Ketamine vs. SSRIs to Treat Depression: Which Is Better?

If you’re feeling overwhelmed by depression, know that you’re not alone. In New York City, nearly 1 in 4 adults faces a mental health disorder each year. While doctors have prescribed selective serotonin reuptake inhibitors (SSRIs) for decades, ketamine offers renewed hope for patients who haven’t found relief yet. Explore each treatment’s unique healing potential and how you can rediscover a life worth living.

How SSRIs and Ketamine Help to Treat Depression

Ketamine and SSRIs both treat depression, but affect the brain in different ways. Understanding these differences can help you make an informed choice:

How Does Ketamine Help to Treat Depression?

Unlike traditional antidepressants, SPRAVATO™ (esketamine) — the form of ketamine FDA-approved for psychiatry — primarily affects the glutamate system, a major communication network in the brain. SPRAVATO™ works by interacting with N-methyl-D-aspartate (NMDA) receptors. These receptors play a key role in how our brains learn and adapt, and SPRAVATO™ helps to stimulate them in a way that can improve mood.

Although research is still ongoing, pioneering studies suggest ketamine’s rapid antidepressant effects come from its ability to:

• Boost glutamate release: Ketamine interacts with NMDA receptors, triggering a glutamate surge and increased brain activity.
• Strengthen brain connections: This increase in glutamate helps the brain form new, stronger connections between brain cells, a process called synaptic plasticity that can elevate mood.
• Quiet the “inner critic”: Some studies suggest ketamine can calm down activity in the default mode network (DMN), a brain region linked to negative self-perception in depression.

How Do Selective Serotonin Reuptake Inhibitors (SSRIs) Treat Depression?

SSRIs primarily affect serotonin, a vital chemical messenger that regulates mood, sleep, appetite and many other functions. Although doctors often prescribe them for acute depression, SSRIs typically take several weeks of consistent use to produce noticeable effects, as the brain gradually adjusts.

SSRIs work by:

• Increasing serotonin availability: SSRIs prevent nerve cells in the brain from reabsorbing serotonin, which increases the amount available for communication between neurons.
• Amplifying serotonin signals: By increasing serotonin levels, SSRIs improve communication between brain cells, which can help stabilize mood and reduce depressive symptoms.

Ketamine vs. SSRIs: Pros and Cons

Consider the advantages and potential drawbacks of each medication to make an informed choice:

What Are the Advantages of SSRIs?

SSRIs like fluoxetine (Prozac), escitalopram (Lexapro) and Sertraline (Zoloft) offer several well-documented benefits, making them a frequently chosen initial treatment for depression:

• Established and accessible: SSRIs have been prescribed, studied and used for decades, so they’re well-understood and easy to source.
• Convenient administration: Patients typically take SSRIs orally, so they are quick and convenient to take.
• Versatile applications: Physicians also prescribe SSRIs for conditions like anxiety and eating disorders, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).

What Are the Considerations of SSRIs?

Despite their benefits, it’s important to be aware of the potential drawbacks and limitations associated with SSRI treatment:

• Delayed symptom relief: It typically takes several weeks for SSRIs to produce noticeable improvements in mood, which can be frustrating if you’re seeking more immediate relief.
• Possible side effects: SSRIs can cause a range of side effects that may be bothersome and potentially lead you to stop treatment.
• Risk of treatment resistance: Unfortunately, SSRIs don’t work for everyone, and some people with depression stop responding to them over time.
• Discontinuation challenges: Suddenly stopping SSRIs can trigger a discontinuation syndrome, which can cause flu-like symptoms, increased anxiety and mood disturbances.

What Are the Advantages of Ketamine?

SPRAVATO™ (esketamine) offers a distinct set of advantages, particularly for individuals who haven’t experienced success with traditional antidepressants:

• Rapid symptom reduction: Ketamine can produce significant improvements in mood within hours or days, much faster than the weeks often required for SSRIs to take effect.
• Efficacy for treatment-resistant cases: It’s been remarkably effective in helping patients who haven’t responded to SSRIs or other antidepressant medications.
• Possible enhancement of brain plasticity: Studies have found that ketamine may promote neural connection growth and strength, potentially improving mood, a phenomenon also being explored in other innovative therapies like electroconvulsive therapy (ECT).

What Are the Considerations of Ketamine?

While SPRAVATO™ offers promising benefits, it’s important to be aware of a few factors:

• Administration: Patients usually take SPRAVATO™ in a clinical setting under medical supervision, so you may need to travel a short distance for a trained team to support your treatment.
• Possible temporary effects: Some people may experience a mild, temporary feeling of detachment during treatment, but this is generally well-managed and short-lived.

Frequently Asked Questions About Ketamine vs. SSRIs to Treat Depression

Every person’s experience with depression is unique. To help you find the best path forward, these frequently asked questions about ketamine and SSRIs may be helpful:

Ketamine vs. SSRIs: Which Is Better for Depression Symptom Relief?

The most effective choice depends on your individual needs and circumstances. SSRIs work well for many people, but they typically take time to reach their full effect. SPRAVATO™ (esketamine) can provide more rapid relief, sometimes within hours or days.

How Do Psychiatrists Choose Between Ketamine and SSRIs for Patients?

To find the best depression treatment, psychiatrists carefully consider your symptom severity, treatment history, specific symptoms and potential side effects. They’ll work with you to create a personalized plan and may suggest intensive outpatient programs (IOPs) for extra support. Open communication is key to finding the right path forward.

Why Consider an Intensive Outpatient Program?

For a comprehensive, flexible ketamine solution, intensive outpatient treatment programs can provide scheduled therapy and support several times a week while allowing you to live at home. You’ll get access to frequent mental health check-ins and therapy, helping to reinforce your progress.

Is Ketamine Safe to Take With Antidepressants?

Research shows this can be a safe approach, but deciding whether to combine SPRAVATO™ with antidepressants is something you and your health care provider will discuss together. Being open and honest about all medications you’re taking, including over-the-counter drugs and supplements, is key to creating a treatment plan that works best for you.

What Is the Best Option for Treating Depression?

There’s no one-size-fits-all solution for depression, and the most effective treatment plan is one that’s developed in partnership with a qualified mental health professional. Whether you’re considering ketamine, SSRIs, or a combination, working together with your doctor is essential. Together, you can explore different treatment options and find the approach that’s right for you.

Factors you and your physician will discuss during your consultation and evaluation include:

• The nature and severity of your symptoms: Are you currently experiencing persistent thoughts of self-harm or symptoms associated with treatment-resistant depression?
• Your specific treatment objectives: Are you primarily seeking rapid symptom relief to address an acute crisis, or are you more focused on long-term symptom management?
• Your personal values and level of comfort: Are you open to exploring innovative and emerging therapies?

Proactively consulting with a qualified mental health professional is crucial for making informed and empowered treatment decisions. A skilled provider can offer personalized guidance, comprehensive support and evidence-based recommendations throughout your mental health journey.

Does Insurance Cover Ketamine for Depression Treatment?

SPRAVATO™ (esketamine) nasal spray is covered by most major insurance providers, making it an accessible option for many people seeking depression treatment. To confirm your coverage, contact your insurance company or speak with a knowledgeable health care provider.

What Can You Expect From a Ketamine Treatment?

Sessions are supervised in a comfortable, private setting. Most treatments are intravenous infusions lasting about an hour, with SPRAVATO™ nasal spray as a needle-free option. After a brief recovery, you’ll head home with a pre-arranged ride. Treatment typically includes six to 10 sessions over two to three weeks, with maintenance sessions as needed to support ongoing progress.

Find Relief From Depression in NYC With Principium Psychiatry

At Principium Psychiatry, we understand the unique challenges New Yorkers face when seeking mental health care. Led by Dr. Cohen and the team at Principium, we offer compassionate, evidence-based care, including innovative therapies like SPRAVATO™, ECT therapy and IOP.

Contact us online today or schedule a consultation and learn more about our personalized approach to lasting relief from depression.