The recent FDA-approval of Johnson & Johnson’s esketamine (Spravato) intranasal spray (REF 1) for the treatment
of depression has stirred a lot of excitement. We are led to believe that all the benefits of ketamine
intravenous (IV) infusion therapy can now be obtained easily with a nasal spray. We are given the
impression that insurance companies will now cover this ketamine analog, so ketamine-based therapies will
be more affordable.
Not so fast!!
Unfortunately, reality does not measure up to the hype. Ketamine IV infusion therapy has a striking response
rate of 85%, particularly with neurotrophin-based protocols are followed (REF 2) , such as are used at Neuro-
Luminance Brain Health Centers. The manufacturer’s own studies concluded that intranasal esketamine was
beneficial for only 60 % of the subjects at 25 days, but 42% of the placebo group also showed a response (REF 3) .
Even when esketamine is administered by intravenous infusion, it does not measure up to ketamine – only
48% of patients given IV esketamine saw a benefit (REF 4).
Esketamine will not be easy! Currently, a patient can go to any one of over 200 ketamine infusion clinics
and get an infusion over 40 minutes and leave after an hour of recovery time. Of course, they cannot drive
themselves home, but in these days of Lyft and Uber, that is a small barrier. In contrast, the FDA has
determined that only “approved and certified treatment centers” (REF 1) will be able to administer esketamine and
patients will be required to remain at these facilities for two hours after a clinician squirts the esketamine into
their noses (REF 1) . Esketamine is to be administered twice a week for four weeks. This represents a minimum of 4-
5 hours per week away from work or family responsibilities.
Esketamine does not come cheap! The above protocol will create huge overhead costs to administer
esketamine and then provide space for all these folks waiting out their two hours. The wholesale price of
Spravato has been estimated at $590 – $885 per dose! When you add in the overhead costs to the clinic, this
could run as much as $2000 per dose! Over the course of the first month, a patient can expect to pay $16,000
for esketamine. Don’t expect insurance companies to be rushing to pay that big bill, either.
At Neuro-Luminance Brain Health Centers, we follow a neurotrophin-based approach to ketamine. Since
it powerfully activates Brain-Derived Neurotrophic Factor (BDNF) which induces neuroplasticity in the
brain over a period of weeks, ketamine does not need to be administered more than once per week. Neuro-
Luminance Brain Health Centers achieves the same 85% response rate as other clinics using a 3x/week
protocol for less than 1/3 the cost. On average, our patients receive 4.3 infusions in their lifetime. Given that
most clinics require six infusions in the first two weeks and booster infusions thereafter, you have to ask
yourself – where’s the payoff to go anywhere else?
1) Hamilton, Jon. FDA Approves Esketamine Nasal Spray For Hard-To-Treat Depression. Shots – Health News from NPR. National Public Radio, March 5, 2019.
2) Theodore A. Henderson. Practical Application of the Neuroregenerative Properties of Ketamine – Real World Treatment Experience. Neural Regen Res, 11(2):195-200, 2016.
3) Canuso CM, Singh JB, Fedgchin M, Alphs L, Lane R, Lim P, Pinter C, Hough D, Sanacora G, Manji H, Drevets WC. Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study. Am J Psychiatry. 175(7):620-630, 2018.
4) Correia-Melo FS, Argolo FC, Araújo-de-Freitas L, Leal GC, Kapczinski F, Lacerda AL, Quarantini LC. Rapid infusion of esketamine for unipolar and bipolar depression: a retrospective chart review. Neuropsychiatr Dis Treat. 13:1627-1632, 2017.