Nasal ketamine: what the new science actually says

Ketamine started as an anesthetic, then researchers noticed it could lift severe depression within hours instead of weeks. That led to esketamine nasal spray, approved for treatment resistant depression. Here is where the science stands.

How clinics use it: esketamine is given as a nasal spray in a certified clinic, under observation for at least two hours, alongside an oral antidepressant. It is not a take home prescription. A randomized trial found fixed dose esketamine nasal spray plus a new oral antidepressant beat placebo plus antidepressant in treatment resistant depression. Earlier work showed intravenous ketamine can reduce depressive symptoms rapidly.

Who may be a candidate: adults with major depression who have not responded to at least two adequate antidepressant trials, and in some programs adults with acute suicidal thoughts alongside depression. Clinics screen carefully because ketamine can raise blood pressure and cause dissociation, a spaced out feeling, during the visit.

What to expect: the spray is given in the office, you rest under monitoring, most people go home the same day once cleared. Treatment usually starts twice a week, then tapers. It is one tool, not a cure, and ongoing care still matters.

The honest limits: long term data are still growing, access is limited to certified sites, and cost and insurance coverage vary. If a clinic offers ketamine with no screening, no monitoring and no plan, walk away.

Anthony

Sources: Fedgchin M et al., International Journal of Neuropsychopharmacology (2019), randomized trial of fixed dose esketamine nasal spray in treatment resistant depression. Singh JB et al., American Journal of Psychiatry (2016), dose frequency study of intravenous ketamine in treatment resistant depression.