? Esketamine, which is sold under the brand name Spravato®, is an anesthetic used as a nasal spray to help treat depression. Spravato® is an alternative for patients who have found antidepressants to be largely unsuccessful in reducing their depression.
When receiving a Spravato® treatment, the patient must stay at the healthcare facility for a minimum of 2 hours and be accompanied by a responsible individual.
Spravato® Cost & Financing Options
Currently, Spravato® is the only ketamine treatment that is FDA-approved and covered by insurance. This gives Spravato® a slight edge over ketamine IV infusions, which are currently neither FDA-approved or covered by insurance. However, Spravato® is very expensive, and can cost between $590 to $885 per treatment session. The initial month of Spravato® therapy can cost anywhere between $4,720 and $6,785. This doesn’t include the followup treatments, which may cost anywhere between $2,360 to $3,540. The benefit is that insurance does cover your treatment, but IV ketamine treatments are still less expensive in the long run.
To understand what your Spravato® cost and financing options will be, please reach out to your healthcare provider and weigh the cost between Spravato® and IV Ketamine treatment.
Spravato® Side Effects
This nasal spray does come with some side effects. Because of these side effects, the FDA requires that Spravato® be administered by trained healthcare providers at a medical facility. Spravato®may cause some serious side effects, including:
- Feelings of sedation and dissociation. You may experience feelings of sleepiness, dizziness, fainting, spinning, anxiety, or feeling disconnected from your thoughts and feelings. Inform your healthcare provider immediately if you feel like you can’t stay awake/you feel you may faint. Your healthcare provider will need to monitor you for a minimum of 2 hours after you have taken Spravato®. They will inform you when you can leave the healthcare facility.
- Abuse/misuse. With Spravato® treatment, there is risk for abuse or physical/psychological dependence. Inform your healthcare provider of past history or present dependence on alcohol, prescription medications, or street drugs.
Spravato® Reviews
“I was able to get to complete remission of my depression that was present for over three decades. No other medication and no psychotherapy was able to give me any relief prior to Spravato®. It has been a life saver.” – review from WebMD.com
“I have experienced years and years of depression and anxiety. My depression has always been the worst, and started when I was about 18 years old. I am 32 now. I have been on and off so many different oral medications over the years, and none of them seemed to really get me to a good, mentally stable point. I even tried TMS for treatment; unfortunately, it did not help. I have been diagnosed with TRD; Treatment Resistant Depression. When Spravato® came on the market I put a lot of hope into it. For me, it was a matter of life and death. I have been on Spravato® since late 2019 and it has been a saving grace! Do I still have issues with depression, yes. Do I still struggle sometimes, yes. But this is the ONLY medication I have ever taken that actually helps and gets me to the point of being able to live life. I would highly suggest talking to your doctor about trying it if you have TRD. I had nothing else to lose, and I feel like it saved my life.” – review from WebMD.com
Spravato® FAQs
Esketamine, sold under the brand name, Spravato®, is a prescription aesthetic medication that is administered via nasal spray and taken alongside an oral antidepressant to help alleviate the symptoms of depression in adults. The FDA requires that patients receive Spravato® treatment at a certified medical facility with specially trained healthcare professionals. The treatment will include a blood pressure test, and overall, approximately 120 minutes of medical supervision before discharge.
Spravato® works by increasing your brain’s neurotransmitters, or glutamate, which tend to weaken due to depression. A regrowth of glutamate can help to significantly improve learning, memory, and overall mood.
Spravato® was developed by Johnson & Johnson and is FDA-approved to help treat depression and reduce the risk of suicidal thoughts in adults.
You cannot take Spravato® on your own. You will need to locate and contact your nearest treatment center in order to be treated with Spravato®.
Limitations of Spravato® Ketamine
On the surface, a nasal spray would be anyone’s first option. No needles, fast delivery, and so on. But that’s far from the case. First, any sort of congestion and the angle of nasal spray can cause drastic variations in dosage. One day a patient might feel great and another day they may feel like nothing happened. 100% of a ketamine IV infusion gets to the brain, vs. about 25-50% for esketamine spray.
For something as simple as a nasal spray, one would think the appointments would be short. Unfortunately, that’s not the case. First, pre-treatment blood pressure is taken, then after that, 40 minutes from the time of dosing another blood pressure test is taken. Additionally, there is another waiting period of 80 minutes where the patient is monitored. In total ~ 120 minutes. Compare that to the IV Ketamine appointment average of 45-60 minutes.
Spravato® Vs Ketamine: The Future?
It’s hard to say just yet what the future holds for these treatments. Future plans might include an initial 6 infusions and then Spravato® for maintenance. What we do know for sure is that more and more people every single day that are using these treatments are experiencing some pretty life-changing results. Similar to IV Ketamine, a study for esketamine nasal spray Spravato® to treat depression showed a 70% response rate.
Learn more about how Ketamine can help with Depresssion, Anxiety, PTSD and OCD.
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Discharge Instructions for IV Ketamine & Spravato® Treatments
| Discharge Criteria | Ketamine IV | esKetamine Nasal |
|---|---|---|
| 1. | Patient and/or home care provider understands all home instructions | Patient and/or home care provider understands all home instructions |
| 2. | Written discharge instructions given to patient/accompanying responsible individual, Concur with pre-arrangements for safe transportation home | Written discharge instructions given to patient/accompanying responsible individual, Concur with pre-arrangements for safe transportation home |
| 3. | Provide additional resource to contact in any problems arise | Provide additional resource to contact in any problems arise |
| 4. | The patient is tolerating any signs and symptoms of nausea and/or has had treatment resulting in reduction of nausea and vomiting which is tolerable to the patient | The patient is tolerating any signs and symptoms of nausea and/or has had treatment resulting in reduction of nausea and vomiting which is tolerable to the patient |
| 5. | Patients must be sent home accompanied by a responsible individual | Patients must be sent home accompanied by a responsible individual |
| 6. | Patient may take public transportation, but needs to be accompanied by an individual other than the public transportation driver | Patient may take public transportation, but needs to be accompanied by an individual other than the public transportation driver |