Dextromethorphan Vs Ketamine: A New (Affordable) Depression Treatment Option Explained – Bipolar Burble Blog

Ketamine and esketamine (Spravato) have been breakthrough remedies for despair, however sadly, many individuals can’t afford ketamine or esketamine (extra on the variations in a second). This is the tragic actuality of so many new remedies (particularly within the United States) — they exist however are unavailable to the individuals who want them most. However, I’ve not too long ago discovered of an antidepressant, dextromethorphan/bupropion, that works equally to ketamine or esketamine, which can be an possibility for these searching for a brand new, distinctive despair remedy, significantly for remedy-resistant despair. Here’s extra on dextromethorphan vs ketamine as despair remedy.

Ketamine Vs Esketamine? How Do They Work?

According to Medscape:

Ketamine is a dissociative anesthetic accepted within the United States for inducing and sustaining anesthesia through intravenous infusion or intramuscular injection. It will not be indicated for main depressive dysfunction (MDD) or TRD [treatment-resistant depression], though it’s continuously used off-label for these indications.

Ketamine is a N-Methyl-D-aspartate (NMDA) receptor agonist. This ends in a rise within the launch of glutamate, which ends up in many downstream results. (This is fascinating as a result of I’ve been speaking about how helpful glutamate could be for despair for years.)

Esketamine (Spravato) is the (S) enantiomer of racemic ketamine. Esketamine is the energetic enantiomer of ketamine by way of NMDA receptor antagonism. It additionally will increase ranges of glutamate. It is Food and Drug Administration (FDA)-approved for adults with remedy-resistant despair and adults with main despair with suicidal ideas or actions together with an oral antidepressant.

Ketamine Vs Esketamine — To Simplify

I do know it’s a bit complicated, nevertheless it has been defined to me that ketamine is made up of two mirror-picture compounds: esketamine and arketamine. These two halves have most of the identical properties and strategies of motion as ketamine. Right now, esketamine is being produced and marketed in an intranasular kind as Spravato. It is used to deal with despair and is FDA-accepted. Ketamine is being utilized in an intravenous (IV) infusion kind off-label to deal with despair. (I think arketmaine could come sooner or later.)

Ketamine and Esketamine (Spravato) Are Expensive

Ketamine tends to be very costly as whereas the drug itself is reasonable (it’s a generic that’s been round because the Sixties), it requires medical personnel to manage the IV infusion and monitor folks afterward. Esketamine (Spravato) is dear as a result of it’s a model-identify drug that the corporate is charging a fortune for, and the affected person have to be noticed for hours after administration within the physician’s workplace.

Some folks have entry to at least one or each of those medicine by their insurance coverage, however many individuals don’t. I feel this can be a large disgrace. I despise understanding there are issues that might assist folks, however they’re out of attain due to cash. (If you’re attempting to get your arms on esketamine (Spravato), see right here for value assist.)

Ketamine Vs Dextromethorphan/Bupropion (Auvelity)?

This brings me to my level. There is an antidepressant that was accepted to be used in August 2022 known as Auvelity. It is a mixture of dextromethorphan (Robitussin) and bupropion (Welbutrin). If you acknowledge the identify “Robitussin,” that could be as a result of it’s a cough suppressant and is on the market over-the-counter in numerous formulations. It was first FDA-accepted in 1958 and has been put in quite a few combos for numerous remedies since. Welbutrin, after all, is a standard antidepressant that was initially FDA-accepted in 1985, though there have been points with the formulation and a sustained-launch model was accepted in 1996. It grew to become well-liked at that time.

Dextromethorphan works on the NMDA receptors and modulates glutamate. Bupropion is mixed with it to extend the bioavailability of the dextromethorphan. In different phrases, bupropion permits the dextromethorphan to be out there to your physique lengthy sufficient in order that it has an opportunity to work. One somewhat sensible firm figured this all out, packaged them collectively, and branded them Auvelity.

Why Does the Alternative Depression Treatment Dextromethorphan Matter for People Wanting Ketamine?

If you’ve been paying consideration (I do know it’s been a bit weighty), you may need observed that dextromethorphan and ketamine have an analogous technique of motion (they work in related methods). You can consider dextromethorphan because the weaker cousin of ketamine. In different phrases, if ketamine works for you, then dextromethorphan would possibly work too.

This is nice for just a few causes:

• You can take dextromethorphan/bupropion in tablet kind at residence, and also you don’t should be supervised.
• Dextromethorphan/bupropion is extensively out there.
• Dextromethorphan is far cheaper (and also you would possibly actually have a higher probability of it being lined by your insurance coverage).

According to the Amazon pharmacy, Auvelity prices $657.60 with out insurance coverage or about $35 with insurance coverage monthly. This is far lower than esketamine (Spravato) or ketamine.

But You Can Probably Get Dextromethorphan and Burprion for Less!

But there’s extra to the story. Because Auvelity is a mixture of two available medicine, you might be able to get bupropion (which your insurance coverage will more than likely pay for as there’s a generic) and dextromethorphan individually. You could should get the dextromethorphan created for you on the right dosage at a compounding pharmacy, so I can’t inform you what which may value, however I strongly suspect it’s wildly lower than $657.60 monthly.

Evidence for Dextromethorphan/Bupropion in Depression and Treatment-Resistant Depression Treatment

Of course, everyone seems to be totally different, however with regards to main depressive dysfunction, a number of research say issues like this:

These information recommend that dextromethorphan-bupropion is an efficient, quick-appearing, and nicely tolerated possibility for despair remedy and produced remission in a big share of sufferers.

Note that it says quick-appearing. For folks with despair, that is welcome information. (I’m not saying it doesn’t take longer for some folks, nonetheless)

Dextromethorphan/Bupropion for Bipolar Depression

Now, with regards to bipolar despair particularly, there are all of the issues that one may need with remedy with any antidepressant. As for proof, the utilization of dextromethorphan/bupropion has proven combined ends in treating bipolar despair. I, personally, don’t really feel this implies it’s price writing it off, although, particularly in case you’re at a remedy roadblock.

Also, different research mix dextromethorphan with compounds apart from bupropion, and there appears to be some promise there, too.

What to Know About Dextromethorphan as an Antidepressant

The lengthy and the wanting it’s this: dextromethorphan, particularly with bupropion, is nicely price contemplating as an antidepressant, particularly in case you’re remedy-resistant. It works in a novel manner, which signifies that in case you’ve failed many different remedies, you might simply reply to this. Ketamine or esketamine may additionally work in a state of affairs like that, however they’re far dearer.

Keep in thoughts that it is best to solely ever take a drugs that you just and your physician really feel is best for you. You would possibly discover some bizarre unwanted side effects with this medicine exactly as a result of it’s totally different than different antidepressants. You additionally want to grasp the dangers earlier than beginning any remedy. I’m not endorsing or recommending this medicine; I’m simply providing you with some data so that you will be extra knowledgeable if you stroll into your subsequent physician’s appointment. I hope this different could assist individuals who can’t entry another remedies.

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