Forms of Treatment Provided
We offer ketamine treatment in two forms: intravenous and nasal spray. The route of administration and, when relevant, the specific preparations used are selected by clinical factors, patient preference, and the goals of treatment.
Intravenous Ketamine
Intravenous ketamine is our primary treatment. It is administered through a small IV placed in the arm and infused gradually over 40 to 75 minutes. Effects typically begin within the first several minutes as the infusion progresses.
Within each treatment, dosing is observed and adjusted through the session in response to how treatment is unfolding — medically and psychiatrically. The physician is in the treatment room for every session to monitor, adjust, and provide reassurance when needed.
Nasal Spray Ketamine
Ketamine is also available as a nasal spray in two slightly different forms: Spravato and compounded ketamine. We believe both to be similar in efficacy, although there are no direct comparison studies.
Spravato is FDA-approved for treatment-resistant depression and for major depressive disorder with suicidal ideation — the only ketamine-based treatment to carry that designation.
Its use requires in-office administration and monitoring for a minimum of two hours following each dose.
While very similar, Spravato and compounded ketamine are distinct and selected based on the clinical situation. Monitoring for compounded ketamine follows the exact rigorous standards followed with Spravato treatments.
How They Compare
As mentioned, no trial has directly compared IV ketamine and intranasal esketamine. The evidence for each has developed in separate studies, which makes direct comparison limited.
Our clinical experience, consistent with the broader literature, is that both are extremely effective. IV ketamine tends to produce improvement earlier and allows for greater dose precision.
Nasal spray options offer a less invasive alternative and, in the case of Spravato, an established regulatory approval. Although the improvement from nasal spray tends to be slower, outcomes are similar to IV. Furthermore, the long term safety and efficacy of Spravato is well studied and are both very favorable.
Treatment selection is made collaboratively, based on a thorough evaluation of each patient's history, clinical needs, and preferences.
