Comparing Esketamine vs Ketamine Infusion Treatment

Although Esketamine and Ketamine infusions can help manage treatment-resistant depression (TRD), each has its differences. Today, we will explore Esketamine vs Ketamine infusion treatment and find out how they affect the brain, how the administration and dosage work, what the side effects are, and much more.

Esketamine vs Ketamine for Treatment-Resistant Depression

A few years ago, in 2019, psychiatrists anxiously awaited a decision by the Food and Drug Administration (FDA). They debated whether to approve Esketamine as a treatment for major depressive disorder (MDD) for those diagnosed with treatment-resistant depression (TRD) or at a higher risk for suicide.

Treatment-resistant depression is a diagnosis given to someone who has tried two or more therapies or a combination of treatments to improve their mental health, including medication and counseling, without success. Current data shows that at least 30% of people with MDD are eventually diagnosed with treatment-resistant depression.

Having either disorder can feel overwhelming, and some may have suicidal ideations. Some may even attempt suicide. One of the best reports regarding Esketamine and ketamine infusions is that they curb thoughts of suicide.

The Brain

Antidepressants increase chemical neurotransmitters like serotonin and norepinephrine, aiding brain cell communication. The theory is that the better the brain cells can communicate, the better your cognitive and emotional regulation.

Ketamine increases the chemical glutamate, which is called “the master neurotransmitter” due to the excitatory responses it creates. Glutamate boosts mood and is needed for normal functioning and neuroplasticity.


Esketamine is a derivative of ketamine created by Johnson and Johnson, who developed it to be administered as a nasal spray. It is sometimes known as S-ketamine and Spravato. The nasal spray is self-administered. However, you do not get a prescription and do not take the medicine home with you.

Every spray is administered in a clinical setting with the supervision and monitoring of a psychiatrist. Treatment consists of two or three doses sprayed five minutes apart. Total treatment time differs by person, but typically it is twice a week for four or five weeks.

Ketamine infusions are also administered only in your psychiatrist’s clinic. Infusions are given intravenously. You do not get a prescription and are not responsible for the delivery of the dose. You simply relax as the ketamine slowly enters your bloodstream, and you begin to feel the effects.

Ketamine infusions are given multiple times a week for six weeks. These are general treatment schedules; depending on your needs, you could need more or fewer sessions.

Ketamine can also be given via intramuscular injections by some providers.


Esketamine is more potent than ketamine infusions. It is prescribed in either 56mg or 84mg doses. Your psychiatrist will likely start you on the lowest dose and change the amount based on how you respond. The manufacturer recommends an induction phase during weeks one through four, starting with 56mg twice a week. The maintenance phase begins in week five, at one dose a week. As time passes, doses can be given weekly or every other week.

Initial ketamine doses are based on your weight and how well you respond to the medicine. Some doctors may start you at the lowest dose of .5mg but may increase it to .75mg. The IV drip typically lasts forty minutes but can last 100 minutes or longer. Your response determines the length.

Other Uses

Major depressive disorder and depressive disorder with suicidal ideations are not the only reasons to consider Esketamine and ketamine infusions.

Side Effects

All drugs have the potential for side effects, even over-the-counter medicines. Esketamine and ketamine infusions are considered so safe they are used for anesthetic purposes in surgeries for children and adults. They have similar side effects:

  • Nausea
  • Headache
  • Drowsiness
  • Increased blood pressure
  • Blurred vision
  • Dissociation
  • Hallucinations
  • Floating feeling


Bioavailability refers to the amount of the drug that makes it to the brain, which determines the effects you experience. Different methods exist for consuming the medicine. Oral medicines must travel through the digestive system, where stomach acids break them down before it enters the bloodstream and travels to the brain. Less than half may reach the brain.

Nasal sprays are inhaled through the nostrils, and only 50% of the medicine is bioavailable. Infusions are injections that deliver medication directly into your veins and bloodstream, sending 100% of the ketamine to your brain, so you receive the full effects.

Miscellaneous Differences

There are a few more differences between Esketamine and ketamine infusions that are worth mentioning if you must choose between them for treatment purposes. For example:

  • When the Food and Drug Administration (FDA) approves a service or product, private insurance companies can approve them for coverage. That doesn’t mean the insurance company will cover them, but they can. The FDA has only approved Esketamine (Spravato) for treating mental health disorders. Because it is federally approved, federally supported insurance programs like Medicare and Medicaid will pay for Esketamine.
  • The time you spend in each treatment session varies. With Esketamine, sessions take a minimum of two hours, whereas, with ketamine infusions, they take no more than two hours.
  • Esketamine must be taken alongside an antidepressant medication. Ketamine infusions can be taken with antidepressants, but they are not required. Ketamine infusions can also be taken alone.
  • It may take between one to three sessions to start noticing the full benefits of Esketamine. Still, people report feeling the full benefits of ketamine infusions in the first session.


Costs will vary depending on the treatment center and factors specific to your mental and physical health. However, the average prices may be as follows:

Esketamine, if not covered by insurance, can average around $6,000. That includes 12 sessions over two months. Most insurance companies cover Spravato, but only the medicine is usually covered. Ketamine infusions are not covered by insurance since they are not FDA-approved. Fortunately, many doctors, like the psychiatrists at the Mental Health Center, do not charge for the drug itself, only for the professional services provided.

Try Esketamine or Ketamine Infusions Today

As you can see, there are many benefits of Esketamine and ketamine infusions. Contact us today to see if you qualify and if so, you can start feeling better soon.