Differences Between Ketamine and Esketamine
According to the DEA, ketamine has been used in the United States since 1970 as a quick-acting injectable anesthetic for humans and animals. As an anesthetic, ketamine causes a dissociative feeling, meaning that the patient feels separated from their surroundings and discomfort. Depending on the dose, patients may retain consciousness but feel sedated and often have little or no memory of what happened while under the influence.
Ketamine is also sold illegally for recreational use. Most of the illegal ketamine in the United States is stolen from places like veterinary clinics or brought in from outside the country. Ketamine is known as a “club drug” under names like Vitamin K, Special K, Purple, and Cat Valium.
Ketamine has proven reliable when used as an anesthetic and has a consistent safety profile. A distinctive trait of ketamine versus other anesthetics is that it does not totally suppress brain activity but lets some activity in the cortex persist.
Where does esketamine come in? Ketamine has two forms, R-type and S-type. Esketamine is the S-type, approved by the FDA for treatment resistant depression and major depressive disorder with suicidal ideation in adults in 2019. It is stronger than ketamine, so doses are kept low to provide the desired effect and reduce side effects.
Esketamine works by boosting the production of glutamate, a neurotransmitter. Glutamate has a strong role in regulating how we sort and retain information, making it essential for learning and remembering. Producing more glutamate increases brain activity across the cortex and necessitates building new neural pathways. Patients experience a better ability to regulate their moods and are better able to produce other neurotransmitters like dopamine, which influences our sense of reward.
Spravato is used in a strictly controlled environment. It is a nasal spray taken in the clinic in the presence of a medical professional. The patient’s healthcare provider watches the patient for any untoward side effects like nausea, confusion, or increased blood pressure after they take Spravato until they are satisfied that the patient may go back to their business.
More good news is that Spravato is usually covered by major health insurance carriers due to its approval by the FDA. However, a patient must have tried at least two antidepressant medications without improving to qualify for Spravato.
No substance is “bad” in itself. Any substance can be abused, even substances used to heal. Opiates, when properly used, give relief to pain and enable doctors to perform procedures that would otherwise be intolerable. When abused, they can kill. Amphetamines, when used properly, can make life with ADHD smoother. When abused, they can ruin lives. Esketamine is a perfect example of a frequently abused substance being carefully prepared and administered in a way that is seeing overwhelmingly positive results.