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AVAILABLE TREATMENTS

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We believe that it is in the best interest of our patients to prescribe and use a specialized form of ketamine that comes in a nasal spray.  Its brand name is Spravato and its generic name is esketamine.  We prefer it, because it is the only FDA approved ketamine product for any psychiatric condition (depression, anxiety, OCD, PTSD, etc.).

 

However, sometimes insurance companies refuse to pay for Spravato, and the cost to purchase it directly can be prohibitively expensive for our patients.  In that instance, we use generic ketamine.  Even when bought without insurance, generic ketamine is much more affordable.  

 

Generic ketamine is also effective.  Most commonly it is given nasally or intravenously. Generic ketamine is probably as effective as Spravato, but because Spravato is uniquely FDA approved, we prefer to start with it.  

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Nasal vs. IV Ketamine

There has not yet been a study to compare directly IV and nasal (also called "intranasal") ketamine.  To date, trials exist to assess the efficacy of only one or another.  That is, they are either studies that assess the effectiveness of IV ketamine by itself or intranasal ketamine alone.  There are papers that try to pull together and combine the separate trials and outcomes.  Unfortunately, this is not an optimal or reliable way to compare drugs or treatments because no two studies are alike -- we cannot compare apples to oranges.    

 

Our best guess is that both forms of ketamine treatment -- IV or Nasal Spray --  are equally effective over time.  However, it is possible that in the early stages of treatment, IV ketamine exerts its beneficial effects sooner.  Based on this possibility, some patients understandably prefer the IV route, which is why we make it available.  

 

We have found most of our patients prefer nasal spray because it is painless, less complicated, less expensive and is sometimes said to be less "intense" during treatment.  

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