Dextromethorphan Vs Ketamine: A New (Affordable) Depression Treatment Option Explained – Bipolar Burble Blog
Ketamine and esketamine (Spravato) have been innovative treatments for depression, but unfortunately, many people cannot afford ketamine or esketamine (more on the differences in a moment). This is the tragic reality of so many new treatments (especially in the United States): they exist but are not available to the people who need them most. However, I recently learned of an antidepressant, dextromethorphan/bupropion, which works similarly to ketamine or esketamine, and may be an option for those seeking a new and unique treatment for depression, particularly resistant depression. to treatment. Here you will find more information about dextromethorphan and ketamine as a treatment for depression.
Ketamine versus esketamine? How do they work?
Ketamine is a dissociative anesthetic approved in the United States for inducing and maintaining anesthesia by intravenous infusion or intramuscular injection. It is not indicated for major depressive disorder (MDD) or TRD. [treatment-resistant depression]although it is frequently used off-label for these indications.
Ketamine is a north-Methyl-d-Aspartate receptor agonist (NMDA). This results in an increase in glutamate release, which leads to many downstream effects. (This is interesting because I’ve been talking for years about how helpful glutamate could be for depression.)
Esketamine (Spravato) is the (S) enantiomer of racemic ketamine. Esketamine is the active enantiomer of ketamine in terms of NMDA receptor antagonism. It also increases glutamate levels. It is approved by the Food and Drug Administration (FDA) for adults with treatment-resistant depression and adults with major depression with suicidal thoughts or actions in combination with an oral antidepressant.
Ketamine vs Esketamine: To simplify
I know it’s a little confusing, but it’s been explained to me that ketamine is made up of two mirror-reflective compounds: esketamine and arketamine. These two halves have many of the same properties and methods of action as ketamine. Currently, esketamine is produced and marketed in intranasular form as Spravato. It is used to treat depression and is approved by the FDA. Ketamine is used as an intravenous (IV) infusion off-label to treat depression. (I suspect arketmaine may arrive in the future).
Ketamine and esketamine (Spravato) are expensive
Ketamine tends to be very expensive since, while the drug itself is cheap (it’s a generic that’s been around since the 1960s), it requires medical staff to administer the intravenous infusion and monitor people afterward. Esketamine (Spravato) is expensive because it is a brand-name drug for which the company charges a fortune and the patient must be observed for hours after administration in the doctor’s office.
Some people have access to one or both medications through their insurance, but many people do not. I think this is a great shame. I hate knowing that there are things that could help people, but are out of reach due to lack of money. (If you are trying to get esketamine (Spravato), check here for cost support.)
Ketamine versus dextromethorphan/bupropion (Auvelity)?
This brings me to my point. There is an antidepressant that was approved for use in August 2022 called Auvelity. It is a combination of dextromethorphan (Robitussin) and bupropion (Welbutrin). If you recognize the name “Robitussin,” it could be because it is a cough suppressant and is available over the counter in various formulations. It was first approved by the FDA in 1958 and has since been used in numerous combinations for various treatments. Welbutrin, of course, is a common antidepressant that was initially approved by the FDA in 1985, although there were problems with the formulation and in 1996 a sustained-release version was approved. It became popular at that time.
Dextromethorphan acts on NMDA receptors and modulates glutamate. Bupropion is combined with it to increase the bioavailability of dextromethorphan. In other words, bupropion allows dextromethorphan to be available in your body long enough for it to have a chance to work. A pretty brilliant company figured all this out, packaged them, and branded them as Auvelity.
Why is alternative depression treatment with dextromethorphan important for people who desire ketamine?
If you’ve been paying attention (I know it’s been a bit heavy), you may have noticed that dextromethorphan and ketamine have a similar method of action (they work in a similar way). Dextromethorphan can be considered the weaker cousin of ketamine. In other words, if ketamine works for you, then dextromethorphan might work too.
This is great for several reasons:
- You can take dextromethorphan/bupropion in pill form at home and do not need to be monitored.
- Dextromethorphan/bupropion is widely available.
- Dextromethorphan is much less expensive (and may even be more likely to be covered by your insurance).
According to Amazon Pharmacy, Auvelity costs $657.60 without insurance or about $35 with insurance per month. This is much less than esketamine (Spravato) or ketamine.
But you can probably get dextromethorphan and burprion for less!
But there is more to the story. Because Auvelity is a combination of two readily available medications, you may be able to get bupropion (which your insurance will likely pay for since it’s generic) and dextromethorphan separately. You may have to get the dextromethorphan created for you at the correct dosage from a compounding pharmacy, so I can’t tell you how much it might cost, but I strongly suspect it’s much less than $657.60 per month.
Evidence for dextromethorphan/bupropion in depression and the treatment of treatment-resistant depression
Of course, every person is different, but when it comes to major depressive disorder, multiple studies say things like this:
These data suggest that dextromethorphan-bupropion is an effective, rapid-acting, and well-tolerated option for the treatment of depression and produced remission in a large percentage of patients.
Note that it says fast action. For people with depression, this is good news. (I’m not saying it doesn’t take longer for some people, though.)
Dextromethorphan/bupropion for bipolar depression
Now, when it comes to bipolar depression specifically, there are all the concerns one could have with treatment with any antidepressant. In terms of evidence, the use of dextromethorphan/bupropion has shown Mixed results in the treatment of bipolar depression. Personally, I don’t think this means it’s worth discarding, especially if you hit a roadblock in treatment.
Additionally, other studies combine dextromethorphan with compounds other than bupropion, and There seems to be some promise there.also.
What you need to know about dextromethorphan as an antidepressant
Bottom line is this: Dextromethorphan, especially with bupropion, is worth considering as an antidepressant, especially if you are resistant to treatment. It works in a unique way, meaning that if you have failed many other treatments, you may simply respond to this one. Ketamine or esketamine can also work in a situation like that, but they are much more expensive.
Keep in mind that you should only take the medication that you and your doctor think is right for you. You may encounter some strange side effects with this medication precisely because it is different from other antidepressants. It is also necessary to understand the risks before starting any treatment. I do not endorse or recommend this medication; I’m just giving you information so you can be more informed when you get to your next doctor’s appointment.. I hope this alternative can help people who cannot access other treatments.
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